Buruli Ulcer: Rapid Assessment Of The Situation In Cameroon

Abstract

Foci of Mycobacterium ulcerans infections (“Buruli Ulcer”) have been described throughout the intertropical zone and they seem to be associated with stagnant or slow–flowing bodies of water. In Cameroon, Buruli ulcer has so far been confirmed in one well circumscribed swampy area in the Nyong river basin. The aim of this study was therefore, to evaluate the importance and the geographical distribution of the disease on the national level using a rapid assessment procedure.

On the basis of the existing leprosy network, investigations were conducted among 1) selected health personnel in district hospitals and leading health centres, and 2) the leprosy supervisors. The spatial distribution of areas reporting suspicious cases, the knowledge on the disease among health personnel and problems in the context of the disease were analysed, including questionnaires from 804 health facilities and 98 (64%) districts.

The two key findings are that the known affected area is much larger than previously described and that additionally, a number of potential foci exist throughout the country. More than 50% of the districts (n=98) stated the presence of suspicious cases. Most areas were located in the equatorial climate zone, 500 to 1500m above sea level and in forested and transitional forest-savannah regions. A considerable part was distributed throughout zones of degraded vegetation or intensive agriculture, and was in or close to regions with certain hydrographical characteristics. The frequency of identified areas tended to decline towards the northern part of the country. Knowledge on the disease was generally low (64% of health staff has never heard of “Buruli ulcer”).

The methodological approach of a rapid assessment procedure allowed identifying potential foci even on a national scale. Results were qualitative and semi–quantitative estimations. However, several observations suggested that the extension of the problem might still be under–estimated. So far identified areas need diagnostic confirmations. The overall strengthening of the sanitary system especially the reinforcement of the health facilities and education of health staff are crucial for the implementation of an adequate national program.

Anja Studer Swiss Tropical Institute 4002 Basel, Switzerland Tel +41 61 284 82 29 Fax +41 61 271 79 51 anja.studer@stud.unibas.ch

Dr Alphonse Um Boock ALES BP 5808 Yaoundé, Cameroon Tel 00237 222 23 78 Fax 00237 222 05 63 Portable 00237 9911460 umboock@yahoo.fr