Socio-cultural determinants of timely and delayed treatment of Buruli ulcer: implications for disease control

Abstract

IntroductionPublic health programmes recommend timely medical treatment for Buruli ulcer (BU) infection to prevent pre-ulcer conditions from progressing to ulcers, to minimise surgery, disabilities and the socio-economic impact of BU. Clarifying the role of socio-cultural determinants of timely medical treatment may assist in guiding public health programmes to improve treatment outcomes. This study clarified the role of socio-cultural determinants and health system factors affecting timely medical treatment for BU in an endemic area in Ghana.MethodsA semi-structured explanatory model interview based on the explanatory model interview catalogue (EMIC) was administered to 178 BU-affected persons. Based on research evidence, respondents were classified as timely treatment (use of medical treatment 3 months from awareness of disease) and delayed treatment (medical treatment 3 months after onset of disease and failure to use medical treatment). The outcome variable, timely treatment was analysed with cultural epidemiological variables for categories of distress, perceived causes of BU, outside-help and reasons for medical treatment in logistic regression models. The median time for the onset of symptoms to treatment was computed in days. Qualitative phenomenological analysis of respondents’ narratives clarified the meaning, context and dynamic features of the relationship of explanatory variables with timely medical treatment.ResultsThe median time for initiating treatment was 25 days for pre-ulcers, and 204 days for ulcers. Income loss and use of herbalists showed significantly negative associations with timely treatment. Respondents’ use of herbalists was often motivated by the desire for quick recovery in order to continue with work and because herbalists were relatives and easily accessible. However, drinking unclean water was significantly associated with timely treatment and access to health services encouraged timely treatment (OR 8.5, p = 0.012). Findings show that health system factors of access are responsible for non-compliance to treatment regimes.ConclusionsFindings highlight the importance of an integrated approach to BU control and management considering the social and economic features that influence delayed treatment and factors that encourage timely medical treatment. This approach should consider periodic screening for early case-detection, collaboration with private practitioners and traditional healers, use of mobile services to improve access, adherence and treatment outcomes.

Outcome of Streptomycin-Rifampicin treatment of Buruli Ulcer in two Ghanaian districts

“…Hence affected people tend to look for spiritual help as a primary step. The observation of sociocultural belief influencing the timely reporting of BU patients to health facilities[15, 16] was also observed in our study. The findings also emphasize the need for education on the importance of early reporting to the formal sector to seek help.…”

Itineraires Therapeutiques Pluriels Et Recours Tardif Des Malades De L’ulcere De Buruli Dans Les Centres De Prise En Charge Dans Le District Sanitaire De Yamoussoukro (Côte d’Ivoire)

“…Ainsi, les malades expriment un sentiment de tristesse et de préoccupation. Il s'agit d'une préoccupation qui survient quand la maladie est perçue comme grave, quand ils se questionnent sur l'évolution qu'elle aura et quand ils se retrouvent face à une situation complexe qu'ils ne comprennent pas et qui finit par les dépiter (Ackumey et al, 2012).…”

Economic inequality caused by feedbacks between poverty and the dynamics of a rare tropical disease: the case of Buruli ulcer in sub-Saharan Africa

“…The benefits of awareness, education campaigns and active search of BU cases have been previously reported [24,25], but research on BU treatment and management lags way behind most of the other NTDs [38]. Many of the financial and geographical barriers associated with late presentation of cases [35,47] could be overcome with a change to a decentralized all-oral antibiotherapy, given in an outpatient basis [48]. In addition, implementation of simplified wounds dressing and rehabilitation programmes, among others, could greatly improve case management [38].…”