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Implementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa
PLOS Neglected Tropical Diseases ( IF 3.8 ) Pub Date : 2018-03-12 , DOI: 10.1371/journal.pntd.0006291
Arnaud Setondji Amoussouhoui , Ghislain Emmanuel Sopoh , Anita Carolle Wadagni , Roch Christian Johnson , Paulin Aoulou , Inès Elvire Agbo , Jean-Gabin Houezo , Micah Boyer , Mark Nichter

Background

Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU), is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In Benin, BU patient care is being integrated into the government health system. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin’s most endemic districts previously served by centralized hospital-based care.

Methodology/Principal findings

We conducted intervention-oriented research implemented in four steps: baseline study, training of health district clinical staff, outreach education, outcome and impact assessments. Study results demonstrated that early BU lesions (71% of all detected cases) could be treated in the community following outreach education, and that most of the afflicted were willing to accept decentralized treatment. Ninety-three percent were successfully treated with antibiotics alone. The impact evaluation found that community confidence in decentralized BU care was greatly enhanced by clinic staff who came to be seen as having expertise in the care of most chronic wounds.

Conclusions/Significance

This study documents a successful BU outreach and decentralized care program reaching early BU cases not previously treated by a proactive centralized BU program. The pilot program further demonstrates the added value of integrated wound management for NTD control.



中文翻译:

在西非贝宁Ouinhi区实施以社区为基础的分散治疗计划,以改善Buruli溃疡的管理

背景

溃疡分枝杆菌感染,通常称为布鲁氏溃疡(BU),是一种使人衰弱的被忽视的热带病。它的管理仍然很复杂,并且具有三个主要组成部分:利福平和链霉素联合抗生素治疗56天;大溃疡形成的伤口敷料和皮肤移植物;以及物理治疗,以防止护理后的功能受限。在贝宁,BU的病人护理已被整合到政府的卫生系统中。在本文中,我们报告了一项创新的试点计划,该计划旨在引入Ouinhi地区的BU权力下放,该地区以前是贝宁最流行的地区之一,以前曾由中央医院提供医疗服务。

方法/主要发现

我们进行了以干预为导向的研究,该研究分四个步骤实施:基线研究,卫生区临床人员培训,外展教育,结果和影响评估。研究结果表明,早期BU病变(占所有检出病例的71%)可以在外展教育后在社区得到治疗,而且大多数患病者愿意接受分散治疗。仅使用抗生素就成功治疗了百分之九十三。影响评估发现,诊所工作人员大大增强了社区对分散式BU护理的信心,后来被视为在大多数慢性伤口的护理方面具有专长。

结论/意义

这项研究记录了一个成功的BU推广和分散式护理计划,该计划针对以前未由主动的集中BU计划治疗的早期BU病例。该试点计划进一步展示了集成伤口管理对NTD控制的附加价值。

更新日期:2018-03-13
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