A neglected tropical disease on the march

As illnesses go, Buruli ulcer does not receive the attention given to conditions such as HIV/Aids or bird flu: the World Health Organisation (WHO) has even termed it a ”neglected tropical disease”.

In the conflict-torn nation of Côte d’Ivoire, however, matters are somewhat different.

A survey issued by the National Programme for the Fight against Mycobacterial Ulcers (Programme national de lutte contre les ulcères à mycobactéries, PNUM) has shown that there were 22 000 cases of the disease in the country last year — a marked increase against the number recorded in 1997 (4 642). Just over 10 000 cases of Buruli ulcer were recorded in 1991. (Mycobacteria are known to cause several serious illnesses apart from Buruli ulcer. These include tuberculosis and leprosy.)

According to the WHO, Côte d’Ivoire is the African country worst-affected by Buruli ulcer, followed by Ghana with 10 000 cases, and Benin with 4 000. The condition is named after a region in Uganda, which had a high incidence of Buruli ulcer during the 1960s.

People who contract the sickness form swellings in their skin that are heavily infected with tissue-attacking bacteria, and which lead to unsightly, albeit relatively painless, sores as the skin is destroyed. The bacteria may even penetrate to, and destroy, bone.

As antibiotics have not been effective in treating Buruli ulcer, infected areas are typically cut away during surgery.

Early diagnosis and treatment can limit the toll the disease takes on patients. Some lose eyes and breasts to the illness, however, or face the prospect of amputation. Those persons with sores risk social exclusion, while scarring from healed ulcers may cause loss of movement.

Children are more affected by Buruli ulcer than adults, although the disease can infect anyone. Little is known about the way in which it is transmitted to people, according to the WHO.

”I have been ill for five years,” said Théodore Koffi, during an interview conducted at a clinic in the financial hub of Abidjan.

At first, he consulted a traditional healer about the illness — but the treatment he received made no difference to his condition.

”My parents didn’t want anything more to do with me because I was frightening to look at, with big, open sores on my body,” he added. Fourteen operations later, he is still battling the disease.

Next to him, 13-year-old Philippe Atsé is studying the emergence of a new Buruli ulcer swelling on his right wrist. After the disease had severely affected other parts of his body, he was forced to leave school.

Buruli ulcer first appeared in the Côte d’Ivoire in 1978, in the south-eastern Yamoussoukro region. But, it was only in 1989 that health authorities began to pay serious attention to the illness, this after discovering that it had become endemic in the west-central region of Daloa.

As a result of the outbreak in this area, some people started referring to the condition as the ”mysterious sickness of Daloa”.

Central parts of Côte d’Ivoire continue to be worst-affected by Buruli ulcer, accounting for half of recorded cases.

A lack of resources has stood in the way of a concerted campaign against the disease. Last year, however, PNUM pushed for a national system to be put in place to monitor the sickness, and provide care for infected people.

This would enable early diagnosis of the condition, and rapid provision of care at local level.

The health ministry has also provided $40 000 to buy medicines used to treat Buruli ulcer for 11 clinics — and to improve efforts to raise awareness of the condition.

Nonetheless, providing adequate care to everyone who develops Buruli ulcer remains a daunting challenge in a country where almost 40% of people live on less than two dollars a day, according to the 2005 ”Human Development Report”, produced by the United Nations Development Programme.

”The cost of treatment varies between $325 and $425 a month per person,” says an Italian Catholic priest who manages a Buruli ulcer centre in Angré, a suburb of Abidjan. The centre provides free treatment to its patients, who come from around the country — three-quarters of them children.

Clay dressings imported from France are applied to sores three times daily at the centre, to extract the infection. This produces results more slowly than the excision of infected areas; however, it is also five to six times cheaper than surgery.

”We are obliged to treat them [Buruli ulcer patients] with the means at our disposal, but these are not sufficient,” says Bernard Allah Kouakou, a doctor from Bécouéfin in the south-eastern region of Adzopé — which has been especially affected.

In 1998, the WHO set up the Global Buruli Ulcer Initiative to coordinate programmes related to the disease.

A year earlier, a website on Buruli ulcer was started in the Côte d’Ivoire to draw international attention to the extent of the problem in the West African country.

”We have placed pictures of Buruli ulcer cases there that sensitive people will find disturbing,” says PNUM executive director Jean-Marie Kangah.

”But, they should be seen for people to appreciate the progression of the disease.” -IPS

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