Implementing active community-based surveillance-response system for Buruli ulcer early case detection and management in Ghana

Abstract

BackgroundBuruli Ulcer (BU) is one of the most neglected debilitating tropical diseases caused by Mycobacterium ulcerans, which causes considerable morbidity and disability. Building on earlier findings that community-based interventions could enhance case detection and reduce treatment dropout and defaulter rates, we established an active surveillance-response system in an endemic sub-district in the Ga West municipality of Ghana to enhance early case detection, diagnosis and treatment to reduce or eliminate severe ulcers and its related disabilities.MethodsWe established surveillance response system, implemented in collaboration with the sub-district disease control officers, selected clinical staff and trained community-based volunteers. The active community-based surveillance- response system was implemented for 12 months. Also, pre and post intervention surveys were conducted to document any change in perceptions on BU in the study population over the period. The baseline and endline surveys were conducted in August 2016 and August 2017 respectively.ResultsOn average, each person was seen 11 times in 12 months. In all 75 skin lesions were detected during surveillance rounds, out of which 17 were suspected to be BU and 12 out of the 17 were confirmed as BU using Polymerase chain reaction (PCR). Out of the 12, five, three and four were categories I, II and III lesions respectively. Physical examination was done on 94% of the people seen during the surveillance rounds. Knowledge on BU has also increased in the communities at the end of the study.ConclusionThe findings from this study have demonstrated that it is possible to establish surveillance-response system for BU and by extension, other neglected tropical diseases to enhance control and elimination efforts through the use of community-based volunteers.

Community-based surveillance of infectious diseases: a systematic review of drivers of success

“…The CBS workers were described as those responsible for active case detection. Additionally, CBS workers were often responsible for a number of additional tasks including: reporting, referral, follow-up, case management, health promotion, physical examinations (eg, for buruli ulcer 33 ), and testing (eg, taking blood slides for malaria parasites 26 ).…”

Quantifying Population Burden and Effectiveness of Decentralized Surveillance Strategies for Skin-Presenting Neglected Tropical Diseases, Liberia

“…The use of CHWs for disease-specific surveillance is common in West Africa, particularly for Buruli ulcer, for which increased case numbers or earlier stages of detection have been reported in quasiexperimental studies ( 13 , 29 , 30 ). Our findings illustrate the feasibility of training a rural community-based workforce with limited smartphone experience to screen for multiple diseases, reliably capture electronic data, and achieve high and equitable population coverage.…”

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

“…An important observation from several studies in West African countries is that education, both general and Buruli ulcer specific, is associated with a lower incidence of Buruli ulcer [ 118 , 119 ]. Improving access to education and educational facilities in endemic regions may be a significant and effective intervention in reducing case numbers [ 125 , 126 ]. More specifically, targeted educational programmes about Buruli ulcer and the causes and risks should be implemented to increase awareness of this disease and improve daily decision-making to help individuals protect themselves from contracting Buruli ulcer.…”