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Risk factors for Buruli ulcer disease in Ghana: A matched case-control study in four selected endemic districts of
Mawuli Gohoho1,2,3, Samuel Adolf Bosoka1,2,4, George Sarpong Agyemang1,2,5
1Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana.
Background:
Buruli ulcer disease (BUD) remains a poorly understood neglected tropical disease (NTD). The 2021-2030 WHO NTD Roadmap prioritises addressing knowledge gaps in BUD transmission and calls for the need to better understand the factors contributing to disease occurrence. In Ghana, reported BUD cases declined from over 600 in 2018 to 81 in 2023. While previous case-control studies in Ghana have used a 1:1 matching ratio, this study examined potential risk factors for BUD in four endemic districts using an improved methodological approach.
Methods:
A community-based 1:2 matched case-control study was conducted in four BUD-endemic districts (Akwapim South, Akwapim North-Okere, Jasikan, and Biakoye) in the Eastern and Oti Regions of Ghana. Seventy (70) BUD cases and 140 community controls were recruited and matched by age (±5 years), sex, and place of residence. Data on socio-demographic, behavioural, environmental, water use, and injury management factors were collected by trained research assistants using semi-structured questionnaires designed with KoboCollect. Multivariable conditional logistic regression produced adjusted odds ratios (aORs) with 95% confidence intervals at p < 0.05.
Results:
In the multivariable analysis, farming without adequate protective clothing (aOR = 3.02, 95% CI: 1.03-8.89) and living near waterbodies (aOR = 4.45, 95% CI: 1.46-13.55) were associated with increased odds of BUD. Being married (aOR = 0.32, 95% CI: 0.13-0.78) and applying alcohol to injury sustained (aOR = 0.17, 95% CI: 0.03-0.83) reduced the odds of BUD.
Conclusion:
Farming without adequate protective clothing and proximity to waterbodies were the main risk factors for BUD in endemic districts in Ghana. In contrast, being married and practising injury care using alcohol appeared protective. The Ghana Health Service should promote the consistent use of protective clothing during agricultural activities, raise awareness among communities living near waterbodies, and encourage proper injury care practices to reduce the risk of BUD.
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