Outcome of Streptomycin-Rifampicin treatment of Buruli Ulcer in two Ghanaian districts.
BACKGROUND
Buruli ulcer (BU) is an infectious skin disease, caused by Mycobacterium ulcerans, endemic in more than 30 countries worldwide especially Africa. Brong-Ahafo Region implemented WHO recommended daily treatment with streptomycin and rifampicin for eight weeks (SR8). Yet limited assessment of therapy exists. This study seeks to determine the outcome of SR8 therapy on BU in two endemic districts in Brong-Ahafo.


METHODS
Longitudinal study was done with laboratory confirmed Buruli ulcer patients selected consecutively and put on SR8. Patient follow-up involved daily administration of SR8 and Bi-Weekly monitoring of treatment in the form of measurement of wound size and taking photographs.


RESULTS
The mean age of participants was 34.6 ± 16.6 years with minimum and maximum ages of 10 to 65 respectively. Those in the 10-19year age group 13 (26%) were most affected. Majority, 26 (52%) had no formal education and 27 (54.0%) were peasant farmers. Thirty-eight (76.0%) had previously used traditional treatment. Forty completed treatment and of these, 28 (70.0%) healed completely and 12 (30. 0%) improved by 80%-90%. Duration of lesion before seeking healthcare (P =0.04), use of traditional treatment P < 0.001, clinical form of lesion P = 0.04, lesion category (p = 0.01), significantly affected healing. Mean time to healing, was 7.7 weeks (95% CI, 7.3 - 7.9).


CONCLUSIONS
Though SR8 is effective in curing BU, late reporting, use of herbs and access to health care impeded wound healing. This calls for provision of accessible health care and education to improve early reporting.
Ghana Field Epidemiology and Laboratory Training programme, School of Public Health, University of Ghana; Ghana Health Service.
Florence Nzilanye
FN
Iddrisah
Noguchi Memorial Institute for Medical Research, University of Ghana.
Dorothy
D
Yeboah-Manu
Ghana Field Epidemiology and Laboratory Training programme, School of Public Health, University of Ghana.
Pricillia Awoh
PA
Nortey
Ghana Field Epidemiology and Laboratory Training programme, School of Public Health, University of Ghana.
Kofi Mensah
KM
Nyarko
Ghana Health Service.
Jones
J
Anim
Ghana Health Service.
Simon Nyovuura
SN
Antara
Department of Epidemiology and Disease Control, School of Public Health, University of Ghana.
Ernest
E
Kenu
Ghana Field Epidemiology and Laboratory Training programme, School of Public Health, University of Ghana.
Fred
F
Wurapa
Ghana Field Epidemiology and Laboratory Training programme, School of Public Health, University of Ghana.
Edwin Andrew
EA
Afari
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005869:Ghana; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000302:isolation & purification; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D013307:Streptomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin
Buruli Ulcer; Streptomycin/Rifampicin; Survival; endemic