Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (2011) 459–465 Contents lists available at ScienceDirect Transactions of the Royal Society of Tropical Medicine and Hygiene j ourna l ho me pag e: htt p://www.elsevier.com/locate/trstmh Factors enhancing the control of Buruli ulcer in the Bomfa communities, Ghana Pius Agbenorku a,* , Margaret Agbenorku b , Adela Amankwa c , Lawrence Tuuli d , Paul Saunderson e a Reconstructive Plastic Surgery and Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana b Health Education Unit, Global Evangelical Mission Hospital, Apromase-Ashanti, Ghana c Surgical Unit, Global Evangelical Mission Hospital, Apromase-Ashanti, Ghana d Department of Anaesthesia, Presbyterian Hospital, Agogo, Asante-Akim, Ghana e American Leprosy Missions, 1 ALM Way, Greenville SC 29601, USA a r t i c l e i n f o Article history: Received 21 April 2010 Received in revised form 5 May 2011 Accepted 5 May 2011 Available online 8 June 2011 Keywords: Buruli ulcer Control Antibiotics Biomedical approach Psychosocial approach a b s t r a c t This study examines factors that may enhance the control and holistic treatment of Buruli ulcer in an endemic area of the Ashanti Region in Ghana. A total of 189 Buruli ulcer patients from the Bomfa sub-district were treated at the Global Evangelical Mission Hospital, Apro- mase – Ashanti, Ghana, from January to December 2005. Diagnosis was based on clinical findings and confirmed by any two positives of Ziehl-Neelson test for acid fast bacilli, polymerase chain reaction and histopathology. Children up to age 14 made up 43.4% of the cases; male: female ratio was 3:2. The mean duration of hospitalization was 77 days and hospital stay was significantly correlated with the time spent at home with the dis- ease prior to admission; also, 76.7% of the cases were late ulcers. Of the 189 patients, 145 (i.e. 76.7%) were treated with antibiotics and surgery which involved excision, skin graft- ing with or without contracture release. A follow-up survey after the introduction of the psychosocial approach recorded fewer (85) new Buruli ulcer (BU) cases of which, the major- ity (78.8%, 67) were nodules and only 21.2% (18) were ulcers. Health education plays a major role in the holistic treatment of BU. This paper proposes a further study in other endemic areas on the treatment of BU with emphasis on psychosocial approach for holistic treatment. © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. 1. Introduction The third most common mycobacterial disease of non- immunocompromised humans, after tuberculosis (TB) and leprosy, is Buruli ulcer (BU). It is caused by Mycobacterium ulcerans and often leads to massive destruction of the skin followed by debilitating deformities. 1 The increasing number of cases in West Africa has raised serious health * Corresponding author. Tel.: +233 24 459 9448; fax: +233 32 202 2307. E-mail address: pimagben@yahoo.com (P. Agbenorku). concerns. 2 The first suspected case of BU in Ghana was reported at the Korle-Bu Teaching Hospital in Accra in 1971; 1 the disease is found predominantly in the Ashanti Region. The management of BU is difficult, treatment costs are high, and complications of the disease are frequently severe. Costs of treatment could pose a serious challenge to a struggling rural economy and its health system given the growing number of cases and current control strategies. 3 Buruli ulcer frequently occurs near water: slow flowing rivers, ponds, swamps and lakes; cases have also occurred following flooding. Activities that take place near water, such as farming, are risk factors, and wearing protective 0035-9203/$ – see front matter © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.trstmh.2011.05.003