Factors Associated to Diagnosis Delay of Patients with Buruli Ulcer in Akonolinga District Hospital-Cameroon
Abstract
Introduction: Buruli Ulcer (BU) is the most common human mycobacterial disease worldwide after tuberculosis and leprosy. The early detection and immediate recourse to the treatment centre are decisive for the progression of the disease. Despite international and national efforts for early management, there are still BU patients with disabling lesions. It is within this context that our study aims to describe the factors associated with the diagnosis delay of BU patients in Akonolinga District Hospital (ADH).
Materials and methods: The cross-sectional, retrospective, mixed descriptive study was carried out from 2015-2019 among 291 BU cases and 6 informants admitted to ADH. Quantitative data from a survey sheet were analyzed using CSPRO 7.1, SPSS 21, SPAD, and STATA 13 software while content analysis of qualitative data collected using an interview guide was investigated manually.
Results: 63.6% of patients arrived late at the centre for diagnosis and the average age was 21 years. Associated factors were female sex (68.4%), the first resort to traditional practitioners (88.6%), ulcerated forms (80.8%), and disability (91.7%). Female patients were 3.64 (95% CI. 1.15-11.53; P-value = 0.028) times more likely to have a delayed diagnosis compared to their male counterparts. Patients that resort to traditional practitioners usually experience psychological problems as they suffer from a negative self-image and self-conscience of themselves when faced with social rejection, stigma, and a downfall period from a healthy status to a BU status.
Conclusion: Emphasis should be placed on raising awareness among household heads as well as strengthening collaboration with traditional practitioners to further reduce the stigma around the disease and delays in diagnosis.
References
Merritt., Walker., Small., Wallace., & Johnson. (2010). Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review. PLoS Neglected Tropical Diseases, 4(12):911. doi: https://doi.org/10.1371/journal.pntd.0000911
World Health Organization “WHO”. (2004). Buruli ulcer disease. Weekly Epidemiological Record, 79(20), 194–199. [PubMed] [Google Scholar]
World Health Organization “WHO”. (2017). WHO meeting on Buruli Ulcer and other neglected tropical skin diseases. Geneva, Switzerland: World Health Organization.
Janssens, P., Pattyn S, Meyers W., & Portaels F. (2005). Buruli ulcer: an historical overview with updating to 2005. Bulletin des Séances. Académie Royale des Sciences d'Outre-Mer, 51(3), 265-299. http://dspace.itg.be/handle/10390/1794
Johnson, P., Stinear, T., Small, P., Pluschke, G., & Merritt, R. (2005). Buruli Ulcer (M. ulcerans Infection): new insights, New Hope for Disease Control. PLOS Medicine, 2(5), 173. https://doi.org/10.1371/journal.pmed.0020108
Nienhuis, W., Stienstra, Y., Thompson, W., Awuah, P., & Abass, K. (2010). Antimicrobial treatment for early, limited Mycobacterium ulcerans infection: a randomised controlled trial. Lancet, 375(9715), 72-664. Doi: https://doi.org/10.1016/s0140-6736(09)61962-0
World Health Organization “WHO”. (2014). Buruli ulcer epidemiological situation. World Health Organisation. http://apps.who.int/neglected_diseases/ntddata/buruli/buruli.html
World Health Organization “WHO”. (2000). Buruli Ulcer-Mycobacterium ulcerans infection. [Google Scholar].https://apps.who.int/iris/handle/10665/66164
World Health Organization “WHO”. (2004). Provisional guidance on the role of specific antibiotics in the management of Mycobacterium ulcerans disease (Buruli ulcer). https://apps.who.int/iris/handle/10665/68839
Kibadi. (2004). Knowledge - Attitudes - Practices (KAP) survey of the Songololo population (DR Congo) on Buruli Ulcer. Le Bulletin de la Société de Pathologie Exotique, 97(4).
Um, B., Eyango S, Wyss K., & Nsom Mba, C. (2004). National preliminary survey on the situation of Buruli Ulcer in Cameroon. Swiss Tropical Institute, 1-34.
World Health Organisation “WHO”. (2007). Everybody's Business: Strengthening Health Systems to Improve Health Outcomes: WHO's framework for action. [Google Scholar]. https://apps.who.int/iris/handle/10665/43918
Capela, C., Sopoh, E. G., Houezo G. J., Fiodessihoué, R., Dossou, D. A., Patrício, C., &Jorge., P. (2015). Clinical Epidemiology of Buruli Ulcer from Benin (2005-2013): Effect of Time-Delay to Diagnosis on Clinical Forms and Severe Phenotypes. PLOS Neglected Tropical Diseases,1-17. doi:https://doi.org/10.1371/journal.pntd.0004005
Coutts, S. P., Colleen, L. L., Emma, J. F., Michael, J. Loftus, & Ee Laine, T. (2019). Delays in Patient Presentation and Diagnosis for Buruli Ulcer (Mycobacterium ulcerans Infection) in Victoria, Australia, 2011–2017. Tropical Medicine and Infectious Disease, 2-10. doi: https://doi.org/10.3390/tropicalmed4030100
Agbenorku, P., Agbenorku, M., Amankwa, A., Tuuli, L., & Saunderson, P. (2011). Factors enhancing the control of Buruli ulcer in the Bomfa communities, Ghana. The Royal Society of Tropical Medicine and Hygiene, 105(8), 459–465. https://doi.org/10.1016/j.trstmh.2011.05.003
Agbenorku, P., Donwi, I., Kuadzi, P., & Saunderson, P. (2012). Buruli Ulcer: Treatment Challenges at Three Centres in Ghana. Journal of Tropical Medicine, 1-7. doi: https://doi.org/10.1155/2012/371915
Quentin, V., Landier, J., Fontanet, A., & Texier, G. (2014). Defining and targeting high-risk populations in Buruli ulcer. The Lancet Global HealthIn their article, 2(11), 629. https://doi.org/10.1016/S2214-109X(14)70311-0
Georgia, W., Friedman, D., O'Brien, M., Cooper, C., McDonald, A., Callan, P., & O'Brien, P. (2019). Paediatric Buruli ulcer in Australia. Journal of Paediatrics and Child Health. doi: https://doi.org/10.1111/jpc.14704
Ukwaja, K., Meka, A., Chukwuka, A., Asiedu, K., Huber, K., Eddyani, M., &Ntana, K. (2016). Buruli ulcer in Nigeria: results of a pilot case study in three rural districts. Infectious Diseases of Poverty, 5(39). http://dx.doi.org/10.1186/s40249-016-0119-8
Dégboé, B., Koudoukpo, C., Mouhaéminath, A., Sopoh, G., Akpadjan, F., Johnson, R., & Atadokpèdé, F. (2019). Buruli Ulcer: Epidemiological,Clinical and Biological Profile of Patients in the Centre de Depistage et de Traitement d’Allada (Benin) from 2010 to 2014. Journal of Cosmetics, Dermatological Sciences and Applications, 9(2), 67-82. doi: http://dx.doi.org/10.4236/jcdsa.2019.92006
Yeboah-Manu, D., Aboagye, Y., Asare, P., Asante-Poku, A., Ampah, K., Danso, E., & Ampadu, E. (2018). Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016. Plos Neglected Tropical Diseases. https://doi.org/10.1371/journal.pntd.0006560
Meka, A. O., Chukwu, J. N., Nwafor, C. C., Oshi, D. C., Madichie, N. O., Ekeke, N., &Ukwaja, K. N. (2016). Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria. The Royal Society of Tropical Medicine and Hygiene, 502-509. doi: https://doi.org/10.1093/trstmh/trw065
Mondjo, A. (2019). Epidemiological surveillance of Buruli Ulcer in Gabon in 2015 and 2016. Geneva, Switzerland: WHO meeting on Buruli Ulcer and other neglected tropical skin diseases.
WHO. (2016). Buruli ulcer disease factsheet . Geneva: World Health Organization.
Ahorlu, K., Koka, E., Yeboah-Manu, D., Lamptey, I., & Ampadu, E. (2013). Enhancing Buruli ulcer control in Ghana through social interventions: a case study from the Obom sub-district. BMC Public Health (59). Doi: https://doi.org/10.1186/1471-2458-13-59
Simonet, V. (2008). Prevention of disability in Buruli ulcer: basic rehabilitation. Practical field guide. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/70147
Smith-Lovin. (1995). The sociology of affect and emotion. Sociological perspectives on social psychology, 118-148. https://scholars.duke.edu/display/pub1019416
Nzilanye, I., Yeboah-Manu, D., Nortey, P., Nyarko, K., Anim, J., Antara, N., & Afari, A. (2016, October 1). Outcome of Streptomycin-Rifampicin treatment of Buruli Ulcer in two Ghanaian districts. Pan African Medical Journal, 25(1), 1-13. doi: https://doi.org/10.11604/pamj.supp.2016.25.1.6203
Boum, Y. (2019). Cooperation between traditional medicine and biomedicine to improve the care of Buruli Ulcer patients. Geneva, Switzerland: WHO meeting on Buruli Ulcer and other neglected tropical skin diseases.
Nsoga, M. T., Nko’o, M., Ndjalla, A., Wanda, F., Kohlbrenner, B., Assane, D., & Vuagnat, H. (2019). Chronic wounds, Buruli ulcer and traditional practitioners: design of a study to better understand the realities of the field in the health district of Akonolinga, Centre region Cameroon. Geneva, Switzerland: WHO meeting on Buruli Ulcer and other neglected tropical skin diseases.
Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York: Scribner.