Socio-Environmental Factors Associated with the Risk of Contracting Buruli Ulcer in Tiassalé, South Côte d’Ivoire: A Case-Control Study

Abstract

BackgroundBuruli ulcer (BU) is a cutaneous infectious disease caused by Mycobacterium ulcerans. The exact mode of transmission remains elusive; yet, some studies identified environmental, socio-sanitary, and behavioral risk factors. The purpose of this study was to assess the association of such factors to contracting BU in Tiassalé, south Côte d’Ivoire.MethodologyA case-control study was conducted in 2012. Cases were BU patients diagnosed according to clinical definition put forth by the World Health Organization, readily confirmed by IS2404 polymerase chain reaction (PCR) analysis prior to our study and recruited at one of the health centers of the district. Two controls were matched for each control, by age group (to the nearest 5 years), sex, and living community. Participants were interviewed after providing oral witnessed consent, assessing behavioral, environmental, and socio-sanitary factors.Principal FindingsA total of 51 incident and prevalent cases and 102 controls were enrolled. Sex ratio (male:female) was 0.9. Median age was 25 years (range: 5–70 years). Regular contact with unprotected surface water (adjusted odds ratio (aOR) = 6.5; 95% confidence interval (CI) = 2.1–19.7) and absence of protective equipment during agricultural activities (aOR = 18.5, 95% CI = 5.2–66.7) were identified as the main factors associated with the risk of contracting BU. Etiologic fractions among exposed to both factors were 84.9% and 94.6%, respectively. Good knowledge about the risks that may result in BU (aOR = 0.3, 95% CI = 0.1–0.8) and perception about the disease causes (aOR = 0.1, 95% CI = 0.02–0.3) showed protection against BU with a respective preventive fraction of 70% and 90%.Conclusions/SignificanceMain risk factors identified in this study were the contact with unprotected water bodies through daily activities and the absence of protective equipment during agricultural activities. An effective strategy to reduce the incidence of BU should involve compliance with protective equipment during agricultural activities and avoidance of contact with surface water and community capacity building through training and sensitization.

Buruli Ulcer: Epidemiological, Clinical and Biological Profile of Patients in the Centre de Depistage et de Traitement d’Allada (Benin) from 2010 to 2014

“…A slight female predominance was reported in our study with a sex-ratio of In our study population 53.3% of patients were uneducated. Our result is consistent with those found in an endemic area in southern Ivory-Coast and in a population of gold miners in Ghana, which is 56.9% and 52% of uneducated patients [19] [35]. A lack of education does not appear to be a direct risk factor for BU according to a meta-analysis of studies conducted in 14 endemic regions [1].…”

“…More than three-quarters of patients used herbal to treat their lesions before the consultation. The same observation has been made in most endemic countries of the sub-region where patients between 41% and 90% use herbal as a first-line treatment [19] [28] [35] [36]. This practice undeniably extends the consultation period, which has the consequences listed above.…”

Buruli Ulcer, a Prototype for Ecosystem-Related Infection, Caused by Mycobacterium ulcerans

“…Since only half of these countries regularly report data to the WHO, the full extent of the problem is unknown. Nevertheless, Buruli ulcer is regarded as the third-most-common mycobacterial infection in immunocompetent patients (15,22) and is the second-most-common mycobacterial disease after tuberculosis in some countries with low endemicity for leprosy (23,24). Buruli ulcer is one of the 17 tropical diseases classified as neglected diseases by the WHO, which recognized Buruli ulcer as an emerging public health problem in 1998 at the Yamoussoukro Conference (25).…”

Individual and clinical variables associated with the risk of Buruli ulcer acquisition: A systematic review and meta-analysis

“…Ten case-control studies determined BCG-vaccination status, mostly through BCG scar, although one did report the vaccine strains under use at the time of evaluation [28] (S5 Table). Results among authors were highly heterogeneous (Tau 2 = 0.48; Chi 2 = 126.03; p < 0.00001; I 2 = 93%), with four studies showing a protective [18,29,37,42] (total n participants = 1953), five a neutral [16,30,31,35,38] (total n participants = 2338), and one a detrimental [10] (total n participants = 2742) role for the vaccine (S5 Fig). Thus, focus was placed exclusively on results…”