Early detection and treatment of Buruli Ulcer in Ghana

Buruli ulcer (BU) is caused by the Mycobacterium ulcerans (M. ulcerans) bacteria and is the third most common mycobacterial disease affecting Ghana. Although mortality of the disease is low, morbidity and subsequent disability are very high, with up to half of those treated being left with disabilities.

In April 2010, IANPHI awarded a $60,000 grant to the Noguchi Memorial Institute for Medical Research to scale up early detection capacity and improve treatment to reduce BU morbidity in the Asante-Akim district, the third most BU endemic district in Ghana. 

The overall aim of the project is to implement strategies to promote active community participation in early case detection and to support health centers in confirming and treating BU. The project will be completed in three phases. In the baseline study, socio-medical and cultural data will be collected and reviewed to better understand local perceptions, behaviors and attitudes towards BU. Intervention strategies will include programs to strengthen the community’s ability to identify the early stages of BU, to seek prompt medical treatment, and a program to strengthen the health system’s ability to diagnose and treat the disease. Activities of community volunteers and health workers will be monitored and evaluated through regular meetings of all the stakeholders involved. The impact of intervention will be determined from hospital records. The project will also involve a basic research component aimed at developing and evaluating a field applicable, DNA amplification -based diagnostic method for Buruli ulcer.

BU occurs mainly in remote areas deprived of basic health care facilities, potable water, and good roads. These areas are also poorly covered by the national health surveillance systems and under-reporting is often suspected in many endemic countries in Africa. Early stages of BU are more responsive to treatment and patients presenting with early lesions have good treatment outcomes. However about 90% of patients in Africa seek late medical attention when radical surgery is needed. Surgery is technically difficult, resource intensive and often results in significant morbidity; it is also not easily accessible in terms of cost and availability. In Ghana, patients with advanced BU are usually hospitalized for more than three months, which causes a huge loss in productivity for adult patients and family caregivers, and loss of educational opportunities for children who represent over 50% of BU victims. BU therefore imposes serious economic burden on already impoverished households and fragile health systems of many endemic countries

The research team will consist of doctors and researchers from the Agogo Presbyterian Hospital (APH) and the Noguchi Memorial Institute for Medical Research, University of Ghana. The research project is an evidence based intervention which impacts directly on health systems as well as the health of the population. It is expected that at the end of the project at least 80% of BU cases will be detected at the pre- or early ulcer stages.

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