title: Risk factors for buruli ulcer in Ghana-a case control study in the Suhum-Kraboa-Coaltar and Akuapem South Districts of the eastern region.
abstract: BACKGROUND
  Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. Its exact mode of transmission is not known. Previous studies have identified demographic, socio-economic, health and hygiene as well as environment related risk factors. We investigated whether the same factors pertain in Suhum-Kraboa-Coaltar (SKC) and Akuapem South (AS) Districts in Ghana which previously were not endemic for BU.
  
  
  METHODS
  We conducted a case control study. A case of BU was defined as any person aged 2 years or more who resided in study area (SKC or AS District) diagnosed according to the WHO clinical case definition for BU and matched with age- (+/-5 years), gender-, and community controls. A structured questionnaire on host, demographic, environmental, and behavioural factors was administered to participants.
  
  
  RESULTS
  A total of 113 cases and 113 community controls were interviewed. Multivariate conditional logistic regression analysis identified presence of wetland in the neighborhood (OR=3.9, 95% CI=1.9-8.2), insect bites in water/mud (OR=5.7, 95% CI=2.5-13.1), use of adhesive when injured (OR=2.7, 95% CI=1.1-6.8), and washing in the Densu river (OR=2.3, 95% CI=1.1-4.96) as risk factors associated with BU. Rubbing an injured area with alcohol (OR=0.21, 95% CI=0.008-0.57) and wearing long sleeves for farming (OR=0.29, 95% CI=0.14-0.62) showed protection against BU.
  
  
  CONCLUSIONS
  This study identified the presence of wetland, insect bites in water, use of adhesive when injured, and washing in the river as risk factors for BU; and covering limbs during farming as well as use of alcohol after insect bites as protective factors against BU in Ghana. Until paths of transmission are unraveled, control strategies in BU endemic areas should focus on these known risk factors.
authors.affiliation: Korle-Bu Teaching Hospital, Department of Medicine-Fevers Unit, Korle-Bu, Ghana; University of Ghana School of Public Health, Department of Epidemiology and Disease Control, Accra, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Kenu
authors.affiliation: Ghana Health Service, Disease Control and Prevention Department, Accra, Ghana.
authors.forename: Kofi Mensah
authors.initials: KM
authors.lastname: Nyarko
authors.affiliation: University of Bielefeld, Department of Epidemiology, School of Public Health, Bielefeld, Germany.
authors.forename: Linda
authors.initials: L
authors.lastname: Seefeld
authors.affiliation: Korle-Bu Teaching Hospital, Department of Medicine-Fevers Unit, Korle-Bu, Ghana.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ganu
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Käser
authors.affiliation: Korle-Bu Teaching Hospital, Department of Medicine-Fevers Unit, Korle-Bu, Ghana; University of Ghana Medical School, Department of Medicine, Korle-Bu, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lartey
authors.affiliation: Korle-Bu Teaching Hospital, Department of Medicine-Fevers Unit, Korle-Bu, Ghana.
authors.forename: Benedict Nii Laryea
authors.initials: BN
authors.lastname: Calys-Tagoe
authors.affiliation: Noguchi Memorial Institute of Medical Research, Department of Epidemiology, University of Ghana, Logan, Ghana.
authors.forename: Kwodwo
authors.initials: K
authors.lastname: Koram
authors.affiliation: University of Ghana School of Public Health, Department of Epidemiology and Disease Control, Accra, Ghana.
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
authors.affiliation: University of Bielefeld, Department of Epidemiology, School of Public Health, Bielefeld, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
authors.affiliation: University of Ghana School of Public Health, Department of Epidemiology and Disease Control, Accra, Ghana.
authors.forename: Edwin
authors.initials: E
authors.lastname: Afari
authors.affiliation: University of Health and Allied Sciences, Department of Epidemiology and Disease Control, Ho, Ghana.
authors.forename: Fred N
authors.initials: FN
authors.lastname: Binka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture; D000818:Animals; D054312:Buruli Ulcer / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005843:Geography; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007299:Insect Bites and Stings; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000302:isolation & purification*; D012111:Residence Characteristics; D012307:Risk Factors; D045483:Rivers; D011795:Surveys and Questionnaires; D053833:Wetlands; D055815:Young Adult