Buruli ulcer : a manual on how to prevent disability

Overview

Buruli ulcer was described decades ago in both Australia and Uganda. Buruli County in Uganda – the site of an outbreak of the disease in the 1960s – gave its name to the condition, which is an infection caused by Mycobacterium ulcerans. Since 1980, the disease has emerged rapidly in several parts of the world – particularly West Africa – prompting action by the World Health Organization (WHO) in 1998.

In view of the increasing geographical spread, the severe consequences, and the limited knowledge of the disease, the World Health Assembly in 2004 adopted a resolution to improve the surveillance and control of Buruli ulcer and to accelerate research to develop better tools for its control. WHO and its partners have produced a number of publications to facilitate the mobilization and training of health staff in the affected areas.

In developing countries, the persons who are most affected live in remote rural areas with little contact with the health system, and often seek treatment late. In most affected areas, health and rehabilitation services are poorly developed or non-existent. Although mortality from Buruli ulcer is low, the main problem is long-term disability in an estimated 25% of those affected. The scarring process is similar to that in severe burns and often leads to contractures, sometimes resulting in marked disability and deformity. In some severe cases of Buruli ulcer, amputation may be necessary. Stigma may add to the burden of those affected, leading to loss of participation in normal community affairs

Current strategies for treating Buruli ulcer are antibiotics (a combination of rifampicin and streptomycin/amikacin) to limit the infection; surgery to remove necrotic tissue and restore skin coverage; and interventions to prevent or minimize disabilities. So far, however, not enough attention has been devoted to preventing disability. It is now clear that “prevention of disability” activities must be started in every case of Buruli ulcer – right at the beginning of treatment – if the contractures, stiffness, and weakness so typical of late cases are to be avoided or reversed.

This manual has been developed – after extensive training sessions for health workers in Cameroon and Ghana – to assist Buruli ulcer programme managers, policy-makers, health workers, social workers, and other actors in the field of prevention of disabilities and rehabilitation to implement activities that can reduce suffering and disability. It is also the hope of the authors, WHO, and partners that the implementation of the manual will contribute to strengthening general rehabilitation services in affected areas.