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Methods and Approaches for Buruli Ulcer Surveillance in Africa: Lessons Learnt and Future Directions

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Book cover Mycobacterium ulcerans

Part of the book series: Methods in Molecular Biology ((MIMB,volume 2387))

Abstract

Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programs have implemented various approaches to improve detection and reporting of incident cases over recent decades. Regional incidence rates are currently in decline; however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programs are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluation.

In this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa: (1) Passive case detection, (2) Data systems, (3) Clinical training, (4) Active case finding, (5) Burden estimation, and (6) Laboratory confirmation pathways. We discuss successes, challenges, and relevant case studies before highlighting opportunities for future development and evaluation including novel data collection tools, risk-based surveillance, and integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.

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References

  1. Merritt RW, Walker ED, Small PLC et al (2010) Ecology and transmission of buruli ulcer disease: a systematic review. PLoS Negl Trop Dis 4:1–15

    Article  Google Scholar 

  2. Thacker SB (2000) Principles and practices of public health surveillance. Oxford University Press, New York, pp 1–16

    Google Scholar 

  3. Omansen TF, Erbowor-Becksen A, Yotsu R et al (2019) Global epidemiology of Buruli ulcer, 2010-2017, and analysis of 2014 WHO programmatic targets. Emerg Infect Dis 25:2183–2190

    Article  PubMed  PubMed Central  Google Scholar 

  4. O’Brien DP, Jeanne I, Blasdell K, Avumegah M, Athan E (2019) The changing epidemiology worldwide of Mycobacterium ulcerans. Epidemiol Infect 147:1–8

    Google Scholar 

  5. Asiedu K, Scherpbier R, Marion R (2000) Buruli ulcer. WHO

    Google Scholar 

  6. Eddyani M, Sopoh GE, Ayelo G et al (2018) Diagnostic accuracy of clinical and microbiological signs in patients with skin lesions resembling buruli ulcer in an endemic region. Clin Infect Dis 67:827–834

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yeboah-Manu D, Aboagye SY, Asare P et al (2018) Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016. PLoS Negl Trop Dis 12:2008–2016

    Article  CAS  Google Scholar 

  8. Tabah EN, Johnson CR, Degnonvi H, Pluschke G, Röltgen K (2019) Buruli ulcer in Africa. In: Buruli ulcer. Springer International Publishing, pp 43–60

    Chapter  Google Scholar 

  9. Stienstra Y, Van Der Graaf WTA, Asamoa K, Van Der Werf TS (2002) Beliefs and attitudes toward Buruli ulcer in Ghana. Am J Trop Med Hyg 67:207–213

    Article  PubMed  Google Scholar 

  10. Renzaho AMN, Woods PV, Ackumey MM, Harvey SK, Kotin J (2007) Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana. Trop Med Int Heal 12:445–458

    Article  Google Scholar 

  11. Aujoulat I, Johnson C, Zinsou C, Guédénon A, Portaels F (2003) Psychosocial aspects of health seeking behaviours of patients with Buruli ulcer in southern Benin. Trop Med Int Heal 8:750–759

    Article  Google Scholar 

  12. Eyangoh S (2014) Good data collection is essential for a better understanding of Buruli ulcer. Lancet Glob Heal 2:e371–e372

    Article  Google Scholar 

  13. World Health Organization (2020) Ending the neglect to attain the sustaianable development goals - a road map for neglected tropical diseases 2021–2030. pp 1–13

    Google Scholar 

  14. Lönnroth K, Tomlin K, Afnan-Holmes H et al (2013) The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis 17:432–446

    Article  PubMed  Google Scholar 

  15. Cudahy PGT, Andrews JR, Bilinski A et al (2019) Spatially targeted screening to reduce tuberculosis transmission in high-incidence settings. Lancet Infect Dis 19:e89–e95

    Article  PubMed  Google Scholar 

  16. Saunders MJ, Tovar MA, Collier D et al (2019) A comparison of active and passive case finding in tuberculosis-affected households: a 10-year prospective cohort study, Peru. Lancet Infect Dis:1–10

    Google Scholar 

  17. Ackumey MM, Kwakye-Maclean C, Ampadu EO, de Savigny D, Weiss MG (2011) Health services for Buruli ulcer control: lessons from a field study in Ghana. PLoS Negl Trop Dis 5:e1187

    Article  PubMed  PubMed Central  Google Scholar 

  18. Portaels F, Johnson P, Meyers W (2001) Buruli ulcer: diagnosis of Mycobacterium ulcerans disease. WHO/CDS/GBUI

    Google Scholar 

  19. WHO (2016) WHO | New recording and reporting forms. WHO. https://www.who.int/buruli/control/forms_2/en/. Accessed 31 January 2020

  20. MBUAGBAW J, CIAFFI L, KUABAN C et al (2004) Buruli ulcer disease in Cameroon rediscovered. Am J Trop Med Hyg 70:520–526

    Article  PubMed  Google Scholar 

  21. Nsai FS, Cumber SN, Nkfusai NC et al (2018) Knowledge and practices of health practitioners on treatment of buruli ulcer in the mbonge, ekondo titi and muyuka health districts, South West Region, Cameroon. Pan Afr Med J 31:1–11

    Article  Google Scholar 

  22. Ekeke N, Meka AO, Chukwu JN et al (2017) Assessment of health care workers’ knowledge, attitude and risk perception of Buruli ulcer disease in Southern Nigeria. Trans R Soc Trop Med Hyg 111:226–232

    Article  PubMed  Google Scholar 

  23. Toutous Trellu L, Nkemenang P, Comte E et al (2016) Differential diagnosis of skin ulcers in a mycobacterium ulcerans endemic area: data from a prospective study in Cameroon. PLoS Negl Trop Dis 10:1–12

    Article  CAS  Google Scholar 

  24. Leeflang MMG, Bossuyt PMM, Irwig L (2009) Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis. J Clin Epidemiol 62:5–12

    Article  PubMed  Google Scholar 

  25. Lockwood DNJ, Shetty V, Oliveira G (2014) Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign. BMJ 348:1–5

    Article  Google Scholar 

  26. Liu D, Li G, Huang W, Gao J, Yue C, Xiao Q (2009) Analysis of newly detected leprosy cases and misdiagnosis in Wuhan (1990-2004). Lepr Rev 80:410–415

    PubMed  Google Scholar 

  27. Manabe YC, Zawedde-Muyanja S, Burnett SM, Frank M, Naikoba S, Coutinho A (2017) Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting. Open Forum Infect Dis 2:1–10

    Google Scholar 

  28. Awah PK, Boock AU, Mou F et al (2018) Developing a Buruli ulcer community of practice in Bankim, Cameroon: a model for Buruli ulcer outreach in Africa. PLoS Negl Trop Dis 12:1–20

    Article  Google Scholar 

  29. Tabah EN, Nsagha DS, Bissek A-CZ-K et al (2016) Buruli ulcer in Cameroon: the development and impact of the National Control Programme. PLoS Negl Trop Dis 10:e0004224

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nicol E, Bradshaw D, Phillips T, Dudley L (2013) Human factors affecting the quality of routinely collected data in South Africa. Stud Health Technol Inform 192:788–792

    PubMed  Google Scholar 

  31. Bosch-Capblanch X, Ronveaux O, Doyle V, Remedios V, Bchir A (2009) Accuracy and quality of immunization information systems in forty-one low income countries. Trop Med Int Heal 14:2–10

    Article  Google Scholar 

  32. Rufai T, Aninagyei E, Sackey SO, Kenu E, Afari EA (2019) Evaluation of Buruli ulcer disease surveillance system in the Ga West Municipality, Ghana, 2011-2015. J Trop Med 2019:2011–2015

    Article  Google Scholar 

  33. CDC (2001) Updated guidenlines for evaluating public health surveilance systems. Morb Mortal Wkly Rep 50:1–35

    Google Scholar 

  34. Aquil A, Lippeveld T, Hozumi D, Abdou M, Johsnton A (2011) Tools for data demand and use in the health sector - performance of routine information systems management (PRISM) tools. Meas Eval Man 1–39

    Google Scholar 

  35. Portaels F, Silva MT, Meyers WM (2009) Buruli ulcer. Clin Dermatol 27:291–305

    Article  PubMed  Google Scholar 

  36. Webb BJ, Hauck FR, Houp E, Portaels F (2009) Buruli ulcer in West Africa: strategies for early detection and treatment in the antibiotic era. East Afr J Public Health 6:144–147

    PubMed  Google Scholar 

  37. Nichter M (2019) Social science contributions to BU focused health service research in West-Africa. https://doi.org/10.4161/hv.7.11.17751

  38. Debacker M, Aguiar J, Steunou C et al (2004) Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, southern Benin, 1997-2001. Emerg Infect Dis 10:1391–1398

    Article  PubMed  PubMed Central  Google Scholar 

  39. Amoussouhoui AS, Sopoh GE, Wadagni AC et al (2018) Implementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa. PLoS Negl Trop Dis 12:1–25

    Article  Google Scholar 

  40. Evans MRW, Phillips R, Etuaful SN et al (2003) An outreach education and treatment project in Ghana for the early stage of Mycobacterium ulcerans disease. Trans R Soc Trop Med Hyg 97:159–160

    Article  CAS  PubMed  Google Scholar 

  41. Beissner M, Huber KL, Badziklou K et al (2013) Implementation of a National Reference Laboratory for Buruli ulcer disease in Togo. PLoS Negl Trop Dis 7:e2011

    Article  PubMed  PubMed Central  Google Scholar 

  42. Ukwaja KN, Meka AO, Chukwuka A et al (2016) Buruli ulcer in Nigeria: results of a pilot case study in three rural districts. Infect Dis Poverty 5:1–9

    Article  Google Scholar 

  43. Phanzu DM, Suykerbuyk P, Imposo DBB et al (2011) Effect of a control project on clinical profiles and outcomes in buruli ulcer: a before/after study in Bas-Congo, democratic republic of Congo. PLoS Negl Trop Dis 5:e1402

    Article  PubMed  PubMed Central  Google Scholar 

  44. Prochazka M, Timothy J, Pullan R et al (2020) “Buruli ulcer and leprosy, they are intertwined”: patient experiences of integrated case management of skin neglected tropical diseases in Liberia. PLoS Negl Trop Dis 14:1–16

    Article  Google Scholar 

  45. Dean L, Tolhurst R, Nallo G, Kollie K, Bettee A, Theobald S (2019) Neglected tropical disease as a ‘biographical disruption’: listening to the narratives of affected persons to develop integrated people centred care in Liberia. PLoS Negl Trop Dis 13:1–22

    Article  Google Scholar 

  46. Martos-Casado G, Vives-Cases C, Gil-González D (2020) Scoping review: community-based programmes with people affected by leprosy. Trop Med Int Heal 25:144–158

    Article  Google Scholar 

  47. Peters RMH, Dadun ZMBM, Bunders JFG, Irwanto, van Brakel WH (2015) A cluster-randomized controlled intervention study to assess the effect of a contact intervention in reducing leprosy-related stigma in Indonesia. PLoS Negl Trop Dis 9:1–24

    Article  Google Scholar 

  48. Sengupta S, Banks B, Jonas D, Miles MS, Smith GC (2011) HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav 15:1075–1087

    Article  PubMed  PubMed Central  Google Scholar 

  49. Abass KM, Van Der Werf TS, Phillips RO et al (2015) Short report: Buruli ulcer control in a highly endemic district in Ghana: role of community-based surveillance volunteers. Am J Trop Med Hyg 92:115–117

    Article  PubMed  PubMed Central  Google Scholar 

  50. WHO (2005) Buruli ulcer: a pocket guide for community health workers. World Health Organization, Geneva

    Google Scholar 

  51. WHO (2011) Buruli ulcer: Recognize and act now! A guide for field health workers. World Health Organization, 92, Geneva

    Google Scholar 

  52. Barogui YT, Sopoh GE, Johnson RC et al (2014) Contribution of the community health volunteers in the control of Buruli ulcer in Bénin. PLoS Negl Trop Dis 8:1–9

    Article  Google Scholar 

  53. Saunders MJ, Tovar MA, Collier D et al (2019) Active and passive case-finding in tuberculosis-affected households in Peru: a 10-year prospective cohort study. Lancet Infect Dis 19:519–528

    Article  PubMed  PubMed Central  Google Scholar 

  54. Ahorlu CSK, Okyere D, Ampadu E (2018) Implementing active community-based surveillance-response system for Buruli ulcer early case detection and management in Ghana. PLoS Negl Trop Dis 12:1–12

    Article  Google Scholar 

  55. Vouking MZ, Takougang I, Mbam LM, Mbuagbaw L, Tadenfok CN, Tamo CV (2013) The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon. Pan Afr Med J 16:1–5

    Article  Google Scholar 

  56. World Health Organization (2017) Design and validation of a trachomatous trichiasis-only survey. Geneva: (WHO/HTM/NTD/PCT/2017.08). Licence: CC BY-NCSA 3.0 IGO.

    Google Scholar 

  57. Bratschi MW, Bolz M, Minyem JC et al (2013) Geographic distribution, age pattern and sites of lesions in a cohort of Buruli ulcer patients from the Mapé Basin of Cameroon. PLoS Negl Trop Dis 7:e2252

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ampah KA, Asare P, Binnah DDG et al (2016) Burden and historical trend of Buruli ulcer prevalence in selected communities along the Offin River of Ghana. PLoS Negl Trop Dis 10:1–18

    Article  Google Scholar 

  59. Mavinga Phanzu D, Suykerbuyk P, Saunderson P et al (2013) Burden of mycobacterium ulcerans disease (Buruli ulcer) and the underreporting ratio in the territory of Songololo, Democratic Republic of Congo. PLoS Negl Trop Dis 7:1–8

    Article  Google Scholar 

  60. Amofah G, Bonsu F, Tetteh C et al (2002) Buruli ulcer in Ghana: results of a national case search. Emerg Infect Dis 8:167–170

    Article  PubMed  PubMed Central  Google Scholar 

  61. Porten K, Sailor K, Comte E et al (2009) Prevalence of Buruli ulcer in Akonolinga health district, Cameroon: results of a cross sectional survey. PLoS Negl Trop Dis 3:1–7

    Article  Google Scholar 

  62. Myatt M, Feleke T, Sadler K, Collins S (2005) A field trial of a survey method for estimating the coverage of selective feeding programmes. Bull World Health Organ 83:20–26

    PubMed  PubMed Central  Google Scholar 

  63. Checchi F, Stewart BT, Palmer JJ, Grundy C (2013) Validity and feasibility of a satellite imagery-based method for rapid estimation of displaced populations. Int J Health Geogr 12

    Google Scholar 

  64. Stanton MC (2017) The role of spatial statistics in the control and elimination of neglected tropical diseases in sub-Saharan Africa : a focus on human African trypanosomiasis. Schistosomiasis and Lymphatic Filariasis, Elsevier Ltd

    Book  Google Scholar 

  65. Cano J, Rodríguez A, Simpson H, Tabah EN, Gómez JF, Pullan RL (2018) Modelling the spatial distribution of aquatic insects (order Hemiptera) potentially involved in the transmission of Mycobacterium ulcerans in Africa. Parasit Vectors 11:1–16

    Article  CAS  Google Scholar 

  66. Simpson H, Tabah E, Phillips R et al (2020) Mapping suitability for Buruli ulcer at fine spatial scales across Africa: a modelling study. PLoS Negl Tropi Dis 15(3):e0009157

    Google Scholar 

  67. Fronterre C, Amoah B, Giorgi E, Stanton MC, Diggle PJ (2020) Design and analysis of elimination surveys for neglected tropical diseases. J Infect Dis 221(Supplement_5):S554–S560

    Article  PubMed  PubMed Central  Google Scholar 

  68. Mableson HE, Martindale S, Stanton MC, Mackenzie C, Kelly-Hope LA (2017) Community-based field implementation scenarios of a short message service reporting tool for lymphatic filariasis case estimates in Africa and Asia. mHealth 3:28–28

    Article  PubMed  PubMed Central  Google Scholar 

  69. Stanton MC, Mkwanda SZ, Debrah AY et al (2015) Developing a community-led SMS reporting tool for the rapid assessment of lymphatic filariasis morbidity burden: case studies from Malawi and Ghana. BMC Infect Dis 15:1–13

    Article  CAS  Google Scholar 

  70. Sime H, Deribe K, Assefa A et al (2014) Integrated mapping of lymphatic filariasis and podoconiosis: lessons learnt from Ethiopia. Parasit Vectors 7:397

    Article  PubMed  PubMed Central  Google Scholar 

  71. Steiner A, Hella J, Grüninger S et al (2016) Managing research and surveillance projects in real-time with a novel open-source eManagement tool designed for under-resourced countries. J Am Med Informatics Assoc 23:916–923

    Article  Google Scholar 

  72. Open Data Kit. https://opendatakit.org/. Accessed 31 January 2020

  73. KoBoToolbox | Data Collection Tools for Challenging Environments. https://www.kobotoolbox.org/. Accessed 31 January 2020

  74. Portaels F (ed) (2014) Laboratory diagnosis of Buruli ulcer disease. https://doi.org/10.2217/fmb.10.3

    Book  Google Scholar 

  75. O’Brien DP, Globan M, Fyfe JM et al (2019) Diagnosis of Mycobacterium ulcerans disease: be alert to the possibility of negative initial PCR results. Med J Aust 210:416

    Article  PubMed  Google Scholar 

  76. Siegmund V, Adjei O, Nitschke J et al (2007) Dry reagent-based polymerase chain reaction compared with other laboratory methods available for the diagnosis of Buruli ulcer disease. Clin Infect Dis 45:68–75

    Article  CAS  PubMed  Google Scholar 

  77. Mitjà O, Marks M, Bertran L et al (2017) Integrated control and management of neglected tropical skin diseases. PLoS Negl Trop Dis 11:1–13

    Article  Google Scholar 

  78. Engelman D, Fuller LC, Solomon AW et al (2016) Opportunities for integrated control of neglected tropical diseases that affect the skin. Trends Parasitol 32:843–854

    Article  PubMed  Google Scholar 

  79. Boock AU, Awah PK, Mou F, Nichter M (2017) Yaws resurgence in Bankim, Cameroon: the relative effectiveness of different means of detection in rural communities. PLoS Negl Trop Dis 11:1–14

    Article  Google Scholar 

  80. Yotsu RR, Yotsu RR, Kouadio K et al (2018) Skin disease prevalence study in schoolchildren in rural Côte d’Ivoire: implications for integration of neglected skin diseases (skin NTDs). PLoS Negl Trop Dis 12:1–18

    Article  Google Scholar 

  81. Barogui YT, Diez G, Anagonou E et al (2018) Integrated approach in the control and management of skin neglected tropical diseases in Lalo, Benin. PLoS Negl Trop Dis 12:1–12

    Article  Google Scholar 

  82. WHO (2011) Helminth control in school-age children

    Google Scholar 

  83. Mahé A, Faye O, Thiam N’Diaye H et al (2005) Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa. Trans R Soc Trop Med Hyg 99:39–47

    Article  PubMed  Google Scholar 

  84. Walker SL, Collinson S, Timothy JWS et al (2020) A community-based validation of the international alliance for the control of scabies consensus criteria by expert and non-expert examiners in Liberia. PLoS Negl Trop Dis 1–11

    Google Scholar 

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Authors and Affiliations

  1. Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK

    Joseph W. S. Timothy & Rachel L. Pullan

  2. School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan

    Rie R. Yotsu

  3. Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan

    Rie R. Yotsu

  4. Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA

    Rie R. Yotsu

Authors
  1. Joseph W. S. Timothy
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  2. Rachel L. Pullan
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  3. Rie R. Yotsu
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Editors and Affiliations

  1. Swiss Tropical and Public Health Institute, Basel, Switzerland

    Gerd Pluschke

  2. Stanford School of Medicine Department of Pathology, Stanford University, Stanford, CA, USA

    Katharina Röltgen

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Timothy, J.W.S., Pullan, R.L., Yotsu, R.R. (2022). Methods and Approaches for Buruli Ulcer Surveillance in Africa: Lessons Learnt and Future Directions. In: Pluschke, G., Röltgen, K. (eds) Mycobacterium ulcerans. Methods in Molecular Biology, vol 2387. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-1779-3_10

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  • DOI: https://doi.org/10.1007/978-1-0716-1779-3_10

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