Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review
BACKGROUND Buruli ulcer (BU) disease is a chronic debilitating skin disease caused by Mycobacteriumulcerans. It is associated with areas where the water is slow-flowing or stagnant. Policy makers take the necessary strategic and policy decisions especially where to target interventions based on available evidence including spatial distribution of the disease. Unfortunately, there is limited information on the spatial distribution of BU in Ghana. The aim of the study was to use Geographical Information System (GIS) technology to show the spatial distribution and hot spots of BU in Greater Accra and Eastern Regions in Ghana. The information could then be used by decision makers to make the necessary strategic and policy decisions, especially where to target intervention. METHODS We conducted a community case search and spatial mapping in two districts in Eastern region (Akuapem South and Suhum- Kraboa-Coaltar) and two districts in Greater Accra region (Ga West and Ga South Municipalities) of Ghana to identify the spatial distribution of BU cases in the communities along the Densu River. These municipalities are already known to the Ministry of Health as having high case load of BU. Structured questionnaires on demographic characteristics, environmental factors and general practices were administered to the cases.Using the E-trex Garmin Geographical Positioning System (GPS), the location of the case patient was marked along with any important attributes of the community. ArcGIS was used to generate maps showing BU distribution and hot spots. RESULTS Two hundred and fifty-seven (257) probable BU patients were enrolled in the study after the case search. These cases and their houses (or homes) were located with the GPS. The GIS maps generated showed a varying distribution of BU in the various communities. We observed clustering of BU patients downstream of the Densu River which had hitherto not been observed. CONCLUSIONS There is clustering of BU in areas where the river was most contaminated. The identified hot spots for BU should be targeted for interventions by policy makers to ensure effective control of BU in Ghana.