Buruli ulcer

Volunteers and health-care workers pivotal to early case detection of Buruli ulcer (Mycobacterium ulcerans infection)

25 March 2011 | Geneva

© Asiedu Kingsley. A health worker providing information on early detection of Buruli Ulcer

The World Health Organization (WHO) says support from village volunteers and primary or front-line health-care workers is crucial to early case detection and control of Buruli ulcer (Mycobacterium ulcerans infection), a neglected tropical disease. Local support contributes to motivating community involvement in control activities and strengthening public health programmes. Timely detection of patients greatly improves their chances of a full recovery from the disease.

Re-focusing the strategy

The introduction of antibiotic treatment in 2005 re-focused WHO’s strategy for control of the disease. Accumulating field experience and studies since then have proven that antibiotic therapy with rifampicin and streptomycin is effective in curing patients without the need for surgery in about a third of cases. Recurrence (relapse) of infection is today uncommon.

Through early detection, most patients receive ambulatory treatment from local health centres, thereby minimizing disruption to their daily activities such as schooling or work. Primary health-care workers play an important role in ensuring adherence to treatment and in supervising the work of village volunteers.

One of the key control strategies is enhancing case detection at the community level and strengthening the capacity of decentralized health centres to provide high-quality care of patients. In recognition of their contributions, village volunteers and front-line health-care workers from Benin, Cameroon, Ghana and Togo will participate for the first time in the annual meeting of the Global Buruli Ulcer Initiative at WHO’s headquarters in Geneva, Switzerland.

This international meeting is important for global advocacy; it provides a platform to share and disseminate new information about the disease as well as coordinate efforts among all partners. The views and contributions of the village volunteers and front-line health workers will be crucial in formulating recommendations for actions at the grassroots level.

The meeting will be attended by about 150 participants from 29 endemic and non-endemic countries. WHO’s Global Buruli Ulcer Initiative has organized this annual event every year since it was established in1998. The meeting convenes representatives from the ministries of health of affected countries, nongovernmental organizations, the research community and other interested parties involved in activities to control Buruli ulcer.

The disease

Buruli ulcer, a chronic skin disease caused by infection with Mycobacterium ulcerans, starts as a painless nodule or lesion. Infection frequently leads to extensive destruction of the skin and soft tissue and the formation of large ulcers, usually on the arms and legs.

Patients in whom the disease is diagnosed at an early stage can be successfully treated using antibiotics without the need for surgery. Delayed diagnosis may lead to long-term functional disability, sometimes involving amputated limbs, and serious social and economic impacts on affected people, especially women and children.

“Today, village volunteers and front-line health-care workers are the bedrock of the current early detection strategy of Buruli ulcer control”...“It is based on their referral that suspected cases are sent to the nearest health centre for treatment.”

Dr Kingsley Asiedu, Medical Officer in charge of WHO’s Global Buruli Ulcer Control Programme

“One of our greatest challenges is the lack of mobility to help us visit a number of affected villages to carry out our work. A simple bicycle could help us a lot”...“We often have to contend with some traditional beliefs (such as witchcraft) and have to continuously convince the populations that Buruli ulcer is a disease which at an early stage, is easy to treat with antibiotics.”

Mr Yusif Quaye, a teacher and village volunteer, Obom, Ghana.