Buruli ulcer

Cultural and socio-economic studies

Rationale

In general, the aim of studies in this area is twofold:

  • to assist in the design and evaluation of specific culturally appropriate and behaviourally feasible prevention and treatment interventions;
  • to inform policymakers to incorporate findings of such studies in designing and changing policies aimed at managing the disease.

Patients’ perceptions about a disease, its effective treatment, and the socio-economic dislocation caused by the illness and related symptoms, generally have a significant impact on when and where to go for diagnosis and treatment. Today, the majority of people affected by Buruli ulcer seek treatment too late. There are multiple reasons ranging to beliefs to problems of access to treatment.

Although these beliefs can vary considerably from culture to culture, there are some general traits that permeate several cultures. These include:

  • If a disease does not follow its expected course, (e.g. “wounds that do not heal”) a supernatural cause such as a curse or witchcraft is often suspected. In such cases, patients seek supernatural cure.
  • People with limited resources (particularly those in rural areas) seek medical help first from the least expensive and the closest sources. Multiple, simultaneous or sequential sources of treatment may also be sought (e.g., home treatment, traditional healers, and finally before going to the hospital).
  • Local understandings of what constitutes a “severe” disorder (or in the case of Buruli ulcer, a severe skin disorder).
  • Perceived (or lack of) threat to the individual.

Recommended studies:

  • To determine local explanatory models of skin disorders and Buruli ulcer in particular (signs, causes, relative severities, treatments, perceived threat), local terminology associated with Buruli ulcer, patterns of health-seeking behaviour (use of home remedies, traditional healers, local clinics and pharmacies, and other therapeutic resources), and factors influencing these patterns of health-seeking behaviour;
  • To determine community opinions of any proposed interventions such as health education, treatment, and community-based rehabilitation;
  • To determine the potential role of traditional healers in the early recognition and treatment of Buruli ulcer and the possible use of home and traditional remedies;
  • To determine the socio-economic dislocations of social and cultural norms caused by Buruli ulcer and the coping strategies employed by affected people and their family members;
  • To determine the impact of Buruli ulcer (including disability) on the lives of the patients and family members;
  • To determine the costs of both static (or facility-based) and outreach management of Buruli ulcer. This will include both direct and indirect costs of such management strategies. Such costs studies should also include the assessment of the costs of treatment of various forms of the disease;
  • To determine the economic impact of the disease treatment on the health system, the community and the country at large.
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