ORIGINAL ARTICLE Trans R Soc Trop Med Hyg 2016; 110: 502–509 doi:10.1093/trstmh/trw065 Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria Anthony O. Meka a , Joseph N. Chukwu a , Charles C. Nwafor a , Daniel C. Oshi a,1 , Nelson O. Madichie a , Ngozi Ekeke a , Moses C. Anyim a , Chukwuka Alphonsus a , Obinna Mbah a , Glory C. Uzoukwa a , Martin Njoku b , Kentigern Ntana b and Kingsley N. Ukwaja c, * a Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria; b St Benedict’s Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria; c Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria 1 Department of Community Health and Psychiatry, University of West Indies (UWI), Mona, Kingston 7, Jamaica *Corresponding author: Tel: +234 803 624 3196; E-mail: ukwajakingsley@yahoo.co.uk Received 29 August 2016; revised 3 October 2016; accepted 4 October 2016 Background: Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong dur- ation of management, and impose avoidable additional costs on patients and health providers. We investi- gated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria. Methods: This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients’ clinical profile, delays in diagnosis and duration of hospitalisa- tion were prospectively collected. Results: Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospi- talisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; mul- tiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003). Conclusions: Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria. Keywords: Care-seeking, Delays, Diagnosis, Mycobacterium ulcerans, Nigeria, Treatment Introduction Mycobacterium ulcerans is the third most common mycobac- teria infection globally after TB and leprosy. 1 The Uganda Buruli Group coined the name ‘Buruli ulcer’ (BU) for the disease because early cases were first detected in Buruli county, near lake Kyoga. 2 Worldwide, BU has been reported in 33 countries in Africa, the Americas, Asia and the Western Pacific. 1 With the exception of Australia, China and Japan, the majority of notified cases occur in tropical and subtropical settings. 1–4 In addition, a key feature of BU is its focal distributions even in highly endemic regions. Thus, estimating accurate population-based disease burden is challenging. 1 However, in highly endemic communities in West Africa, point prevalence has been estimated to range between 22/100 000 to 150.8/100 000 population. 5–9 The mode of transmission of M. ulcerans infection remains unclear. Substantial data points to the disease being acquired from an environmental source, possibly from exposure to contaminated soil or vegetation or by aerosol inhalation. 4 Recent evidence has implicated arthropods and aquatic organisms in disease trans- mission in endemic regions. 4 Although situated between two countries (Benin and Cameroon) with regions of high BU endemicity, only very few cases of BU have been reported from Nigeria over the last four decades. 10,11 Most of these reports had limitations, such as the use of a purely descriptive approach (i.e., no measurement of © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 502 Downloaded from https://academic.oup.com/trstmh/article/110/9/502/2290847 by guest on 02 September 2022