02317nas a2200181   4500000000100000008004100001260003900042653001600081653002200097653003200119653001700151100001200168245006100180856012500241300001200366520173500378020002202113       2016                            d  bUniversity of GroningenaGroningen10aWest Africa10aTreatment Failure10acommunity health volunteers10aBuruli ulcer1 aZeeuw J00aBuruli ulcer in West Africa: Suffering beyond the wound.  uhttp://www.rug.nl/research/portal/en/publications/buruli-ulcer-in-west-africa(5f1452bd-30ae-4ffa-bb37-4e0f8039dc05).html  a147 p. 3 a<p>Buruli ulcer (BU) a skin disease caused by infection with Mycobacterium ulcerans, is endemic in West Africa. BU has always been described as a relatively painless condition, however results showed wound care dressings can be painful and that pain might be undertreated. Health care personnel confirmed this and stressed the need for adequate identification and treatment of pain. Therefore a two-day multidisciplinary interactive workshop was held in Ghana to discuss future steps in pain management. A proposed pain guide was developed entailing pain assessment and clinical judgment, and non-pharmaceutical and pharmaceutical options to relieve pain either suitable at district level or at village health care level.<br />
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Furthermore, it would be helpful if physicians had a test to differentiate treatment failure from a paradoxical reaction. The potential value of neopterin has been evaluated. It was found that neopterin does not show added value regarding the detection of paradoxical reactions.<br />
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Former studies have addressed the importance of rehabilitation, primarily to prevent functional limitations. Not only might functional limitations be a consequence of BU, but social problems might occur as well, for example because of stigma. The results demonstrate participation restrictions that are common among former BU patients and persist long after healing. Finally, as patients present late to hospitals the referral system has been evaluated. The results show that community health volunteers play an important role in referring BU patients. In any program targeting early case detection, these volunteers, but also former patients and teachers, are expected to play a pivotal role.</p>
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