School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
BMC Public Health. 2012 May 11;12:264. doi: 10.1186/1471-2458-12-264.
Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra.
Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher's exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents' narratives clarified illness experiences and meanings with reference to PC and PD variables.
Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messages
Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives.
加纳是布吕利溃疡（BU）流行地区，但关于 BU 的社会文化研究却很少。研究 BU 前期溃疡和溃疡患者的独特经历和意义，可以阐明疾病负担、疾病体验以及对病因和传播、BU 的环境特征的当地认知，这有助于指导公共卫生计划和未来的研究。本研究旨在解释加纳西部和南部直辖市 Ga-West 和 Ga-South 地区的 BU 前期溃疡和溃疡患者对 BU 的当地意义和体验。
采用基于解释模型访谈目录框架的半结构式访谈，对 181 名受访者进行了调查，其中包括 15 名前期溃疡患者和 166 名溃疡患者。使用 Wilcoxon 秩和检验比较了前期溃疡和溃疡患者的疾病经历（PD）和感知病因（PC）类别。使用 Fisher 精确检验比较了最困扰 PD 和最重要 PC 变量。参考 PC 和 PD 变量，对受访者叙述的内容进行了定性现象学分析，以阐明疾病经历和意义。
前期溃疡患者的家庭和患者本人经常对疾病进展感到焦虑，而溃疡患者的家庭则因需要照顾患者而担心收入损失和学业中断。前期溃疡患者经常报告在池塘和河流中游泳是一种感知到的病因，并认为这是最重要的 PC（53.3%）。溃疡患者经常将 BU 疾病归因于巫术（64.5%），而那些声称自己没有接触水的患者，则对健康信息的可信度提出质疑。
由于社会和经济限制以及没有疼痛，前期溃疡患者可能会延迟治疗。对于溃疡患者来说，对水在疾病传播和愈合过程中的作用的怀疑，使得巫术作为病因的观点更具可信度。健康信息应该解决当地感知到的风险和脆弱性问题。在研究结果的指导下，还需要进一步研究环境、社会文化和遗传因素在 BU 传播中的作用，以澄清和制定健康信息，加强公共卫生倡议。
