Clinical epidemiology of Buruli ulcer disease in Ghana, 2006-2024

Buruli ulcer, a neglected tropical disease, is common in West Africa and imposes a significant burden on health systems. Examining epidemiological data is important to guide health systems planning to facilitate control activities in endemic countries.

We aimed to provide a comprehensive description of the clinical epidemiology of a large cohort of polymerase chain reaction-confirmed cases of Buruli ulcer in districts in the middle belt of Ghana over an 18-year period.

We retrospectively analysed demographic and clinical data for affected individuals. Data were collected using World Health Organization standard case-based forms and managed in Microsoft Excel. Descriptive analysis was performed using SPSS and Stata statistical software.

In total, 956 individuals with a median (interquartile range) age of 18 (10-35) years were included; 40% (385/956) of patients with Buruli ulcer were under 15 years. Clinical lesions included ulcers (61.5%), nodules (15.6%), plaques (14%) and osteomyelitis (1.4%). Regarding lesion severity, 38.6% were category I, 32.3% category II and 22.6% category III. Most lesions (51.7%) were located on the lower limbs. There was notable variability in the number of recorded cases across the years, with 2014 witnessing the highest and 2010 the lowest numbers. The Ahafo Ano North district reported the highest number of cases.

Despite a general decline in case numbers, Ghana continues to be an endemic area for Buruli ulcer. Our findings support the need for policies emphasizing active surveillance for early case detection using integrated approaches. Further investigation into the changing epidemiology of Buruli ulcer is warranted.