03133nas a2200349   4500000000100000008004100001653001600042653002700058653001600085653000900101653001100110653002900121653003500150653001000185653001100195653001000206653001700216653000900233653001000242653001500252100001400267700002100281700001300302700001400315700001200329245008300341856009000424300001000514490000600524520223900530022001402769       2011                            d10aYoung Adult10aMycobacterium ulcerans10aMiddle Aged10aMale10aHumans10aHealth Services Research10aHealth Services Administration10aGhana10aFemale10aChild10aBuruli ulcer10aAged10aAdult10aAdolescent1 aAckumey M1 aKwakye-Maclean C1 aAmpadu E1 aSavigny D1 aWeiss M00aHealth services for Buruli ulcer control: lessons from a field study in Ghana.  uhttp://journals.plos.org/plosntds/article/asset?id=10.1371%2Fjournal.pntd.0001187.PDF  ae11870 v53 a<p><strong>BACKGROUND: </strong>Buruli ulcer (BU), caused by Mycobacterium ulcerans infection, is a debilitating disease of the skin and underlying tissue. The first phase of a BU prevention and treatment programme (BUPaT) was initiated from 2005-2008, in the Ga-West and Ga-South municipalities in Ghana to increase access to BU treatment and to improve early case detection and case management. This paper assesses achievements of the BUPaT programme and lessons learnt. It also considers the impact of the programme on broader interests of the health system.</p>

<p><strong>METHODS: </strong>A mixed-methods approach included patients' records review, review of programme reports, a stakeholder forum, key informant interviews, focus group discussions, clinic visits and observations.</p>

<p><strong>PRINCIPAL FINDINGS: </strong>Extensive collaboration existed across all levels, (national, municipality, and community), thus strengthening the health system. The programme enhanced capacities of all stakeholders in various aspects of health services delivery and demonstrated the importance of health education and community-based surveillance to create awareness and encourage early treatment. A patient database was also created using recommended World Health Organisation (WHO) forms which showed that 297 patients were treated from 2005-2008. The proportion of patients requiring only antibiotic treatment, introduced in the course of the programme, was highest in the last year (35.4% in the first, 23.5% in the second and 42.5% in the third year). Early antibiotic treatment prevented recurrences which was consistent with programme aims.</p>

<p><strong>CONCLUSIONS: </strong>To improve early case management of BU, strengthening existing clinics to increase access to antibiotic therapy is critical. Intensifying health education and surveillance would ultimately increase early reporting and treatment for all cases. Further research is needed to explain the role of environmental factors for BU contagion. Programme strategies reported in our study: collaboration among stakeholders, health education, community surveillance and regular antibiotic treatment can be adopted for any BU-endemic area in Ghana.</p>
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