Management of Mycobacterium ulcerans disease (buruli ulcer) in the Territory of Songololo, Democratic Republic of Congo: Outcomes, challenges and prospects

Abstract

Background: Buruli ulcer is caused by infection with Mycobacterium ulcerans, an organism which belongs to the family of bacteria that causes tuberculosis and leprosy. Without treatment, the infection leads to destruction of skin and soft tissue with large ulcers usually on limbs, resulting to long-term functional disability. The General Reference Hospital of the “Institut Médical Evangélique” of Kimpese, located in the Territory of Songololo, known to be one of the main Buruli ulcer (BU) foci in the Democratic Republic of Congo, launched in 2004 a specialized BU program, offering in-patient treatment free-of-charge and supplementary aid. Although the number of BU cases admitted in the hospital was rising, a survey conducted in July-August 2008, in the Territory of Songololo, showed that only one in thirteen active BU cases was notified at the hospital at Kimpese in the 8 months prior to the survey. Methods & Materials: We conducted a prospective observational study from 2009 through 2012 to assess the impact of decentralization and integration of BU control activities at the primary level of the health system in Songololo. Results: The preliminary impact evaluation of the decentralization showed: (i) strong increase in case detection (3.6 times more cases detected), four years (2004-2007) before the Songololo survey conducted in 2008, 183 new cases have been reported, while 655 were detected after (2009-2012); (ii) the preponderance of category I lesions the last four years; (iii) around 50% of reported cases were confirmed by at least one laboratory test; (iv) three-quarters of reported cases have been treated in peripheral health centres; (v) increase in number of health areas reporting cases: On average, 15 out of 40 health areas before and 28 out of 40 after. Conclusion: Decentralization and integration of BU control activities seem to be key ways of improvement of access to diagnosis and care at the most peripheral level of the health system. Partnership with health zones are of utmost importance for the implementation of a simple, functional, and efficient surveillance system in a resource-limited context, exportable in other BU endemic regions of the country. Meanwhile, sustaining the project's impact remains a big challenge in the region.