Africa bears the major brunt of the global Buruli ulcer (BU) burden. In the past decade, more than 95% of all cases have been reported from Africa, with Côte d’Ivoire, Ghana, Benin, and Cameroon being the four most endemic countries. As the disease affects mainly populations in remote, rural areas, where access to formal healthcare structures is limited, the true prevalence of BU is difficult to gauge. The continued preference of BU patients in many of these endemic areas to first consult traditional healers before seeking biomedical treatment, results in a high proportion of patients with advanced stages of the disease, which often cause permanent disabilities. Reasons for a marked reduction of new infections reported from Africa in the past few years are poorly understood and include—apart from an actual reduction in BU incidence—the decline in international support for BU control programs and consequently decreased BU case-finding activities. Major efforts are required in the coming years to mobilize resources to maintain established healthcare infrastructure, surveillance systems, and expertise among health staff. Continued research is needed to solve serious challenges in the diagnosis and treatment of patients at primary healthcare facilities and district hospitals and to fill knowledge gaps on environmental reservoirs, potential vectors, and transmission mechanisms of Mycobacterium ulcerans, a crucial prerequisite for more targeted BU control strategies.
Copyright 2019, The Author(s).