LOCAL PERCEPTIONS OF BURULI ULCER IN THE GA DISTRICT, GREATER ACCRA REGION

ABSTRACT

The Buruli ulcer disease is assuming public health importance in many countries

apart from Ghana, prompting the establishment of a Global Buruli Ulcer Initiative

by the World Health Organization (WHO) in early 1998. The disease caused by

Mycobacterium ulcerans infection has been reported throughout the tropical and

sub-tropical regions of the world. In Africa, several countries particularly in

western, eastern and central parts of the continent have reported cases of the

disease. One characteristic of the disease is its apparent association with bodies

of water worldwide. To date the exact mode of transmission is unknown and

there is no scientific evidence to suggest person- to- person transmission. This

study sought to study the local perceptions of buruli ulcer, etiology of the disease

from the community's point of view, treatment seeking behaviour of the people

and community reaction towards patients. The study employed both qualitative

and quantitative data collection techniques employing a structured questionnaire

a Focus Group Discussion Guide (FGD) and documented case studies.

Statistical analysis was done employing SPSS.

The study found out that endemic communities are situated along the river

Densu and depend on unwholesome sources of water such as ponds, shallow

hand dug wells and the river Densu for all domestic purposes. Mycobacterium

ulcerans, the main causative agent is spongy-like in nature. This spongy-like

substance has also been identified by the people as the main causative agent

and forms the basis for the various names given to it by the local people. Hence,

in Ga the name is "odontihela" and"detsifudor", in Ewe.

Causes of buruli ulcer are attributed to three main factors: casting of a spell

through witchcraft, poor personal hygiene/wading in ponds dirty surroundings

and drinking water from the river/pond. There is the perceived possibility of

contagion or person-to-person transmission through the ingestion of pus from the

iv

infected wound which could get lodged under finger nails or on any part of the

hand. Children (69.4 %) both male and female are known to be the most affected

by the disease. Most buruli ulcer patients seek treatment from the herbalist

(46%) as compared to the hospital (38%). To understand the etiology of buruli

ulcer fully, consideration must be given to the interplay of political, economic,

social, epidemiological and cultural factors. There is the need for further

epidemiological research on the role played by animals in disease transmission

and also the possibility of person-to-person transmission by ingestion of infected

pus.