University of Groningen Contribution of the community health volunteers in the control of buruli ulcer in Bénin Barogui, Yves Thierry; Sopoh, Ghislain Emmanuel; Johnson, Roch Christian; de Zeeuw,

Background: Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers. Methodology/Principal Findings: In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/ BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. Conclusions/Significance: This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU. Citation: Barogui YT, Sopoh GE, Johnson RC, de Zeeuw J, Dossou AD, et al. (2014) Contribution of the Community Health Volunteers in the Control of Buruli Ulcer in Bénin. PLoS Negl Trop Dis 8(10): e3200. doi:10.1371/journal.pntd.0003200 Editor: Gerd Pluschke, Swiss Tropical and Public Health Institute, Switzerland Received February 13, 2014; Accepted August 19, 2014; Published October 2, 2014 Copyright: 2014 Barogui et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The clinical care and case detection for BU patients in Benin are financially supported by Raoul Follereau Foundation (http://www.raoul-follereau.org), Follereau Luxembourg Foundation (http://www.ffl.lu), ANESVAD Foundation (http://www.anesvad.org/fr/). YS received a grant from the Netherlands Organisation of scientific research (NWO-veni, http://www.nwo.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * Email: yvesbaro@yahoo.fr