Community‐based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana

Abstract

SummaryBuruli ulcer disease (BUD), a devastating tropical disease caused by Mycobacterium ulcerans, occurs in more than 80% of the administrative districts of Ghana. To elucidate community perceptions and understanding of the aetiology of BUD, attitudes towards Buruli patients and treatment-seeking behaviours, we conducted a survey with 504 heads of households and seven focus group discussions in Ga West District, Ghana. Although 67% of participants regarded BUD as a health problem, 53% did not know its cause. Sixteen per cent attributed the cause to drinking non-potable water, 8.1% mentioned poor personal hygiene or dirty surroundings, and 5.5% identified swimming or wading in ponds as a risk factor. About 5.2% thought that witchcraft and curses cause BUD, and 71.8% indicated that BU sufferers first seek treatment from herbalists and only refer to the hospital as a last resort. The main reasons were prospects of prolonged hospital stay, cost of transport, loss of earnings and opportunity associated with parents attending their children's hospitalization over extended period, delays in being attended by medical staff, and not knowing the cause of the disease or required treatment. The level of acceptance of BUD sufferers was high in adults but less so in children. The challenge facing health workers is to break the vicious cycle of poor medical outcomes leading to poor attitudes to hospital treatment in the community. Because herbalists are often the first people consulted by those who contract the disease, they need to be trained in early recognition of the pre-ulcerative stage of Buruli lesions.

Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana

“…Our study complements findings of earlier sociocultural studies of Buruli ulcer 3,9,16,17 and clarifies help-seeking for preulcers and ulcers of persons affected by Buruli ulcer. This information is critical for health programming in the Ga-West and Ga-South municipalities, where sociocultural research has been lacking.…”

“…Additionally, 72% of respondents said there was no program in place to address Buruli ulcer. 9 Since then, there has been a public health initiative to create awareness about Buruli ulcer and availability of medical care, improve case-management, and access to care. Our study not only supports previous findings of this study 9 about herbal medicine as the first treatment choice, but shows evidence of increasing awareness and use of medical treatment, and clarifies current treatment needs and gaps for Buruli ulcer.…”

“…The design of the semi-structured interview was informed by preliminary ethnographic field experience, focus group discussions, and earlier studies. 9,15 Help-seeking practices were elicited by questions on self-help, home-based care, places visited for help, and providers approached for care outside the home. The first source of outside help, reasons for this choice, and the most helpful outside help were queried in the interview.…”

“…Cultural beliefs, financial capacity, access to treatment facilities, prolonged hospitalization, and the fear of surgical outcomes are possible explanations. [7][8][9][10][11] However, there is limited information to distinguish help-seeking for pre-ulcer and ulcer infections. Explaining the distinguishing features of sociocultural features of help-seeking for pre-ulcer and ulcer conditions is important.…”

Social and Economic Factors Influencing Buruli Ulcer Health Seeking Decision Making in the Ga West and South Municipalities

“…Most socio-cultural and economic studies on BU reported on local perceptions (beliefs, knowledge and attitudes), and social and economic burdens of the disease to patients and their families (Ahorlu et al, 2013;Stienstra et al, 2002;Adamba & Owusu, 2011;Peeters et al, 2008;Renzaho et al, 2007;Debacker et al, 2004;Aujoulat et al, 2003;Bigelow et al, 2002;Asiedu & Atuaful, 1998). This paper on the other hand focused on identifying social and economic factors that are considered when the affected and infected are making health seeking decisions on where and when to seek for health.…”