Buruli ulcer in southern Côte D’ivoire: dynamic schemes of perception and interpretation of modes of transmission

Abstract

Buruli ulcer (BU) belongs to the group of neglected tropical diseases and constitutes a public health problem in many rural communities in Côte d’Ivoire. The transmission patterns of this skin infection are poorly defined, hence the current study aimed to contribute to the understanding, perceptions and interpretations of its mode of transmission using a socio-environmental approach. Social and environmental risk factors that may expose people to infection, and the dynamics of local transfer of knowledge and practices related to BU, were assessed in two endemic locations in southern Côte d’Ivoire, i.e. Taabo and Daloa. Data were generated by the administration of a household questionnaire (N=500) between February and June 2012 to assess how the population perceived transmission of BU, focus group discussions with local communities (N=8) to analyse ideologies regarding transmission patterns and semi-structured interviews with patients or their parents, former BU patients and traditional healers (N=30). The interviewees’ empirical knowledge of the disease was found to be close to its biomedical description. Their aetiological perception of the disease was linked to natural (e.g. dirty water, insects) and supernatural (e.g. witchcraft, fate) causes. Some informants attributed the spread of the disease to recently immigrated neighbouring communities whose arrival coincided with an increase in reported BU cases. However, the general consensus seemed to be that the main mode of transmission was contact with infested soil or ulcerated wounds. The participants were aware that BU was a socio-environmental problem in these endemic areas, offering a good starting point for educational campaigns for at-risk communities. Buruli ulcer control programmes should therefore include educational campaigns and Water, Sanitation and Hygiene (WASH) interventions for those at risk in affected communities.

Impact of common skin diseases on children in rural Côte d’Ivoire with leprosy and Buruli ulcer co-endemicity: A mixed methods study

“…Often, delay in accessing healthcare facilities by patients with leprosy and BU are reported to occur due to a belief that these diseases are a result of witchcraft, fear of incurring cost for treatment (direct and indirect), or stigma and discrimination [37][38][39]. In addition, the asymptomatic nature of the initial stages of these diseases, and also a fact that there are so many other skin diseases in children to differentiate from, contributes to this failure to access healthcare facilities at an early stage.…”

Understanding the transmission of Mycobacterium ulcerans: A step towards controlling Buruli ulcer

“…ulcerans suitability [ 56 , 57 ]. Likewise, from a social perspective, residents in the Ivory Coast (a Buruli ulcer–endemic region of Africa) also associate unclean water with acquiring Buruli ulcer [ 58 ].…”

“…In addition, a recent model of aquatic insect distribution in West Africa predicted that insects likely to be involved in the transmission of Buruli ulcer were those which had adapted to environments of two highly affected regions, Ghana and Cameroon [ 77 ]. Also consistently, aquatic insects are one of the main perceived causes of Buruli ulcer by residents in the Ivory Coast [ 58 ], and receiving insect bites near a river has recently been identified as a risk factor for developing Buruli ulcer in Togo [ 78 ].…”

Social Science Contributions to BU Focused Health Service Research in West-Africa

“…Stigma appeared to decrease post treatment with less than a third of former patients reporting stigma. 2 Stigma was largely associated with the smell emanating from the wound. Patients often engaged in self-stigmatization, isolating themselves from others out of embarrassment.…”

“…Two recent studies conducted in Cote' D'ivoire by Konan et al[2] and Uganda by Pearson[3] are worthy of mention.…”