He succeeded his elder brother Nab Agaasa Ayieta, as Sandem-Nab and consequently Paramount Chief of Builsa in December, 1931. At the time of his death on the 14th November, 2006, he was one of the longest known reigning Paramount Chiefs in Ghana.

He had many wives, children and several grand and great grand children.

Nab Dr. Ayieta Azantilow was concerned with the Social, Political, Educational and Economic Development of the Builsa District. As a result he mobilized his people to build the first ever Native Authority Primary Boarding School in Sandema in 1935 which was opened in 1936. Surprisingly, he refused an offer of a loan from the British Colonialists and rather offered £10 out of the £15 that was needed to complete the school project.

By 1948, he had expanded primary educational facilities to other areas in Builsa including: Siniensi, Fumbisi and Chuchuliga, all of which schools were built through communal labour.

He fought for the building of the first Middle Boarding School in Sandema in 1952 and was instrumental in the building of the Sandema Secondary Technical School in 1976 and also led his people to build a dispensary at Sandema in 1937.

The British relied heavily on him for soldiers for the Second World War, so in 1942, he was called upon by the Governor of the then Gold Coast to give a word of encouragement to the Regiment stationed in Kumasi before their departure to the war front in Abyssinia and Burma.

In 1945, he again addressed the whole West African Regiment in Accra. A good number of his people were part of the group of ex-servicemen who marched to the Castle on the 28"‘ February 1948 to protest to the Governor. It was one of them, Sgt. Issa Kanjarga who counter ordered his fellow countrymen in Hausa not to shoot when Lt. Imray ordered them to open fire on the advancing ex-servicemen. Lt. Imary then seized a gun from one of the soldiers and shot, killing Sgt. Adjetey and the two others.

He was a strong advocate of gender issues. For example he often on several occasions settled marriage matters that came before him by allowing the women to choose their preferred husbands between claimants. He promoted and participated seriously in the human rights and anti-nudity campaigns that were launched before and after independence and which greatly enhanced the dignity of the local women.

To ensure the security and economic well being of his people, he initiated the cattle kraal system where he negotiated with one of his people, the late Adeetuk from Akaring-yeri to relocate to the Suwaransa community as a care taker of a cattle kraal that was opened there. This also explains the presence of the Adeetuks at Suwaransa but not at Abil-yeri. The first Native Authority Passenger Vehicle was purchased with proceeds from this kraal.

As Sandem-Nab he had been the President of the Builsa Traditional Council since December 1931.

He was Vice President of the Northern Territorial Council with its Headquarters at Tamale.

In 1960, when the Upper Region was carved from the Northern Territories, he became the first Vice-President of the Regional House of Chiefs.

From 1966-1972 Nab Azantilow was the President of the Upper Region House of Chiefs, during which time there was not a single chieftaincy dispute in the Region. He declined further offer of Presidency thereafter. Until then he was a permanent member of the National House of Chiefs. It was during his tenure that the present Regional house of Chiefs was built.

Due to his love for Agricultural activities, he became the Chairman of the Upper Region Agricultural Council (1967-1968).

Nab Dr. Ayieta Azantilow was a leading signatory to the irrevocable agreement of the Northern Territories to join the rest of the Gold Coast for Self-Government on 30th May 1956 at Tamale.

He had earlier reprensented the Gold Coast at the Coronation of Queen Elizabeth II in London. Until his death, he was in constant contact with the Royal family of England.

He received a number of Medals and Citations recognition of his contribution to both National and international Relations and Progress: Notably: