Expressing gratitude to healthcare workers is a natural human instinct, but in recent years, such gestures have taken on even greater significance. In Burkina Faso, one family’s ‘thank you’ came in the form of a chicken—a traditional present symbolizing their appreciation.

When members of the field team working on IVI’s Group A Streptococcus Surveillance project in Burkina Faso were asked to share memorable moments, one story stood out.

It came from Ismaël Ouoba, who is responsible for enrolling participants in the project’s study when families arrive at participating health facilities with children showing symptoms of Strep A infection, most commonly a sore throat or skin lesions.

Ismaël Ouoba and his chickens. The original gift has produced an offspring. Credit: IVI

One day, a family returned to the health center in Boromo, a rural town about 200 kilometers from the capital, Ouagadougou. Their child had received care through the project, and they wanted to express their gratitude. Their gift was a chicken.

“It’s the customary gift in this part of the country—a way of saying thank you that carries real meaning and reflects both gratitude and respect,” Ismaël explains.

More than “just” a sore throat

For many parents in Burkina Faso, group A Streptococcus (GAS) is not a familiar diagnosis. Few know that this bacterium can cause common throat and skin infections that, if untreated, may lead to serious complications.

“They just know it as throat problems,” says Lady Rosny Wandji Nana, a pharmacist and field coordinator for the project, who has worked in public health research with IVI in Burkina Faso for the past decade. “Everyone knows that during the cold season children can have a sore throat. Some people think it is because of dry air or drinking cold water.”

Strep A commonly causes strep throat (pharyngitis), impetigo, and cellulitis. While these infections are often treatable, they can progress to acute rheumatic fever, rheumatic heart disease, or kidney disease. In low-resource settings, limited access to diagnostic tools such as echocardiography means many cases may go undetected until the disease becomes severe.

Globally, the Strep A disease burden is substantial, with low- and middle-income countries bearing the greatest impact. Sub-Saharan Africa sees one of the world’s highest burdens of Strep A-related rheumatic heart disease, according to the World Health Organization.

Yet, reliable data on how many people become infected, which diseases Strep A causes most frequently, and which populations are most affected remain scarce. Without such data, there are challenges in planning effective control programs, allocating healthcare resources, and preparing future prevention strategies.

Building the evidence for prevention

Although Strep A affects millions of people globally, efforts to develop a vaccine have only recently gained momentum. IVI is helping advance that work as a partner in the Strep A Vaccine Global Consortium (SAVAC), a research collaboration working to ensure that safe, effective, and affordable vaccines are available and implemented to decrease the burden of Strep A disease. Meanwhile, surveillance studies like this one in Burkina Faso can also contribute to understanding the burden of disease in the communities most affected.

Skin swab sample collection. Credit IVI

“We heard from the site teams that they see many children with strep-like sore throats and skin infections,” says Thaint Thaint Thwe, a researcher in IVI’s Epidemiology, Public Health, Impact (EPIC) unit and technical lead for the GAS project. “But there wasn’t robust local data to confirm the scale of the problem. That was exactly why we carried out the study.”

The project focuses on the two most common clinical presentations of Strep A: pharyngitis (strep throat) and skin infections such as impetigo and cellulitis. At participating health facilities, nurses examine children for signs of infection, swab sore throats and suspicious skin lesions, and send samples daily to a central laboratory for testing. Results are then communicated back to families through the same nurses who cared for the children.

In many low-resource settings, Strep A diagnosis still relies largely on clinical assessment because laboratory testing is not routinely available. “This makes it difficult to distinguish Strep A infections from other causes of sore throat or skin disease,” Thwe explains. “Skin infections, in particular, can be challenging because their symptoms often resemble those of other conditions.”

Early findings and insights

Participant enrollment concluded at the end of July 2026, with 500 children aged 3–15 years meeting the study criteria and 11% testing positive for group A Streptococcus. The study also assessed antimicrobial resistance among confirmed cases.

“This testing helps us understand whether the bacteria are resistant to certain antibiotics,” Thwe explains. “If resistance is identified, we communicate this information to healthcare facilities so treatment can be reviewed.”

Alongside clinical surveillance, IVI is conducting a qualitative study to understand how families recognize illness, seek care, and navigate barriers to treatment. Together, the findings will provide an important first picture of the burden of Strep A in these communities and the factors influencing access to care.

While additional studies will be needed to understand the disease burden across Burkina Faso, the project is laying the groundwork for stronger surveillance, better clinical management and, ultimately, future prevention strategies.

Pictured l-r: Professor Nicolas Méda, ISSP Director; Nana Lady, field study coordinator; Namyee Kim, Gihyeok Kim, Thaint Thaint Thwe, Yi Ting Wang, IVI; Enoch Cakpo, field study coordinator; Professor Abdramane Bassiahi Soura, Site Principal Investigator. Credit: IVI

Why Strep A matters to IVI

Strep A is a global health problem often hiding behind very ordinary symptoms. It is estimated that severe GAS diseases cause at least 517,000 deaths annually and disproportionately affect children, older adults, and people with weakened immune systems.

IVI considers group A Streptococcus a key research area because the burden of disease is both significant and unevenly distributed, with the greatest impact seen in low- and middle-income countries where diagnostic capacity and prevention tools remain limited.

Momentum around Strep A vaccine development has grown in recent years. A resolution of the 71st World Health Assembly in 2018 recognized rheumatic heart disease and related streptococcal diseases as a global health priority, helping to drive increased attention and the establishment of SAVAC, which brings together partners, including IVI, working towards vaccine development.

For the GAS team in Burkina Faso, the work is built on routine moments: screening throats, swabbing skin lesions, waiting for laboratory results, and follow-ups with families. Yet these everyday efforts grow into something much bigger. Like Ismaël’s chicken, which has now produced its own offspring, the impact of a simple gesture can multiply over time—and together they are a reminder of the appreciation communities have for the work and the people behind it.