title: Socio-Environmental Factors Associated with the Risk of Contracting Buruli Ulcer in Tiassalé, South Côte d'Ivoire: A Case-Control Study.
abstract: BACKGROUND
  Buruli ulcer (BU) is a cutaneous infectious disease caused by Mycobacterium ulcerans. The exact mode of transmission remains elusive; yet, some studies identified environmental, socio-sanitary, and behavioral risk factors. The purpose of this study was to assess the association of such factors to contracting BU in Tiassalé, south Côte d'Ivoire.
  
  
  METHODS
  A case-control study was conducted in 2012. Cases were BU patients diagnosed according to clinical definition put forth by the World Health Organization, readily confirmed by IS2404 polymerase chain reaction (PCR) analysis prior to our study and recruited at one of the health centers of the district. Two controls were matched for each control, by age group (to the nearest 5 years), sex, and living community. Participants were interviewed after providing oral witnessed consent, assessing behavioral, environmental, and socio-sanitary factors.
  
  
  RESULTS
  A total of 51 incident and prevalent cases and 102 controls were enrolled. Sex ratio (male:female) was 0.9. Median age was 25 years (range: 5-70 years). Regular contact with unprotected surface water (adjusted odds ratio (aOR) = 6.5; 95% confidence interval (CI) = 2.1-19.7) and absence of protective equipment during agricultural activities (aOR = 18.5, 95% CI = 5.2-66.7) were identified as the main factors associated with the risk of contracting BU. Etiologic fractions among exposed to both factors were 84.9% and 94.6%, respectively. Good knowledge about the risks that may result in BU (aOR = 0.3, 95% CI = 0.1-0.8) and perception about the disease causes (aOR = 0.1, 95% CI = 0.02-0.3) showed protection against BU with a respective preventive fraction of 70% and 90%.
  
  
  CONCLUSIONS
  Main risk factors identified in this study were the contact with unprotected water bodies through daily activities and the absence of protective equipment during agricultural activities. An effective strategy to reduce the incidence of BU should involve compliance with protective equipment during agricultural activities and avoidance of contact with surface water and community capacity building through training and sensitization.
authors.affiliation: Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.|Unité de Formation et de Recherche des Sciences Médicales, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
authors.forename: Raymond T A S
authors.initials: RT
authors.lastname: N'krumah
authors.affiliation: Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.|Institut de Gestion Agropastorale, Université Péléforo Gon Coulibaly, Korhogo, Côte d'Ivoire.
authors.forename: Brama
authors.initials: B
authors.lastname: Koné
authors.affiliation: Unité de Formation et de Recherche des Sciences Médicales, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
authors.forename: Issaka
authors.initials: I
authors.lastname: Tiembre
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Guéladio
authors.initials: G
authors.lastname: Cissé
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Gerd
authors.initials: G
authors.lastname: Pluschke
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054312:Buruli Ulcer / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012307:Risk Factors; D012959:Socioeconomic Factors; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water