The objective is to minimize the morbidity, disability and socio-economic burden of Buruli ulcer. The strategy is based on early detection and antibiotic treatment.
Community level activities integrated with other skin NTDs
- Early case detection at the community level.
- Information, education and communication (IEC) campaigns in communities and schools.
- Training of community health workers (village volunteers) and strengthening of community-based surveillance system.
- Organization of refresher training for community health workers and schoolteachers to detect, document, and refer cases to the health facilities.
Strengthening of the health system
- Assess the health service capacity (e.g. surgical, laboratory and physiotherapy) to manage Buruli ulcer (assessment checklist in English and in French).
- Construct or rehabilitate infrastructures, including operating theaters, wards, physiotherapy unit.
- Strengthen the laboratory capacity to confirm cases.
- Provide equipment such as dermatomes and skin graft meshers, drugs, medical and surgical supplies to support the care of patients with extensive lesions.
- Develop the basic infrastructure to implement prevention of disability activities at the community level.
- Provide transport and logistics (e.g. computers and audiovisual) to support field activities.
- Organize training and refresher training for health workers (doctors, nurses, laboratory technicians and physiotherapists/physiotherapists assistants) in the diagnosis and management of Buruli ulcer and other skin NTDs
- Organize a short-term training for general doctors and surgeons to improve competence in basic plastic surgery to deal with complicated cases at the district and regional levels.
- Organize training for the regional and district health managers in the organization and management of a Buruli ulcer control programme
- Ensure that BU 01, BU 02 and BU 03 forms are used to register and report cases at district and facility levels. The BU 01 can be developed into patients’ booklets, BU 02 forms can be developed into registers and BU 03 can be single forms or booklets with serial numbering. A simplified version of the BU 02 can be developed for recording basic information cases at the community level.
- Data should be analyzed and used for programmatic decision making at the facility, district, regional and national levels.
Recording and reporting BU01, BU02 and BU03 forms
Standardized case management
Laboratory confirmation of cases
- Collection of samples: Ensure that health facilities have the swabs for collecting samples and health workers have been trained to collect, store and transport sample.
- National level: PCR is the recommended confirmatory test. A number of laboratories of the BU LABNET (Buruli ulcer laboratory network) in Africa provide confirmation of cases in their respective countries.
- Local level: Direct smear examination – Ziehl-Neelsen (ZN) staining technique – may be done in facilities where tuberculosis microscopy is done. Fluorescent thin layer chromatography to detect mycolactone may be done in district laboratories equipped to perform this test. These tests are complementary to PCR.
Organization of case management
- Community level: Community health workers can directly supervise patients on treatment, assist in the prevention of disability and provide social support.
- Health center level: Antibiotic treatment, wound care, basic prevention of disability and social and mental health support.
- District hospital level: Antibiotic treatment, surgery (mainly debridement and skin grafting), wound care, prevention of disability, social and mental health support.
- Regional and tertiary levels: Antibiotic treatment, surgery (complicated cases and correction of deformities), wound care, prevention of disability and social support.
Specific treatments and support
Specific antibiotics
The recommended treatment is a combination of rifampicin (10 mg/kg once daily) and clarithromycin (7.5 mg/kg twice a day) for 8 weeks for all forms of the disease and at all levels of the health system (health centers, district, regional and tertiary hospitals).
Wound care
Wound care is an essential part of the management of Buruli ulcer. Health workers should be properly trained on the basic principles of wound dressing and infection control. Wound dressing materials should be adequately provided.
Surgery
Currently, the main role of surgery is to speed up healing of extensive lesions. Surgery as the primary treatment of Buruli ulcer is no longer recommended. Majority of patients will heal with antibiotics and wound dressing. Ideally, patients should complete the 8 weeks of antibiotics treatment before any consideration of surgery. Clinical judgement should be used to determine which patients would need surgery (mainly skin grafting) and the optimal timing for such an intervention.
Prevention of disabilities (POD)
Disability is the main consequence of Buruli ulcer. POD is an important part of Buruli ulcer management which should be implemented right from diagnosis until complete healing. Community health workers, health workers, patients and family members should be involved in the care and interventions to prevent disability.
Social and mental support
This includes the provision of nutritious food supplements for in-patients, education of children during hospitalization and after treatment, mental health support to patients and the family members dealing with the disease, social and economic rehabilitation of those deformed to restore them to position of dignity in society.
Supervision, monitoring and evaluation of control activities
- Monitor trends of the disease at all levels (community, district, regional and national) to guide programmatic interventions.
- Annual reporting of surveillance data to WHO and other stakeholders.
- Monitor the quality of patient care, sequelae and long-term treatment outcomes at the district level.
- Evaluate the impact of control programme activities, such as community awareness, training, early detection.
- Organize regular meetings (quarterly or 6-monthly) with all local actors to review progress of implementation of activities within the national, regional and district NTDs activities.
- Organize an evaluation of the programme by an external team at least once every 3 to 5 years.
Advocacy, social mobilization and partnership
- Develop an advocacy strategy to put Buruli ulcer and other skin NTDs on the local, national and international health and development agendas – in the context of the neglected tropical diseases and poverty alleviation.
- Intensify material and financial resource mobilization efforts to support control and research efforts.
- Strengthen governmental and nongovernmental partnership at international, national and local levels to build network for controlling Buruli ulcer and other skin NTDs in particular and NTDs in general.
- Publish and present results at local and international conferences and meetings.
- WHO Resolution (WHA57.1) and Declarations (1998 and 2009) on Buruli ulcer
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