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Barriers to Buruli ulcer treatment completion in the Ashanti and Central Regions, Ghana.

Abstract：

BACKGROUND:Buruli ulcer is a chronic ulcerating skin condition, with the highest burden found in Central and West Africa where it disproportionately affects the most vulnerable populations. Treatment is demanding, comprising eight-weeks of daily antibiotics, regular wound care and possible surgical intervention. Treatment completion is key to optimising outcomes, however the degree of and barriers to this are not well understood. Recent change from injectable treatment (SR8) to oral treatment (CR8) has made it feasible to further decentralise care, potentially improving treatment access and completion. However, the impact of this and of other demographic and clinical influences on treatment completion must be explored first to ensure appropriate models of care are developed. METHODOLOGY/PRINCIPAL FINDINGS:A retrospective clinical notes review and secondary data analysis of records from patients diagnosed between 1 January 2006-31 December 2018 at four district hospital clinics in the Ashanti and Central Regions, Ghana. Univariable analyses and multivariable logistic regression were performed to assess the association between explanatory variables and treatment completion. There were 931 patient episodes across the four clinics with overall treatment completion of 84.4%. CR8 was associated with higher treatment completion compared to SR8 (OR 4.1, P = 0.001). There was no statistically significant association found between distance from patient residence to clinic and treatment completion. CONCLUSIONS/SIGNIFICANCE:Improved treatment completion with CR8 supports its use as first line therapy and may enable decentralisation to fully community-based care. We did not find an association between distance to care and treatment completion, though analyses were limited by data availability. However, we did find evidence that distance to care continues to be associated with more severe forms of disease, which may reflect the higher costs of accessing care and lower awareness of the condition the further a patient lives. Decentralised care must therefore also continue to support community engagement and active outreach to identify cases early.

journal_name

PLoS Negl Trop Dis

journal_title

PLoS neglected tropical diseases

authors

Collinson S,Frimpong VNB,Agbavor B,Montgomery B,Oppong M,Frimpong M,Amoako YA,Marks M,Phillips RO

doi

10.1371/journal.pntd.0008369

subject

Has Abstract

pub_date

2020-05-26 00:00:00

pages

e0008369

issue

eissn

1935-2727

issn

1935-2735

pii

PNTD-D-20-00091

journal_volume

pub_type

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Barriers to Buruli ulcer treatment completion in the Ashanti and Central Regions, Ghana.