Research Article: Risk Factors for Buruli Ulcer in Ghana—A Case Control Study in the Suhum-Kraboa-Coaltar and Akuapem South Districts of the Eastern Region

Date Published: November 20, 2014

Publisher: Public Library of Science

Author(s): Ernest Kenu, Kofi Mensah Nyarko, Linda Seefeld, Vincent Ganu, Michael Käser, Margaret Lartey, Benedict Nii Laryea Calys-Tagoe, Kwodwo Koram, Richard Adanu, Oliver Razum, Edwin Afari, Fred N. Binka, Richard O. Phillips.

Abstract: BackgroundBuruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. Its exact mode of transmission is not known. Previous studies have identified demographic, socio-economic, health and hygiene as well as environment related risk factors. We investigated whether the same factors pertain in Suhum-Kraboa-Coaltar (SKC) and Akuapem South (AS) Districts in Ghana which previously were not endemic for BU.MethodsWe conducted a case control study. A case of BU was defined as any person aged 2 years or more who resided in study area (SKC or AS District) diagnosed according to the WHO clinical case definition for BU and matched with age- (+/−5 years), gender-, and community controls. A structured questionnaire on host, demographic, environmental, and behavioural factors was administered to participants.ResultsA total of 113 cases and 113 community controls were interviewed. Multivariate conditional logistic regression analysis identified presence of wetland in the neighborhood (OR = 3.9, 95% CI = 1.9–8.2), insect bites in water/mud (OR = 5.7, 95% CI = 2.5–13.1), use of adhesive when injured (OR = 2.7, 95% CI = 1.1–6.8), and washing in the Densu river (OR = 2.3, 95% CI = 1.1–4.96) as risk factors associated with BU. Rubbing an injured area with alcohol (OR = 0.21, 95% CI = 0.008–0.57) and wearing long sleeves for farming (OR = 0.29, 95% CI = 0.14–0.62) showed protection against BU.ConclusionThis study identified the presence of wetland, insect bites in water, use of adhesive when injured, and washing in the river as risk factors for BU; and covering limbs during farming as well as use of alcohol after insect bites as protective factors against BU in Ghana. Until paths of transmission are unraveled, control strategies in BU endemic areas should focus on these known risk factors.

Partial Text: Buruli ulcer (BU) is a chronic debilitating skin disease caused by Mycobacterium ulcerans[1], [2]. BU depicts the third and second most common mycobacterial disease, globally and in Ghana, respectively [3], [4]. Currently, BU has been reported in over 30 countries in four continents [1], [2], [5], [6] but West Africa is the region most affected [1], [6]. The first case of BU in Ghana was reported in 1971 by Barley [7], [8], and ever since over 426 communities have reported cases. These communities are in the Ashanti, Brong Ahafo, Eastern, Greater Accra and Western regions. Amofah et al found the highest prevalence rate of 87.7/100,000 in the Ga West District [9].

This study identified activities that showed statistically significant association with BU in SKC and AS Districts of the Eastern region of Ghana, an area recently identified as being endemic for BU. Farming with long sleeve clothes and rubbing an insect bite area with alcohol were associated with decreased risk of contracting BU. On the other hand, presence of wetland, insect bites in water/mud, washing in the Densu river, use of adhesive bandage and house walls built with mud were identified as risk factors for BU.



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