Knowledge and attitude towards Buruli ulcer disease in Adjumani district, Northwestern Uganda

Abstract

Background: Buruli ulcer is a devastating skin disease caused by Mycobacterium ulcerans. It produces a necrotissing toxin, which destroys the skin, subcutaneous tissue and bone, often leaving the patients with debilitating deformities. The mode of transmission of the disease is unclear, but water borne vectors may transmit M. ulcerans. Treatment is difficult and often involves extensive surgery, which is the current standard treatment, but it may result in scarring and subsequent physical limitations due to scar retraction. These physical limitations may result in psychosocial and economic problems. It was hypothesised that superstitious beliefs about the illness, and stigma were important determinants for health seeking behaviour. The consequences of the disease include social isolation and economic problems in family life.

Objective: To explore the knowledge and attitude of the people affected by Buruli ulcer disease in Adjumani district, in northwestern Uganda.

Design: A semi-structured questionnaire was administered to all the selected patients.

Setting: Selected Health centres in Adjumani district, which included Adjumani hospital, Pakele HCIII, Dzaipi HCIII, Mungula HCIII and Opinjinji HCIII.

Subjects: A total of Nineteen (19) clinically diagnosed patients with Buruli ulcer were consented and interviewed for this study.

Results: A total of nineteen (19) patients were interviewed for this study. Of these, 10 (52.6%) were female and nine (47.4%) were male. Majority of the respondents were peasant farmers (N=9, 47.4%), mainly undertaking subsistence farming for home consumption. Most of the patients (N=16, 84.2%) had their lesions on either the upper or lower limbs. The majority (N=13, 68.4%) said they know the disease affecting them and only 6 (31.6%) patients did not know. Majority of patients 17 (89.5%) sought for medical and/or traditional therapy, while only two (10.5%) did not do anything about it. Of those who sought for help, nine (52.9%) opted for traditional herbal treatment, while 8 (47.1%) went for conventional medical treatment at a health unit. Most patients reported a wide range of stigma labeled against them, and these included; fear that they may infect others (N=2, 10.5%), fear that they have been bewitched or cursed (N=2, 10.5%), discrimination at school to the extent that he dropped out of school, and avoidance by others.

Conclusion: This study has shown that patients with Buruli ulcer are still stigmatised as members of the community. It is important that educational programme on Buruli ulcer be developed which increases awareness of the disease and may also lower the level of stigma. These programme will also help in disease detection and hopefully improve the health seeking behaviour of patients.