The socio-economic impact of Buruli Ulcer in the Amansie-West District of the Ashanti Region

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Buruli ulcer, which is a disease, caused by mycobacterium ulcerans, a bacterium similar to those of tuberculosis (TB) and leprosy has affected a lot of people all over the world in about 31 countries (WHO Report, 1998). Thus in terms of numbers, it is the third most common mycobacteria after TB and leprosy, (Asiedu et al. 2000) In recent years, increasing number of cases have been reported in some countries in West Africa; namely Benin, Ghana, Togo, Cote d’Ivoire and Liberia. In addition to these numbers of cases, there has also been increasing geographical spread of the disease within these countries. In Ghana the first suspected case of Buruli ulcer was reported at the Korle Bu teaching Hospital in Accra in 1971 (Bayley, 1971). Afterwards, the number of cases has been increasing. Between 1993 and 1997, nearly 2000 cases have been reported. Five of the 10 regions and 35 of the 110 Districts of the country are affected. Thus, the disease has generated a serious health concern in Ghana since 1993 to policy makers, health professionals and has affected individuals and communities. In the Amansie West of the Ashanti Region of Ghana, the effects of the disease have been very devastating. At the St. Matins Hospital at Manso Agroyesum, between 1994 and 1996, out of the 102 cases treated, about 1 % of them reported for health services in the early stage, whilst 79% sought treatment in the late stage, resulting in chronic functional disability of 22% of patients, (Etuaful et al, 1998). The affected patients subsequently became socially and economically inactive as far as education, employment and other activities are concerned. This means that the disease has a dramatic socio-economic impact on the infected persons’ lifestyle. This situation needs all sorts of assistance from individuals, Government and NGOs. However, much information on the socio-economic impact of Buruli ulcer on infected persons, and even their households is not available. Yet such information is useful for the identification of victims of the disease who need assistance of any form. One main objective of the study is to identify and assess the socio-economic impacts of Buruli ulcer on the infected persons in the Amansie West District, which may be very useful to individuals and health planners who may offer the patients the required support and rehabilitation. The study was cross-sectional and descriptive which was focused on the indicators of social and economic impacts of Buruli ulcer in the Amansie West District. It was conducted on a randomly selected sample of 100 people of 18 years and above infected by the disease from 10 communities. Selected family members, health personnel and key informants were also interviewed. Closed and open-ended structured interviews were used to elicit information from respondents. The findings of the study showed that 72% of the respondents spent between ¢300,000 and ¢1.5m on herbs, with an average total treatment cost per person of ¢980,000 (US$140), whilst 92% spent between ¢5m and ¢20m as hospital cost with an average total treatment cost of 0 12m (US$ 1,786). The study further revealed that 52% of those interviewed indicated that Buruli ulcer is contagious. Between 2 and 5 persons were infected in a household. The infection rate was between 1 and 9 persons every month. Furthermore it was revealed that 92% of the respondents were physically, socially and economically incapacitated, with 56% being physically deformed and 36% completely disabled. The remaining 8% were not quite strong though not completely incapacitated. Majority (88%) felt psychologically traumatized by the effects of the disease. Findings further revealed that most (88%) of the victims who were still in school could not continue their schooling, and 68% indicated that Buruli ulcer has immensely affected their marriage. Again 68% of those infected could not work any more. The remaining 32% who could work were not satisfied with their overall output. The study further showed that 56% of those who could not work were catered for by their immediate families whilst 44% were supported by their relatives, NGOs and Government. Therefore, the study revealed that all the affected victims of Buruli ulcer were rendered extremely poor by the disease. The research therefore recommended that people in the endemic communities should be educated periodically with simple methods of detecting and reporting the disease early enough to forestall the devastating effects of the disease. It is further recommended that the Ministry of Health (MOH) strengthens Community Based Surveillance Programme (CBSP) through training and provision of adequate funds and logistics for better delivery, and deformed patients should be socially, physically and economically rehabilitated in the health facilities and communities. The researcher again recommended that the treatment of the disease should be entirely free in accordance with Yamoussoukro Conference in 1998. Moreover, relatives and communities should also strengthen their relationship with and support to the Buruli ulcer patients to show much love and care to reduce stigmatization.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of in Health Services Planning and Management, 2003