Geographic distribution, age pattern and sites of lesions in a cohort of buruli ulcer patients from the mapé basin of cameroon

Buruli ulcer (BU), a neglected tropical disease of the skin, caused by Mycobacterium ulcerans, occurs most frequently in children in West Africa. Risk factors for BU include proximity to slow flowing water, poor wound care and not wearing protective clothing. Man-made alterations of the environment have been suggested to lead to increased BU incidence. M. ulcerans DNA has been detected in the environment, water bugs and recently also in mosquitoes. Despite these findings, the mode of transmission of BU remains poorly understood and both transmission by insects or direct inoculation from contaminated environment have been suggested. Here, we investigated the BU epidemiology in the Mapé basin of Cameroon where the damming of the Mapé River since 1988 is believed to have increased the incidence of BU. Through a house-by-house survey in spring 2010, which also examined the local population for leprosy and yaws, and continued surveillance thereafter, we identified, till June 2012, altogether 88 RT-PCR positive cases of BU. We found that the age adjusted cumulative incidence of BU was highest in young teenagers and in individuals above the age of 50 and that very young children (>5) were underrepresented among cases. BU lesions clustered around the ankles and at the back of the elbows. This pattern neither matches any of the published mosquito biting site patterns, nor the published distribution of small skin injuries in children, where lesions on the knees are much more frequent. The option of multiple modes of transmission should thus be considered. Analyzing the geographic distribution of cases in the Mapé Dam area revealed a closer association with the Mbam River than with the artificial lake

Geographic Expansion of Buruli Ulcer Disease, Cameroon

International audienceNo abstract availabl

Un deuxième site endémique d’ulcère de Buruli au Cameroun

International audienceL’ulcère de Buruli, maladie cutanée due à l’infection par Mycobacterium ulcerans, a été décrit au Cameroun dans les années 60 dans la région forestière de la vallée du Nyong, dans les districts d’Ayos et Akonolinga. La maladie y est endémique et la prévalence atteignait 0,47 % en 2007. Une enquête nationale a été réalisée en 2004 au Cameroun afin de rechercher des cas d’ulcère de Buruli dans les autres régions. Deux districts présentaient un nombre important de cas cliniques supposés, le district de Bongué dans la région du Sud-ouest et le district de Bankim, dans la région de l’Adamaoua.En 2008 et 2009, plusieurs missions ont été réalisées pour étudier l’épidémiologie et l’environnement de l’ulcère de Buruli à Bankim.</p

Risk factors for Buruli ulcer in Bankim, a newly endemic area in Cameroon

International audienceIn Cameroon, only one endemic area had been described since 1969, in the Nyong River basin between Ayos and Akonolinga in the central region. Five years ago, clinically suspected BU cases were reported for the first time in the district of Bankim, a rugged land in north-western Cameroon. Interestingly, a dam was built in this region in 1989, creating an artificial lake of 3.2 billion m3&nbsp; capacity. Large amounts of farmland were flooded and several villages relocated. Since 2007, around 75 cases of BU were reported each year from Bankim, for a population close to 70000 inhabitants.In 2007, a case-control study on BU in Akonolinga suggested a protective role of the use of bednets. In order to verify and further investigate this result, a case-control study was conducted in Bankim from the 1st June to 17 August 2009. This study also aimed at investigating other risk factors for BU in a savanna setting. Each of the 79 included cases was matched with two controls of the same sex, age and village.Data analysis was performed using conditional logistic regression. &nbsp;Multivariate analysis confirmed that using a bednet everyday was a protective factor against BU (Odds-Ratio(OR)=0.4 ; 95% Confidence Interval(95%CI)=[0.2-0.9]). Few people had good quality bednets, and thus investigations on impregnation or holes remained inconclusive. Taking proper care of wounds was a strong protective factor (OR [95%CI]=0.1 [0.04-0.4]), providing confirmation for another association identified in the Akonolinga study. Surprisingly, growing cassava was a protective factor (OR[95%CI]=0.4 [0.2-0.9]). We hypothesize that this protection could result from a lower exposure to disease on the savanna farmland where Bankim farmers usually plant cassava or from a diversified nutrition of farmers and their families.Increased risks were associated with Contact not only with the dam swampy area but also with&nbsp; the other River in region and water bodies neighboring houses and environment&nbsp; exposures such as not wearing shoes during washing clothes or household activities (OR[95%CI]=7.7 [1.4-42]). Reporting skin lesions due to itching after insect bites was significantly and independantly associated with disease (OR[95%CI]=2.7 [1.3-5.5]), but this association might result from memory bias. &nbsp;In conclusion, this study shows for the second time that using a bednet is associated to a significant protection against BU. This finding advocates for further studies on transmission of BU focus on dwellings and neighboring water bodies. Communication regarding protection methods should now be provided to local population.&nbsp;</p

Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa

Background In the Cameroon, previous efforts to identify Buruli ulcer (BU) through the mobilization of community health workers (CHWs) yielded poor results. In this paper, we describe the successful creation of a BU community of practice (BUCOP) in Bankim, Cameroon composed of hospital staff, former patients, CHWs, and traditional healers. Methods and principle findings All seven stages of a well-defined formative research process were conducted during three phases of research carried out by a team of social scientists working closely with Bankim hospital staff. Phase one ethnographic research generated interventions tested in a phase two proof of concept study followed by a three-year pilot project. In phase three the pilot project was evaluated. An outcome evaluation documented a significant rise in BU detection, especially category I cases, and a shift in case referral. Trained CHW and traditional healers initially referred most suspected cases of BU to Bankim hospital. Over time, household members exposed to an innovative and culturally sensitive outreach education program referred the greatest number of suspected cases. Laboratory confirmation of suspected BU cases referred by community stakeholders was above 30%. An impact and process evaluation found that sustained collaboration between health staff, CHWs, and traditional healers had been achieved. CHWs came to play a more active role in organizing BU outreach activities, which increased their social status. Traditional healers found they gained more from collaboration than they lost from referral. Conclusion/Significance Setting up lines of communication, and promoting collaboration and trust between community stakeholders and health staff is essential to the control of neglected tropical diseases. It is also essential to health system strengthening and emerging disease preparedness. The BUCOP model described in this paper holds great promise for bringing communities together to solve pressing health problems in a culturally sensitive manner.Optim us Foundation as part of the Stop Buruli InitiativeThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa

<div><p>Background</p><p>In the Cameroon, previous efforts to identify Buruli ulcer (BU) through the mobilization of community health workers (CHWs) yielded poor results. In this paper, we describe the successful creation of a BU community of practice (BUCOP) in Bankim, Cameroon composed of hospital staff, former patients, CHWs, and traditional healers.</p><p>Methods and principle findings</p><p>All seven stages of a well-defined formative research process were conducted during three phases of research carried out by a team of social scientists working closely with Bankim hospital staff. Phase one ethnographic research generated interventions tested in a phase two proof of concept study followed by a three- year pilot project. In phase three the pilot project was evaluated. An outcome evaluation documented a significant rise in BU detection, especially category I cases, and a shift in case referral. Trained CHW and traditional healers initially referred most suspected cases of BU to Bankim hospital. Over time, household members exposed to an innovative and culturally sensitive outreach education program referred the greatest number of suspected cases. Laboratory confirmation of suspected BU cases referred by community stakeholders was above 30%. An impact and process evaluation found that sustained collaboration between health staff, CHWs, and traditional healers had been achieved. CHWs came to play a more active role in organizing BU outreach activities, which increased their social status. Traditional healers found they gained more from collaboration than they lost from referral.</p><p>Conclusion/ Significance</p><p>Setting up lines of communication, and promoting collaboration and trust between community stakeholders and health staff is essential to the control of neglected tropical diseases. It is also essential to health system strengthening and emerging disease preparedness. The BUCOP model described in this paper holds great promise for bringing communities together to solve pressing health problems in a culturally sensitive manner.</p></div

Adequate wound care and use of bed nets as protective factors against Buruli Ulcer: results from a case control study in Cameroon.

BACKGROUND: Buruli ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans. Its exact transmission mechanism remains unknown. Several arguments indicate a possible role for insects in its transmission. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a case-control study on 77 Buruli ulcer cases and 153 age-, gender- and village-matched controls. Participants were interviewed about their activities and habits. Multivariate conditional logistic regression analysis identified systematic use of a bed net (Odds-Ratio (OR) = 0.4, 95% Confidence Interval [95%CI] = [0.2-0.9], p-value (p) = 0.04), cleansing wounds with soap (OR [95%CI] = 0.1 [0.03-0.3], p<0.0001) and growing cassava (OR [95%CI] = 0.3 [0.2-0.7], p = 0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI] = 6.9 [1.4-35], p = 0.02) and reporting scratch lesions after insect bites (OR [95%CI] = 2.7 [1.4-5.4], p = 0.004). The proportion of cases that could be prevented by systematic bed net use was 32%, and by adequate wound care was 34%. CONCLUSIONS/SIGNIFICANCE: Our study confirms that two previously identified factors, adequate wound care and bed net use, significantly decreased the risk of Buruli ulcer. These associations withstand generalization to different geographic, climatic and epidemiologic settings. Involvement of insects in the household environment, and the relationship between wound hygiene and M. ulcerans infection should now be investigated

Format of outreach education.

<p>Format of outreach education.</p