Buruli Ulcer Case Severity at Diagnosis in Benin and Cameroon: An Analysis of World Health Organization Surveillance Data, 2013 Open Access

Smith, Shona (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/zs25x8895?locale=en


Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans infection. Annually, approximately 6,000 new cases are reported from more than 30 countries. To reduce BU burden, routine surveillance data can be analyzed to describe the epidemiologic situation and associations between demographic variables and severity of BU cases at diagnosis. Data were reported from the Benin and Cameroon national BU control programs and provided by the World Health Organization. Descriptive statistics were calculated by frequency analysis to assess the epidemiologic situation. Polytomous logistic and logistic regression analyses were used to assess associations between age, sex, and region of origin and clinical form, case Category, and localization of lesions. In 2013, Benin reported 378 new cases, and Cameroon reported 123. The overall distribution by sex was nearly balanced in each country. The median ages in Benin and Cameroon were 15 and 22 years, respectively. In Benin, we found a significant association between sex and clinical form at diagnosis. Males were more likely to present an ulcer while females were more likely to present a nodule, plaque, or edema. We also found a significant association in Benin between age and Category and lesion localization with cases 15+ years old more likely to be classified as Category III and have a lesion on a site other than lower limbs. We found several associations between region of origin in Benin and case severity; most regions were not significantly associated with any of the outcomes. In Cameroon, we found no significant associations between age, sex, or region and clinical form, case Category or lesion location. In some BU endemic areas, sex, age, and region are associated with one or more clinical disease severity outcomes. Our results indicate that national BU surveillance systems capture data that can be evaluated alongside data from other countries to describe the current disease burden, measure temporal changes, evaluate activities, and plan interventions. Until the exact mode of transmission is known, effective prevention methods are widely implemented, and treatment costs are reduced, the best strategies for reducing BU morbidity are early detection, consistent case reporting, and prompt treatment.

Table of Contents

CHAPTER 1. Literature Review 1

Transmission 1

Risk Factors 2

Clinical Features 4

Functional Limitations 6

Diagnosis 7

Treatment 8

Cost 10

Community-level Perception 11

Prevention 12

Limitations of Surveillance 12

CHAPTER 2. Manuscript 14

Introduction 14

Methods 16

Results 22

Discussion 28

References 36

Tables 44

Figures 47


Summary 51

Public Health Implications 52

Possible Future Directions 53

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
Subfield / Discipline
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files