National Buruli ulcer control programme since 2002 been challenged to;
  • Create awareness of the disease both within the medical circle and the general public.

Over the years the endemic districts have increased from 6 districts to over 30 districts in six regions of the country. In Ghana, the disease is mainly found in swampy areas, mining areas and around some major rivers in the country [Ofin, Densu, Tano].

Diagnoses have been mainly by clinical findings carried out by experienced health workers in endemic areas.
However, with new developments taking place, it is possible to use laboratory to confirm the disease. [Z-N, PCR]. Z-N can be done at the peripheral levels and PCR specialized facilities or at the tertiary levels of service. There is a conscious effort to further develop simpler and more effective tools for diagnosis and treatment.

Treatment of choice is mainly surgery. This included extensive excision of lesions and application of Split skin graft. Indications are that, recurrences before the antibiotic treatment was around 16-30%. Recent findings have proved that specific antibiotics can play a major role in the treatment of the disease.

The development of antibiotics has demonstrated a major breakthrough in the management of the disease and today we are just recording almost 2% of recurrences. This is welcoming news for health service providers, the patients and the communities in the endemic areas.

With the global Buruli ulcer initiatives many strides continue to bestow on the control of the disease. 
Case distribution expands to most forest areas of the country and averagely the national program records over 1000 cases of new Buruli ulcer annually.

Challenges
  • In the long term, the national program seeks to demystify the myth surrounding the disease.
  • The disease is not caused by witchcrafts as communities presume. Incidentally, not all the cases are reported because a sizable number pass through the community herbal practitioners without being captured for documentations.
  • Providing community health services, using Buruli ulcer DOTS approach.

It is our expectation that one day the injection could be avoided to give room for oral medication only. Injections impose a large burden to the patients living in extremely remote areas in the endemic districts and if we can develop a fully or almost fully oral treatment this would considerably help.

Future
  • Our slogan therefore has been early diagnosis and treatment - as important ingredient to preventing disabilities.
  • Government has put in place measures to ensure that victims of the disease are offered free medical services up front. This has increased the number of cases reported. This is a good sign for the program. The next is to ensure improved case management.
  • Patients who are not treated early can suffer from long term functional disabilities such as restriction of joint movement as well as cosmetic problem.
  • This is the time all of us; the stakeholders and the communities put their hands together to bring the disease to a level of not public health importance.
  • The time has come to demystify the disease. Buruli ulcer can be treated! Seek early treatment. Buruli ulcer is not a curse!

Dr. Edwin Ampadu
Program Director GBUP