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Background: Morbidity due to Buruli ulcer disease (BUD), a cutaneous infection caused by Mycobacterium ulcerans, has been increasingly recognized in rural West Africa. The source and mode of transmission remain unknown., Methods: To identify BUD risk factors, we conducted a case-control study in 3 BUD-endemic districts in Ghana. We enrolled case patients with clinically diagnosed BUD and obtained skin biopsy specimens. M. ulcerans infection was confirmed by at least 1 of the following diagnostic methods: histopathologic analysis, culture, polymerase chain reaction, and Ziehl-Neelsen staining of a lesion smear. We compared characteristics of case patients with confirmed BUD with those of age- and community-matched control subjects using conditional logistic regression analysis., Results: Among 121 case patients with confirmed BUD, leg lesions (49%) or arm lesions (36%) were common. Male case patients were significantly more likely than female case patients to have lesions on the trunk (25% vs. 6%; P = .009). Multivariable modeling among 116 matched case-control pairs identified wading in a river as a risk factor for BUD (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27-5.68; P = .0096). Wearing a shirt while farming (OR, 0.27; 95% CI, 0.11-0.70; P = .0071), sharing indoor living space with livestock (OR, 0.36; 95% CI, 0.15-0.86; P = .022), and bathing with toilet soap (OR, 0.41; 95% CI, 0.19-0.90; P = .026) appeared to be protective. BUD was not significantly associated with penetrating injuries (P = .14), insect bites near water bodies (P = .84), bacille Calmette-Guerin vaccination (P = .33), or human immunodeficiency virus infection (P = .99)., Conclusions: BUD is an environmentally acquired infection strongly associated with exposure to river areas. Exposed skin may facilitate transmission. Until transmission is better defined, control strategies in BUD-endemic areas could include covering exposed skin.

Focus group discussions, key informant interviews and structured community interviews were used to describe the perceptions of caretakers of pre-school children in a predominantly rural district in Ghana. Over 75% considered ARI important in the community and there are a variety of local terms of describe various ARI illness entities. The perception of signs of severe ARI in children above two months of age was reasonably high; over 88% could mention at least one of two cardinal signs for severe ARI (difficulty in breathing, rapid breathing). The same cannot be said of their perception of signs for children less than two months of age. There was also a favourable perception of cause; a few misconceptions were however identified. There was no significant difference in perception between locality, age groups and educational levels. A high correlation between perception of cause and prevention of ARI was found. Health education programmes should re-enforce positive perceptions and address misconceptions. The difference in presentation of signs of severe ARI between older children and younger ones should also be stressed.

The paper looks at the phenomenon of global warming and its potential health effects and outlines a number of plausible response by the health sector in developing countries to its threat. It suggests that the health sector should facilitate an international effort at addressing this challenge, mainly through advocacy, epidemiological surveillance and awareness creation.

Caretakers of pre-school children were interviewed in Afigya Sekyere district, Ghana. Over 46% (n = 400) will buy drugs and 33% will use various herbs for mild ARI at home. Food is withheld during ARI episodes and few will attempt to treat perceived severe ARI at home. No association was found between knowledge of signs or causation of ARI and intended practice for mild and severe ARI. Finance and poor attitude of health workers were major concerns expressed by caretakers in seeking help from the orthodox health system.

This paper describes 90 cases of Buruli ulcer in Amansie West district, Ghana. 49% were below 15 years of age while 20% were over 50 years. There was a significant difference in the age and sex composition, with more males among the younger age groups than females but the converse among adults. Seasonal variation is described, with peak incidence in September and October. Cases who had received bacillus Calmette-Guérin (BCG) vaccination had a shorter duration of the ulcer than those who were not vaccinated. No such association was found between BCG vaccination and the age of onset of the disease. There was no significant difference between cases and controls regarding their BCG vaccination status. There is an urgent need to regard Buruli ulcer in Ghana more seriously.