03081nas a2200445   4500000000100000008004100001653001600042653001500058653002600073653001600099653000900115653002000124653001100144653001100155653002900166653001000195653001700205653001000222653001000232653001500242100001300257700001100270700001300281700001500294700001300309700001500322700001400337700001600351700001200367700001300379700001600392700001300408700001400421245009400435856009000529300001000619490000600629520198600635022001402621       2014                            d10aYoung Adult10aVolunteers10aRetrospective Studies10aMiddle Aged10aMale10aLogistic Models10aHumans10aFemale10aCommunity health workers10aChild10aBuruli ulcer10aBenin10aAdult10aAdolescent1 aAsiedu K1 aWerf T1 aAguiar J1 aJohnson RC1 aSopoh GE1 aBarogui YT1 aDossou AD1 aStienstra Y1 aZeeuw J1 aChauty A1 aAgossadou D1 aEdorh PA1 aHouezo JG00aContribution of the community health volunteers in the control of Buruli ulcer in Bénin.  uhttp://journals.plos.org/plosntds/article/asset?id=10.1371%2Fjournal.pntd.0003200.PDF  ae32000 v83 a<p><strong>BACKGROUND: </strong>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.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>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.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>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.</p>
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