Healthcare seeking behaviour for Buruli ulcer in Benin: a model to capture therapy choice of patients and healthy community members

Abstract

Buruli ulcer is a devastating condition emerging in West Africa. We investigated why patients often report late to the hospital. Health seeking behaviour determinants and stigma were studied by in-depth interviews in patients treated in hospital (n=107), patients treated traditionally (n=46) of whom 22 had active disease, and healthy community control subjects (n=107). We developed a model capturing internal and external factors affecting decision making. With increasing severity, extent and duration of Buruli ulcer, a shift of influencing factors on health seeking behaviour appears to occur. Factors causing delay in presenting to hospital were the use of traditional medicine before presenting at the treatment centre; costs and duration of admission; disease considered not serious enough; witchcraft perceived as the cause of disease; and fear of treatment, which patients expected to be amputation. This study confirms the importance of self-treatment and traditional healing in this area. Our study was performed before antimicrobial treatment was introduced in Benin; we suggest that this model and the results from this analysis should be used as a baseline from which to measure the influence of the introduction of antimicrobial treatment on health seeking behaviour for Buruli ulcer in Benin.

Severe Multifocal Form of Buruli Ulcer after Streptomycin and Rifampin Treatment: Comments on Possible Dissemination Mechanisms

“…Other factors that could be explored are the virulence of the bacteria and the herbal treatment sought by most patients in Benin (including DR) as a first treatment choice before presenting to a hospital. 33 Before 2004, BU treatment consisted of wide excision of the affected and healthy surrounding tissue. 12 Thus, the number of surgical interventions that patients with disseminated BU endured was quite significant (up to 32).…”

The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana

“…BU is most endemic in remote rural areas in west Africa, where health-care services are limited, and there is often a delay in seeking treatment. 2 Although an effective treatment with antimicrobials has been introduced more than a decade ago, the healing process is slow, with a median time to healing of 18-30 weeks in small lesions. 3 Large scars and contractures may result in functional limitations.…”

Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana

“…Use of selfmedication for Buruli ulcer has been reported in a study in Benin. 7 Indiscriminate use of antibiotics is a concern because of potentially undesirable health effects 18 and implications for treatment, recovery, and pharmacodynamic interactions with WHO-recommended antibiotics (rifampin and streptomycin) when given later to respondents at health centers.…”

“…15 Perceptions of the imminent severity or progression of Buruli ulcer have been identified as a contributing factor for delay in seeking medical treatment. 7,17 Buruli ulcer is known to affect poor, rural communities. 9,11,[19][20][21][22] Only 19% of our respondents received a regular income, 26.0% were unskilled workers, mainly subsistence farmers or petty traders, and most (55.3%) were in school.…”

“…Cultural beliefs, financial capacity, access to treatment facilities, prolonged hospitalization, and the fear of surgical outcomes are possible explanations. [7][8][9][10][11] However, there is limited information to distinguish help-seeking for pre-ulcer and ulcer infections. Explaining the distinguishing features of sociocultural features of help-seeking for pre-ulcer and ulcer conditions is important.…”