This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Aims. This retrospective study was to identify some challenges in the treatment of Buruli ulcer BU and present a proposed treatment regime. Materials and Methods. Information from patients medical records, hospital database, and follow-up findings on BU treatment procedures from to and from to at three research sites in Ghana were reviewed to determine the treatment challenges encountered.
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Buruli ulcer BU is one of the most neglected tropical diseases caused by Mycobacterium ulcerans. The Ga West Municipality is an endemic area for Buruli ulcer, and we evaluated the BU surveillance system to determine whether the system is meeting its objectives and to assess its attributes.
Materials and Methods. We reviewed records and dataset on Buruli ulcer for the period — The evaluation was carried out at the national, regional, district, and community levels using the Ga West Municipality of the Greater Accra Region as a study site.
Interviews with key stakeholders at the various levels were done using an interview guide, and observations were done with a checklist. Data were entered and analyzed using Epi info 7.
A total of cases of Buruli ulcer were reported from to in Ga West. The number of confirmed cases decreased from in to 17 in The system was useful, fairly simple, flexible, representative, and fairly acceptable. The system was sensitive with a PVP of The system was moderately stable, and timeliness of reporting was The Buruli ulcer surveillance system is meeting its set objectives, and the data generated are used to reliably describe the epidemiologic situation and evaluate the results for actions and plan future interventions.
There is a need for timely submission of data. Introduction Buruli ulcer BU is a neglected tropical disease caused by Mycobacterium ulcerans and is characterized by a chronic necrotizing, ulcerative lesions of the skin [ 1 ]. It is the third most widespread Mycobacterium infection after tuberculosis and leprosy causing morbidity in immunocompetent humans worldwide [ 3 ].
The virulence of M. The exact mode of transmission of M. Studies have shown that BU is commonly found in populations living near rivers, swamps, and wetlands [ 4 — 6 ].
In several instances, local environmental events, such as deforestation, flooding and building of dams, or agricultural activities such as irrigation, have been associated with the emergence of BU [ 5 , 6 ]. At least 33 countries with tropical, subtropical, and temperate climates have reported Buruli ulcer in Africa, South America, and Western Pacific regions [ 3 ].
In , new cases were reported from 13 countries to WHO. In , a national survey conducted in Ghana on the prevalence of BU recorded about cases [ 1 ]. The World Health Assembly adopted a resolution in , which called for increased surveillance, control, and intensified research to develop tools for diagnosis, treatment, and prevention of BU.
From , The National Buruli Ulcer Control Programme NBUCP was established by the Ministry of Health, Ghana, with an objective to minimize the morbidity and disability associated with Buruli ulcer disease, collaborate with research centres in diagnosis and case management, and standardized case management with antibiotics, surgery, and prevention of disability. Though Buruli ulcer disease is not usually fatal, it leads to profound morbidity especially in areas where treatment options are limited.
The large ulcers often lead to scarring, contractual deformities, amputations, and irreversible disabilities; thus, a surveillance system was set up to monitor the impact of Buruli ulcer interventions in terms of incidence and prevalence of the disease. Regular and relevant evaluation of this system is critical in order to improve their performance and efficiency; hence, we evaluated the surveillance system to see whether it is meeting its objectives and to assess its attributes and usefulness.
Methods 2. Study Setting Ga West Municipality is one of the sixteen districts in the Greater Accra Region, carved out of the erstwhile Ga district which was created in It is made up of about communities with Amasaman as its district capital. It occupies a total land surface area of The population of the municipality as of was , [ 7 ]. Currently, the municipality is divided into three submunicipal areas for the purpose of planning and delivery of services, namely, Amasaman, Ofankor, and Pokuase.
Ga West is an endemic municipality in Buruli ulcer cases, and as a result, there are eight BU treatment centres with the municipal hospital serving as the referral point not only for the municipality but also the entire Greater Accra Region and neighbouring regions for severe cases of BU management. There is a ward in the municipal hospital in charge of BU treatment such as antibiotic treatment, surgery, wound debridement, and dressing Figure 1.
Study Design The evaluation was carried out at the national level using the Buruli Ulcer Control Programme, the regional level using the Greater Accra Region, the district, and community levels using the Ga West Municipality in January —March A semistructured interview guide, checklist based on the Centers for Disease Control CDC , updated guidelines for Evaluating Public Health Surveillance Systems, [ 9 ], and the direct observation method was used to collect data at the national, regional, and district levels.
We collected secondary data for the period — We then assessed the performance of the system and its attributes such as simplicity, flexibility, data quality, acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability. Results and Discussion 3. Most of the stakeholders provide logistical and financial support to the program for its activities. The research institutions support the national control programme with case confirmation.
The BU surveillance system in Ga West Municipality has a standard case definition, and because ulcers and nodules are easily identified, it makes the case definition simple to detect cases. Case Definition 3.
Suspected Case A person presenting a painless skin nodule, plaque, or ulcer, living or having visited a BU-endemic area. Operation of the System Data on this system are collected mainly through a combination of passive reporting and active reporting. At the community level, health workers or CBSVs detect cases of BU and report to the health facility, active case searches during home or school visits.
Some patients also report themselves. At the health facility level, diagnosis of Buruli ulcer depends on clinical presentation and laboratory confirmation. Results of the test are ready after a week. No analysis of data is done at this level. The coordinator then compiles all the cases from the facilities on another BU form which is reported quarterly to the regional surveillance unit and NBUCP through e-mail and hardcopy.
Copies are stored in the computer and external drive. The District Disease control officer also compiles the Integrated Disease Surveillance and Response IDSR monthly reports and submits to the regional surveillance unit while soft copies of the monthly morbidity return forms are sent to the Health information unit every month.
Soft copies are stored on computers and hard copies in files at the office. Data analysis is as well carried out at this level using Microsoft Excel to provide information to all the stakeholders in the district for action. At the regional level, the regional surveillance officer compiles all reports received from the districts.
Data analysis is done to assess the trend and to give information to the regional Director of public health as well as the district Directors. Feedback is sent to the districts in the form of emails, telephone calls, review meetings, and annual reports. Data analysis is conducted to generate age, sex, district, and regional distributions.
Data analysis is carried out to generate the BU categories, clinical forms, suspected and confirmed BU cases, and trends of new and recurrent cases. After analysis of the data, feedback is sent to the regions and districts quarterly through e-mail and annual reports. At the end of each year, reports containing the total number of BU cases and the various indicators in Ghana are sent to WHO during the annual meeting in Geneva.
The flow of information from one level to the other is shown in Figure 2. Figure 2 Flow chart of Buruli ulcer surveillance system. NBUCP has strong collaboration with the research centres for confirmation of cases.
At the regional, district, and facility levels, the same officers are used for all public health and disease control activities. The integration with the health service surveillance system makes BU surveillance system less expensive to run. Performance of the BU Surveillance System 4. Usefulness The Buruli ulcer surveillance system in Ga West is a vital source of information. The data are useful for understanding the severity of the disease and for planning and monitoring the impact of interventions put in place to minimize the morbidity and disability associated with the disease Table 1.
This brings the health facilities capable of providing dressing and antibiotic to BU patients to eight. From —, a total of confirmed cases of BU at various stages were identified. According to Johnson [ 10 ], Buruli ulcer is usually not fatal but leads to profound morbidity especially the category II and III ulcers which can lead to permanent disability.
A relevant measure of early reporting is the size of the lesion, which is reflected by the WHO categorization system for BU. Patients commonly present with large lesions, with There was This could be due to interventions such as increased in number of treatment centres, construction of physiotherapy department, special clinic day Wednesday for BU patients, and availability of Buruli ward.
For the years under evaluation, there was a decrease in the number of cases. This could be due to an increase in awareness of the disease.
Buruli Ulcer in Ghana: Results of a National Case Search
The overall crude national prevalence rate of active lesions was The case search demonstrated widespread disease and gross underreporting compared with the routine reporting system. The epidemiologic information gathered will contribute to the design of control programs for Buruli ulcer. Buruli ulcer disease is assuming public health importance in many countries, prompting the establishment of a Global Buruli Ulcer Initiative by the World Health Organization WHO in early Ever since Mycobacterium ulcerans infection was first described in Australia in 1 and later named Buruli ulcer in Uganda 2 , cases have been reported throughout the tropical and subtropical world.
A Swollen patch on the middle finger B about 4 weeks later, ulcers form on the middle finger C 5. A single small less than five centimeters ulcer is category I. Larger ulcers up to 15 centimeters are category II. Ulcers that are larger, disseminated across the body, or include particularly sensitive sites e. Disease is primarily caused by a toxin produced by the bacteria, mycolactone.
This article has been cited by other articles in PMC. Abstract A national search for cases of Buruli ulcer in Ghana identified 5, patients, with 6, clinical lesions at various stages. The overall crude national prevalence rate of active lesions was The case search demonstrated widespread disease and gross underreporting compared with the routine reporting system. The epidemiologic information gathered will contribute to the design of control programs for Buruli ulcer. Key Words: Buruli ulcer, epidemiology, case search Buruli ulcer disease is assuming public health importance in many countries, prompting the establishment of a Global Buruli Ulcer Initiative by the World Health Organization WHO in early