title: Buruli Ulcer Disease and Its Association with Land Cover in Southwestern Ghana.
abstract: BACKGROUND
  Buruli ulcer (BU), one of 17 neglected tropical diseases, is a debilitating skin and soft tissue infection caused by Mycobacterium ulcerans. In tropical Africa, changes in land use and proximity to water have been associated with the disease. This study presents the first analysis of BU at the village level in southwestern Ghana, where prevalence rates are among the highest globally, and explores fine and medium-scale associations with land cover by comparing patterns both within BU clusters and surrounding landscapes.
  
  
  RESULTS
  We obtained 339 hospital-confirmed BU cases in southwestern Ghana between 2007 and 2010. The clusters of BU were identified using spatial scan statistics and the percentages of six land cover classes were calculated based on Landsat and Rapid Eye imagery for each of 154 villages/towns. The association between BU prevalence and each land cover class was calculated using negative binomial regression models. We found that older people had a significantly higher risk for BU after considering population age structure. BU cases were positively associated with the higher percentage of water and grassland surrounding each village, but negatively associated with the percent of urban. The results also showed that BU was clustered in areas with high percentage of mining activity, suggesting that water and mining play an important and potentially interactive role in BU occurrence.
  
  
  CONCLUSIONS
  Our study highlights the importance of multiple land use changes along the Offin River, particularly mining and agriculture, which might be associated with BU disease in southwestern Ghana. Our study is the first to use both medium- and high-resolution imagery to assess these changes. We also show that older populations (≥ 60 y) appear to be at higher risk of BU disease than children, once BU data were weighted by population age structures.
authors.affiliation: Department of Geography, The Pennsylvania State University, University Park, Pennsylvania, United States of America.
authors.forename: Jianyong
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Geography, The Pennsylvania State University, University Park, Pennsylvania, United States of America.
authors.forename: Petra
authors.initials: P
authors.lastname: Tschakert
authors.affiliation: Ghana Health Service, Accra, Ghana.
authors.forename: Erasmus
authors.initials: E
authors.lastname: Klutse
authors.affiliation: Department of Geography, Rutgers University, Piscataway, New Jersey, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Ferring
authors.affiliation: Department of Geography, The Pennsylvania State University, University Park, Pennsylvania, United States of America.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ricciardi
authors.affiliation: Department of Human Ecology, Rutgers University, New Brunswick, New Jersey, United States of America.
authors.forename: Heidi
authors.initials: H
authors.lastname: Hausermann
authors.affiliation: Department of Geography, The University of North Texas, Denton, Texas, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Oppong
authors.affiliation: Department of Geography, The Pennsylvania State University, University Park, Pennsylvania, United States of America.
authors.forename: Erica A H
authors.initials: EA
authors.lastname: Smithwick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000383:Agriculture; D054312:Buruli Ulcer / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D004777:Environment; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008906:Mining; D013997:Time Factors; D055815:Young Adult