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ASSESSING WATER-RELATED RISK FACTORS FOR BURULI ULCER: A CASE-CONTROL STUDY IN GHANA

To assess water-related risk factors of Buruli ulcer, a case-control study of 102 patients (51 cases and 51 controls) was undertaken by matching age group, sex, and bacille Calmette-Guérin (BCG) vaccination history in Ghana. The factors used here for matching have previously been implicated as factors of Buruli ulcer, an emerging infectious disease. This is the first study to delineate a set of previously suspected, water-related risk factors, in a case-control study matching for age group, sex, and BCG vaccination status. The results of both bivariate and multivariate analyses presented a significantly high odds ratio (OR) only for swimming in rivers on a habitual basis (OR = 18.00, P < 0.01) among the major water-related risk factors. Use of water from rivers and ponds for drinking, cooking, bathing, and washing purposes were not significant risk factors. Our data suggest that swimming, or activities on riverbanks associated with it, is a risk factor.

Received December 18, 2003. Accepted for publication April 21, 2004.

Acknowledgments: We thank Dr. S. Etuaful and all the other staff of St. Martin’s Catholic Hospital (Agroyesum, Ghana) and Dr. K. Aseidu (World Health Organization, Geneva, Switzerland) for their tremendous support in the data collection. We also thank Dr. D. Ofori-Adjei (Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana) and Dr. A. Nakazawa (School of Medicine, Yamaguchi University) for their technical advice and support in the laboratory. This work is sincerely dedicated to those who live in Buruli ulcer-endemic areas worldwide.

Financial support: This work was supported by the Foundation for Advanced Studies on International Development, Japan.

Authors’ addresses: Hirotsugu Aiga, Emergency Needs Assessment Unit, (FASID), United Nations World Food Programme, Via Cesare Giulio Viola, 68/70-Parco dé Medici, 00148 Rome, Italy, Telephone: 39-0-6513-2177, Fax: 39-6-6513-3080, E-mail: hirotsugu.aiga{at}wfp.org, Department of Global Health, School of Public Health and Health Services, Medical Center, The George Washington University 2175 K Street, NW, Suite 810, Washington, DC 20037, Telephone: 202-416-0092, Fax: 202-496-0400, E-mail: ihphxa{at}gwumc.edu, and Department of Health Policy and Planning, School of International Health, Faculty of Medicine, The University of Tokyo 7-3-1 Hongo, Bunkyoku, Tokyo 113-0033, Japan, Telephone: 81-3-5841-3688, Fax: 81-3-5841-3637, E-mail: hiroaiga{at}f6.dion.ne.jp. Takayuki Amano, Department of Neurosurgery, Yamaguchi University Hospital, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan, Telephone: Phone: 81-836-22-2012, E-mail: fzf01304{at}nifty.ne.jp. Sandy Cairncross, Disease Control Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Telephone: 44-20-7927-2211, Fax 44-20-7636-7843, E-mail: sandy.cairncross{at}lshtm.ac.uk. Joseph Adomako and Ofosu-Kwabi Nanas, Ashanti Regional Health Administration, Ministry of Health, PO Box 1908, Kumasi, Ashanti Region, Ghana, Telephone: 233-51-24809, E-mail: joseph_adomako{at}hotmail.com. Susan Coleman, Department of Global Health, School of Public Health and Health Services, Medical Center, The George Washington University, 2175 K Street, NW, Suite 810, Washington D.C. 20037, Telephone: 202-416-0406, Fax: 202-496-0400, E-mail: susancol{at}gwu.edu.

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