Buruli Ulcer in Ghana
Buruli Ulcer in Ghana
A national search for cases of Buruli ulcer in Ghana identified 5,619 patients, with 6,332 clinical lesions at various stages. The overall crude national prevalence rate of active lesions was 20.7 per 100,000, but the rate was 150.8 per 100,000 in the most disease-endemic district. 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 1998. Ever since Mycobacterium ulcerans infection was first described in Australia in 1948 and later named Buruli ulcer in Uganda, cases have been reported throughout the tropical and subtropical world. In the African WHO region, at least 16 of 46 member countries report cases, especially in West Africa and parts of Eastern and Central Africa.
One characteristic of the disease is its apparent association with bodies of water worldwide. The recent identification of M. ulcerans in certain water insects has raised the possibility of mechanical transmission of the infection.
Buruli ulcer commonly affects the young, even though cases are reported in all age groups. Oluwasanmi et al. and van der Werf did not find any sex difference in their series, but Barker reported prevalence to be higher among women than men and among boys than girls. The disease is characteristically found more often on the extremities than on the trunk. The infection is usually restricted to relatively small areas and patchy in its distribution.
The first probable case of Buruli ulcer in Ghana was reported in the Greater Accra Region in 1971; the presence of additional cases along the tributaries of the Densu River in the area was considered likely. In 1989, van der Werf et al. described 96 cases in the Asante Akim North District of Ashanti Region. This report was followed by the description of a major endemic focus in Amansie West District in the same region. Since then, isolated cases have been found in scattered communities in many parts of the country, generating much political and media concern and interest.
In 1993, a passive surveillance system for reporting Buruli ulcer was initiated in Ghana. By the end of 1998, approximately 1,200 cases had been reported from four regions. Gross underreporting was suspected, however, as the media continued to report cases in remote rural communities. Because most cases were known to be in relatively deprived, inaccessible areas, the routine reporting system was judged inadequate to provide a true picture of the extent of disease and the geographic distribution of cases for design of a national control program. In addition, a case search would provide baseline data against which intervention measures could be assessed.
The main objective of the national case search was to establish the extent of the disease in Ghana to facilitate development of a national program for its control. The specific objectives were to determine the epidemiologic characteristics of Buruli ulcer in Ghana and determine physical accessibility of disease-endemic communities to health-care services.
A national search for cases of Buruli ulcer in Ghana identified 5,619 patients, with 6,332 clinical lesions at various stages. The overall crude national prevalence rate of active lesions was 20.7 per 100,000, but the rate was 150.8 per 100,000 in the most disease-endemic district. 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 1998. Ever since Mycobacterium ulcerans infection was first described in Australia in 1948 and later named Buruli ulcer in Uganda, cases have been reported throughout the tropical and subtropical world. In the African WHO region, at least 16 of 46 member countries report cases, especially in West Africa and parts of Eastern and Central Africa.
One characteristic of the disease is its apparent association with bodies of water worldwide. The recent identification of M. ulcerans in certain water insects has raised the possibility of mechanical transmission of the infection.
Buruli ulcer commonly affects the young, even though cases are reported in all age groups. Oluwasanmi et al. and van der Werf did not find any sex difference in their series, but Barker reported prevalence to be higher among women than men and among boys than girls. The disease is characteristically found more often on the extremities than on the trunk. The infection is usually restricted to relatively small areas and patchy in its distribution.
The first probable case of Buruli ulcer in Ghana was reported in the Greater Accra Region in 1971; the presence of additional cases along the tributaries of the Densu River in the area was considered likely. In 1989, van der Werf et al. described 96 cases in the Asante Akim North District of Ashanti Region. This report was followed by the description of a major endemic focus in Amansie West District in the same region. Since then, isolated cases have been found in scattered communities in many parts of the country, generating much political and media concern and interest.
In 1993, a passive surveillance system for reporting Buruli ulcer was initiated in Ghana. By the end of 1998, approximately 1,200 cases had been reported from four regions. Gross underreporting was suspected, however, as the media continued to report cases in remote rural communities. Because most cases were known to be in relatively deprived, inaccessible areas, the routine reporting system was judged inadequate to provide a true picture of the extent of disease and the geographic distribution of cases for design of a national control program. In addition, a case search would provide baseline data against which intervention measures could be assessed.
The main objective of the national case search was to establish the extent of the disease in Ghana to facilitate development of a national program for its control. The specific objectives were to determine the epidemiologic characteristics of Buruli ulcer in Ghana and determine physical accessibility of disease-endemic communities to health-care services.
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