Rapid Assessment Survey of The Prevalence of Buruli Ulcer in The Health District of South Maniema, Maniema Province, The Democratic Republic of The Congo

Abstract

Background: Buruli ulcer (BU) is endemic in more than 30 countries worldwide. Africa is the most affected continent with 16 confirmed endemic countries and 7 suspected or potential endemic countries. In the Democratic Republic of the Congo, a survey in 2004 showed the presence of suspected cases of BU in five of the country's 11 provinces. The current survey was carried out in 2010 to confirm the endemicity of BU is the southern part of the Maniema Province and to provide support for case management and control measures if necessary. Method: The method of the survey was based on the protocol of rapid prevalence assessment survey (RPAS), proposed by the Buruli ulcer control Program of the World Health Organization (WHO) Regional Office for Africa to confirm BU endemic in countries. It included: awareness campaign and sensitization of health workers and communities in suspected endemic areas, followed by clinical screening of patients with suspected BU lesions and sampling of suspicious lesions by swab or fine needle aspiration (FNA) for laboratory confirmation of diagnosis, mainly by PCR. WHO-recommended treatment is proposed for cases which clinical features were in favor of the diagnosis of Buruli ulcer. Results: The survey in the Southern part of Maniema province targeted six of the nine health zones of Kasongo district. The three other health zones in the district were not be visited for accessibility and security reasons. A total of 66 suspected cases of Buruli ulcer were found at the Hospital of Kindu and in the six visited health zones. The lab tests with Ziehl-Nielsen (ZN) technique have confirmed 9 cases of BU. PCR tests confirmed eight cases of BU, including three who were not positive to the ZN tests. This makes a total of 12 BU patients confirmed by ZN and/or PCR and gives a proportion of laboratory confirmation of 18%. Discussions: Based on the results of this survey all health zones in South Maniema were classified as Buruli ulcer endemic areas, because of the same geo-climatic features that characterize all of them. These findings are similar to those of previous studies in the same province. The low confirmation rate of BU suspected cases by laboratory tests (18%) could be explained by the fact that many of the suspicious lesions which were sampled were very old wounds and had been evolving for several years. The WHO Regional Office for Africa has developed a plan of surveys, using the same rapid assessment protocol to confirm the endemicity of Buruli ulcer in other suspected endemic provinces of the DRC and in other member states of WHO African Region.