Effect of a control project on clinical profiles and outcomes in buruli ulcer: a before/after study in Bas-Congo, Democratic Republic of Congo.
BACKGROUND
Buruli ulcer (BU) is a necrotizing bacterial infection of skin, subcutaneous tissue and bone caused by Mycobacterium ulcerans. Although the functional impairment caused by BU results in severe suffering and in socio-economic problems, the disease remains largely neglected in Africa. The province of Bas-Congo in Democratic Republic of Congo contains one of the most important BU foci of the country, i.e. the Songololo Territory in the District of Cataractes. This study aims to assess the impact of a BU control project launched in 2004 in the Songololo Territory.


METHODS
We used a comparative non-randomized study design, comparing clinical profiles and outcomes of the group of patients admitted at the General Reference Hospital (GRH) of the "Institut Médical Evangélique" (IME) of Kimpese 3 years before the start of the project (2002-2004) with those admitted during the 3 years after the start of the project (2005-2007).


RESULTS
The BU control project was associated with a strong increase in the number of admitted BU cases at the GRH of IME/Kimpese and a fundamental change in the profile of those patients; more female patients presented with BU, the proportion of relapse cases amongst all admissions reduced, the proportion of early lesions and simple ulcerative forms increased, more patients healed without complications and the case fatality rate decreased substantially. The median duration since the onset of first symptoms however remained high, as well as the proportion of patients with osteomyelitis or limitations of joint movement, suggesting that the diagnostic delay remains substantial.


CONCLUSIONS
Implementing a specialized program for BU may be effective in improving clinical profiles and outcomes in BU. Despite these encouraging results, our study highlights the need of considering new strategies to better improve BU control in a low resources setting.
General Reference Hospital of Kimpese, Institut Médical Evangélique, Kimpese, Bas-Congo, Democratic Republic of Congo.
Delphin Mavinga
DM
Phanzu
Patrick
P
Suykerbuyk
Désiré Bofunga B
DB
Imposo
Philippe Ngwala
PN
Lukanu
Jean-Bedel Masamba
JB
Minuku
Linda F
LF
Lehman
Paul
P
Saunderson
Bouke C
BC
de Jong
Pascal Tshindele
PT
Lutumba
Françoise
F
Portaels
Marleen
M
Boelaert
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D054312:Buruli Ulcer / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control; D002648:Child; D003140:Communicable Disease Control / Q000379:methods*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents