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

Abstract

Background: Buruli ulcer infection is generally referred to as a re-emerging disease with the highest burden in West Africa. In Ghana, about 1000 cases are reported annually. The former Ga district (now the Ga West and Ga South municipalities) continues to report the highest proportion of the worst ulcerated wounds in Ghana, despite various interventions implemented. The aim of this study was to determine factors affecting treatment-related decision making in BU affected families. Methods: Semi-structured questionnaire interview was conducted with 33 patients (≥15 years) and seven caretakers of children aged below 15 years to determine the social and economic factors influencing BU-related health seeking decision making and types of treatment choices that are made. Results: Respondents were afflicted with varied categories of the disease (category one (30%), category two (35%) and category three (35%)). Decisions to seek health care from biomedical facilities are influenced by factors such as advice from health workers (45.0%) and advice from family members (42.5%). Only a quarter (25%) of respondents actually mentioned "financial considerations" as one of the factors that influence their decision to seek for biomedical care. Whereas there was no significant relationship between family involvement in treatment decision making and category one (p = 0.5351) lesion, there was a significant relationship between family involvement in treatment decision making and categories two (p = 0.0434) and three (p = 0.0089) lesions.Conclusion: It appears from this study that financial consideration, which has been widely cited as a cause of treatment delay may be losing its influence to social factors. With the advent of free antibiotics treatment more studies are needed to identify social factors affecting BU treatment decision making so as to redesign health promotion messages appropriately, especially those aimed at getting patients into early treatment.

Experiences of Buruli Ulcer Patients Following Discharge in the Greater Accra Region of Ghana

“…Findings of this study concurs with several other studies that discovered that stigmatization, embarrassment about amputation, permanent physical deformities, shame, and low self-esteem were some of the challenges faced by people with BU leading to psychological distress. 2,16,28 The recent study further discovered that individual with BU become anxious when the nodules caused by the ulcer fails to respond to treatment. Other factors that caused anxiety among individuals with BU in this study were the diagnosis of the ulcer, and the enlargement of the swell on the skin yet painless.…”

“…Findings of this study concurs with several other studies that discovered that stigmatization, embarrassment about amputation, permanent physical deformities, shame, and low self-esteem were some of the challenges faced by people with BU leading to psychological distress. 2,16,28…”

“…1,13,15 BU affects all age groups of which children between 5 and 15 years are mostly the vulnerable group, with the exception of few countries like Australia where it is the opposite. 13,16 BU is predominant in developing countries with the highest prevalence in West Africa. 7 For instance, in 2011, World Health Organization's statistics revealed that BU recorded cases 24 000 in Ivory Coast, 11 000 in Ghana, and 7000 in Benin.…”

Situated knowledge of pathogenic landscapes in Ghana: Understanding the emergence of Buruli ulcer through qualitative analysis

“…Few recent qualitative studies on BU in West Africa focus on local people's understandings of changing landscapes, in contrast to health services for BU control and intervention, decision making, availability and effectiveness of treatment, wound care, and the socio-economic burden on BU-affected households (e.g. Ackumey et al 2011;Ahorlu et al 2013). One noteworthy exception is a grounded ethnohistory of pathogenic landscapes in Cameroon by Giles-Vernick et al (2014).…”

‘I could not be idle any longer’: buruli ulcer treatment assemblages in rural Ghana

“…Chauty et al, 2007;MOH, 2005;Owusu-Sekyere et al, 2013;Stienstra et al, 2002). Ahorlu et al (2013), for example, suggest the role of traditional healers will diminish as family members encourage sick individuals to seek free western biomedical treatment. And Owusu- Sekyere et al (2013: 21) argue Buruli ulcer is less common among educated populations, because "educated people are more likely to practice good hygiene and adhere to the principles and tenets of educational campaigns.…”