Meta-analysis shows integrated MDA reduces yaws attendances in Papua New Guinea

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BMJ global health Published May 14, 2026 Medically reviewed May 14, 2026 Study authors: Xu Jingyuan, Yohogu Mary, Wong Francisca S Y, Jamil Sarosh, Morishita Fukushi, Sanikullah Kazim Hizb… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider integrated MDA for yaws control in settings with persistent transmission.

This publication is a comparative observational study and systematic review with network meta-analysis focusing on yaws control in Papua New Guinea. The scope includes West New Britain province and New Ireland province, comparing integrated four-drug mass drug administration against observation or single-round azithromycin regimens. The study covers populations in these specific provinces that are often under-reached by standard health programs.

The analysis reports a significant decline in yaws-related outpatient department attendances in West New Britain relative to New Ireland, sustained for at least 6 months. This reduction corresponds to a 41% decrease with a p-value less than 0.0001. Additionally, total skin-related outpatient attendances showed a 33% decline, although specific p-values for this outcome were not reported.

Regarding active disease, the odds of active yaws at follow-up were lower with three rounds of azithromycin MDA versus observation, with an odds ratio of 0.04 and a 95% credible interval of 0.005 to 0.24. Single-round azithromycin MDA also reduced odds compared to observation, with an odds ratio of 0.15 and a 95% credible interval of 0.05 to 0.45. Safety data, adverse events, and tolerability were not reported in this review.

The authors conclude that these results should inform considerations for yaws control efforts in settings with persistent transmission. Because the source is observational, causal language is avoided, and the certainty of the findings is tempered by the study design. No specific funding or conflicts of interest were reported.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42128492

View Original Abstract ↓

BACKGROUND: Yaws is a chronic infectious disease that disproportionately affects under-reached communities. In 2023, Papua New Guinea (PNG) reported 100 165 suspected yaws cases, accounting for 45% of cases reported worldwide. The WHO targets yaws eradication by 2030, primarily through mass drug administration (MDA) of azithromycin. This study evaluates the impact of an integrated MDA programme in PNG and reviews global evidence on optimal MDA strategies through a network meta-analysis (NMA). METHODS: A comparative observational study was undertaken analysing outpatient department (OPD) attendances between West New Britain province (WNB; intervention) and New Ireland province (NIP; comparator) from November 2023 to August 2024. The intervention in WNB involved a single-round, integrated four-drug MDA provided in December 2023, comprising azithromycin, ivermectin, diethylcarbamazine and albendazole. Temporal trends in OPD attendances were analysed using negative binomial regression. A Bayesian NMA of six studies identified through a systematic review compared the effectiveness of azithromycin-based regimens for yaws eradication. RESULTS: Between Q3 2023 and Q1 2024, yaws-related OPD attendances in WNB declined significantly, with a 41% (p<0.0001) reduction relative to the comparator province (NIP). This reduction was sustained for at least 6 months following MDA. Over the same period, a 33% decline in total skin-related outpatient attendances was observed. In the NMA, three rounds of azithromycin MDA were associated with lower odds of active yaws at follow-up than observation (OR 0.04, 95% CrI 0.005 to 0.24) and had the highest probability of being ranked most effective. Single-round azithromycin MDA was also associated with reduced odds of active yaws at follow-up (OR 0.15, 95% CrI 0.05 to 0.45). CONCLUSION: In a high-burden setting, a single round of integrated MDA was associated with substantial early reductions in yaws burden. Multi-round azithromycin strategies, particularly three-round regimens, were associated with larger and more sustained reductions in community prevalence. These findings inform considerations for yaws control efforts in settings with persistent transmission.