title: Adequate wound care and use of bed nets as protective factors against Buruli Ulcer: results from a case control study in Cameroon.
abstract: BACKGROUND
  Buruli ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans. Its exact transmission mechanism remains unknown. Several arguments indicate a possible role for insects in its transmission. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon.
  
  
  RESULTS
  We conducted a case-control study on 77 Buruli ulcer cases and 153 age-, gender- and village-matched controls. Participants were interviewed about their activities and habits. Multivariate conditional logistic regression analysis identified systematic use of a bed net (Odds-Ratio (OR) = 0.4, 95% Confidence Interval [95%CI] = [0.2-0.9], p-value (p) = 0.04), cleansing wounds with soap (OR [95%CI] = 0.1 [0.03-0.3], p<0.0001) and growing cassava (OR [95%CI] = 0.3 [0.2-0.7], p = 0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI] = 6.9 [1.4-35], p = 0.02) and reporting scratch lesions after insect bites (OR [95%CI] = 2.7 [1.4-5.4], p = 0.004). The proportion of cases that could be prevented by systematic bed net use was 32%, and by adequate wound care was 34%.
  
  
  CONCLUSIONS
  Our study confirms that two previously identified factors, adequate wound care and bed net use, significantly decreased the risk of Buruli ulcer. These associations withstand generalization to different geographic, climatic and epidemiologic settings. Involvement of insects in the household environment, and the relationship between wound hygiene and M. ulcerans infection should now be investigated.
authors.affiliation: Service de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroon.
authors.forename: Jordi
authors.initials: J
authors.lastname: Landier
authors.forename: Pascal
authors.initials: P
authors.lastname: Boisier
authors.forename: Félix
authors.initials: F
authors.lastname: Fotso Piam
authors.forename: Blanbin
authors.initials: B
authors.lastname: Noumen-Djeunga
authors.forename: Joseph
authors.initials: J
authors.lastname: Simé
authors.forename: Fidèle Gaetan
authors.initials: FG
authors.lastname: Wantong
authors.forename: Laurent
authors.initials: L
authors.lastname: Marsollier
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Sara
authors.initials: S
authors.lastname: Eyangoh
mesh_terms: D000293:Adolescent; D000328:Adult; D054312:Buruli Ulcer / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D002163:Cameroon / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004203:Disinfection / Q000379:methods*; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008297:Male; D057147:Mosquito Nets / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
references.citation: PLoS Med. 2007 Feb;4(2):e64
references.pmid: 17326707
references.citation: PLoS Negl Trop Dis. 2010 Dec 14;4(12):e911
references.pmid: 21179505
references.citation: Am J Trop Med Hyg. 1995 Mar;52(3):219-24
references.pmid: 7694962
references.citation: Cell Microbiol. 2005 Jul;7(7):935-43
references.pmid: 15953026
references.citation: Am J Epidemiol. 1985 Nov;122(5):904-14
references.pmid: 4050778
references.citation: PLoS Negl Trop Dis. 2007 Dec 19;1(3):e101
references.pmid: 18160977
references.citation: Emerg Infect Dis. 2007 Nov;13(11):1661-6
references.pmid: 18217548
references.citation: Emerg Infect Dis. 2007 Nov;13(11):1653-60
references.pmid: 18217547
references.citation: Med J Aust. 2007 Jan 15;186(2):64-8
references.pmid: 17223765
references.citation: Lancet Infect Dis. 2006 May;6(5):288-96
references.pmid: 16631549
references.citation: Clin Infect Dis. 2011 Jan 1;52(1):94-6
references.pmid: 21148526
references.citation: PLoS Negl Trop Dis. 2010 Jul 06;4(7):e731
references.pmid: 20625552
references.citation: Bull Soc Pathol Exot. 2001 Nov;94(4):342-6
references.pmid: 11845532
references.citation: PLoS Negl Trop Dis. 2010 Aug 10;4(8):e791
references.pmid: 20706592
references.citation: Emerg Infect Dis. 2011 Mar;17(3):551-3
references.pmid: 21392458
references.citation: Appl Environ Microbiol. 2002 Sep;68(9):4623-8
references.pmid: 12200321
references.citation: J Epidemiol Community Health. 2004 Aug;58(8):635-41
references.pmid: 15252064
references.citation: Emerg Infect Dis. 2006 Sep;12(9):1325-31
references.pmid: 17073079
references.citation: Am J Epidemiol. 1974 May;99(5):325-32
references.pmid: 4825599
references.citation: Clin Infect Dis. 2005 May 15;40(10):1445-53
references.pmid: 15844067
references.citation: PLoS Negl Trop Dis. 2008 Mar 26;2(3):e178
references.pmid: 18365032
references.citation: Lancet. 1999 Mar 20;353(9157):986
references.pmid: 10459918
references.citation: PLoS Med. 2007 Feb;4(2):e28
references.pmid: 17326704
references.citation: Trop Med Int Health. 2008 Feb;13(2):191-8
references.pmid: 18304265
references.citation: Trans R Soc Trop Med Hyg. 1971;65(6):763-75
references.pmid: 5157438
references.citation: Am J Trop Med Hyg. 2007 Nov;77(5):834-6
references.pmid: 17984337