Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa

Abstract

BackgroundIn the Cameroon, previous efforts to identify Buruli ulcer (BU) through the mobilization of community health workers (CHWs) yielded poor results. In this paper, we describe the successful creation of a BU community of practice (BUCOP) in Bankim, Cameroon composed of hospital staff, former patients, CHWs, and traditional healers.Methods and principle findingsAll seven stages of a well-defined formative research process were conducted during three phases of research carried out by a team of social scientists working closely with Bankim hospital staff. Phase one ethnographic research generated interventions tested in a phase two proof of concept study followed by a three- year pilot project. In phase three the pilot project was evaluated. An outcome evaluation documented a significant rise in BU detection, especially category I cases, and a shift in case referral. Trained CHW and traditional healers initially referred most suspected cases of BU to Bankim hospital. Over time, household members exposed to an innovative and culturally sensitive outreach education program referred the greatest number of suspected cases. Laboratory confirmation of suspected BU cases referred by community stakeholders was above 30%. An impact and process evaluation found that sustained collaboration between health staff, CHWs, and traditional healers had been achieved. CHWs came to play a more active role in organizing BU outreach activities, which increased their social status. Traditional healers found they gained more from collaboration than they lost from referral.Conclusion/ SignificanceSetting up lines of communication, and promoting collaboration and trust between community stakeholders and health staff is essential to the control of neglected tropical diseases. It is also essential to health system strengthening and emerging disease preparedness. The BUCOP model described in this paper holds great promise for bringing communities together to solve pressing health problems in a culturally sensitive manner.

Social Science Contributions to BU Focused Health Service Research in West-Africa

“…A study conducted by Awah et al [16] in the Bankim region of Cameroon found perceptions of BU causality that are similar, yet distinct from those described in the Southern region of the country. BU like symptoms are seen as possibly having a natural cause, being the sign of a powerful spirit (mbouati), or being caused by witchcraft.…”

“…It has been widely reported that traditional healers are often a first resort for wound care in all three index countries [10,16,24,31,32], and that healers often treat BU related wounds for extended periods of time. It is beyond the scope of this chapter to provide a detailed account of the practices of traditional healers.…”

“…Few rigorous studies have been carried out to date to test the conditions under which collaborative relations between hospital staff and healers might be established toward the end of managing BU. One exception is a pilot project in Bankim, Cameroon [16]. The project is briefly summarized below in a section on social science inspired interventions.…”

“…Studies of health care seeking in all three index countries have reported that enabling factors are a major reason for delays in seeking treatment at hospitals and health posts [9,10,16,20,24,41,44,45]. Enabling factors include the seasonal availability and cost of transportation, direct and indirect treatment costs, and opportunity costs in the form of labor loss, especially during peak agricultural seasons.…”

“…Interventions offering patient support have been piloted in each of the three index countries (Benin: Ouinhi, Cameroon: Bankim, Ghana: Obom and Agogo). In each case, when free transportation to health posts and/or free food is offered to patients, clinic popularity increased and treatment delay and treatment drop-out decreased [16,31,40,51].…”