Perceived water-related risk factors of Buruli ulcer in two villages of south-central Côte d’Ivoire

Abstract

Background Buruli ulcer, caused by Mycobacterium ulcerans, is a neglected tropical skin disease that is primarily endemic in West and Central Africa, including Côte d’Ivoire. Studies indicate that M. ulcerans infections are caused by contact with an environmental reservoir of the bacteria, governed by specific human biological conditions. Yet, the nature of this reservoir and the exact mode of transmission remain unknown. Methodology To identify ecologic risk factors of Buruli ulcer in south-central Côte d’Ivoire, we pursued a qualitative study matched with geo-referencing inquiry. Embedded in a broader integrated wound management research project, we (i) mapped households and water sources of laboratory confirmed Buruli ulcer cases and (ii) interviewed 12 patients and four health care workers to assess exposure to surface water and to deepen the understanding of perceived transmission pathways. Principal findings Water availability, accessibility, and affordability were reported as key determinants for choosing water resources. Furthermore, perceived risks were related to environmental, structural, and individual factors. Despite the presence of improved water sources (e.g., drilled wells), communities heavily relied on unprotected surface water for a multitude of activities. The nearby Bandama River and seasonal waterbodies were frequently used for washing, bathing, and collection of water for drinking and cooking. Many residents also reported to cross the river on a daily basis for agricultural chores, and hence, are exposed to stagnant water during farming activities. Conclusions/significance Our study in two Buruli ulcer endemic villages in south-central Côte d’Ivoire revealed a wide range of water-related domestic activities that might expose people to an increased risk of contracting the disease. Environmental, biological, social, and cultural risk factors are closely interlinked and should be considered in future investigations of Buruli ulcer transmission. Active participation of the communities is key to better understand their circumstances to advance research and fight against Buruli ulcer and other neglected tropical diseases.

Buruli ulcer in Africa: Geographical distribution, ecology, risk factors, diagnosis, and indigenous plant treatment options – A comprehensive review

“…The most important ecological predisposing factor to BU is contact with stagnated water, e.g., ponds, dams, swamps, and lakes. Surveys across endemic communities in different African countries like Ghana, Côte d‘Ivoire, Nigeria, and Benin, confirmed the presence of wetland or water bodies in the vicinity of patients suffering from BU ( Table 1 ; [ 7 , [67] , [69] , [70] , 72 ]. People who swim, bathe, and drink water from slow-flowing sources are at risk to get infected with BU as these bodies can be contaminated with M. ulcerans .…”

“…People with higher income levels can afford clean drinking water and often practice better personal hygiene. People who engage in agricultural activities are more predisposed to BU because of frequent insect bites and contact with contaminated water and soil [ 7 ]. Yet, [ 111 ] found no association between the risk to develop BU and the socioeconomic status and occupational hygiene in parts of the Ashanti Region of Ghana.…”

“…The World Health Organization (WHO) considers BU as one of the neglected tropical diseases (NTDs) that affect the skin [ 6 ]. Children account for more than 50 % of all cases, and populations at greatest risk are those with no access to improved sanitation and clean water [ 7 ]. Preulcerative lesions, such as nodules, plaques, or oedematous infiltrates, are the typical symptoms of BU [ 5 , 8 , 9 ].…”