Technical Advisory Group and
Annual Meeting on Buruli ulcer
Geneva, Switzerland
13–17 March 2006
Main conclusions and
recommendations
Buruli ulcer 8-point control strategy
1. Early case detection at the community level and
2.
3.
4.
5.
6.
7.
8.
information, education and communication (IEC)
Training of health workers, schoolteachers and
village health workers
Standardized case management [antibiotics, surgery
and prevention of disability (POD)]
Laboratory confirmation of cases
Strengthening of health facilities
Standardized recording and reporting using forms BU
01 and BU 02 and the HealthMapper software
Monitoring and evaluation of control activities
Advocacy, social mobilization and partnerships
Community education
and early detection of cases
 Training and involvement of village health workers,




schoolteachers and local leaders.
Active screening of populations at risk, particularly
schoolchildren, during community education activities.
Widespread distribution and use of IEC materials at
villages, schools and health facilities to enhance case
detection.
Regular screening of WHO Buruli ulcer video in endemic
villages, at schools and among health facilities.
Ensuring availability of televisions, DVD players and
portable generators at district and health-facility levels to
support community education.
Training – ongoing at country level
 Despite the progress made in many countries, Buruli




ulcer remains poorly understood, leading to
misdiagnosis and mismanagement of cases.
Training and retraining are essential in building
knowledge and skills of health workers and others to
improve diagnosis and treatment of the disease.
Necessary materials should be available to support
training.
Training should be adapted to local contexts and
optimize community participation, including that of
schoolteachers and village health workers.
Governments of endemic countries, WHO, NGOs and
other partners are urged to support countries to
accelerate progress in this area.
Training – surgery
 Antibiotic treatment is reducing the reliance on surgery in
management of the disease.
 However, in some cases, surgery is needed to remove
necrotic tissue and cover skin defects.
 To ensure the standardization of surgical management, a
4-week training programme is expected to start in May
2006 at which 10 countries will participate.
 NGOs are welcome to support this training programme
and help provide basic equipment to facilities from which
trainees are sent to participate.
Antibiotics treatment in the field
 Increasing evidence shows that the combination of




rifampicin and streptomycin heals small- and mediumsized lesions and reduces the extent of surgery in large
lesions.
New evidence shows that in osteomyelitis cases,
previous antibiotic treatment is beneficial and should be
given for at least 4 weeks before surgical intervention.
The widespread use antibiotics is recommended in the
management of all forms of the disease.
Careful monitoring of patients and proper documentation
of treatment outcomes should be carried out according
to WHO guidelines.
WHO will provide drugs to endemic countries upon
request.
Prevention of disability
 Important progress has been made in this area over the past





2 years, including the development of a POD manual and
other materials.
National programmes should identify a POD expert to assist
in training and supervision of POD activities.
All health workers involved in BU management should receive
basic training in POD.
NGOs should continue to assist countries in developing the
basic capacity to implement POD activities in various centres
and communities as well as rehabilitation for those in need.
Essential that the implementation POD activities is well
coordinated among different partners.
WHO will organize a training-of-trainers for national POD
supervisors and programme managers in 2006.
Laboratory diagnosis
 Better organization of laboratory confirmation of cases in





national programmes.
Direct smear examination at any health facility where TB
microscopy is done.
Quality control using other methods, particularly PCR, is
highly recommended.
Identification of laboratory networks to support PCR,
culture and histopathology confirmation and quality
assurance.
Evaluation of feasibility of using needle aspiration to
obtain specimens from non-ulcerative disease for direct
smear examination and PCR (research proposal).
Development of a guideline for laboratory confirmation of
cases (after the evaluation of needle aspiration).
Strengthening of health facilities
 NGOs are contributing to the improvement of
health facilities as a means of improving
access to treatment, and this effort should
continue.
Surveillance
 Endemic countries are urged to use form BU 02
to register cases.
 All countries should report data to WHO using
form BU 02.
 Cases should be mapped using prevalence data
at village level (derived from form BU 02).
 WHO should assist endemic countries to
develop capacity to use the HealthMapper
software to analyse and report data.
Classification of endemic countries
 Group 1. National programmes implementing the 8-
point strategy (Benin, Cameroon, Ghana, Guinea).
However, these countries need to intensify and
increase coverage of their activities.
 Group 2. Need to strengthen the national programme
and begin to actively implement the 8-point strategy
(Togo, Gabon, Congo, Democratic Republic of the
Congo, Côte d'Ivoire).
 Group 3. Need to improve surveillance to identify
endemic foci to assist in targeting activities
(Equatorial Guinea, Liberia, Malawi, Nigeria, Papua
New Guinea, Peru, Sierra Leone, Sudan, Uganda).
Global indicators (core indicators)
All endemic countries should use the following
indicators in reporting to the annual meetings:
 number of new and recurrent cases (analysed
by age, sex and place);
 proportion of cases confirmed by at least one
method (if possible by PCR for quality control);
 proportion of non-ulcerative cases out of the
total number of cases detected;
 proportion of cases healed with antibiotic
treatment only;
 proportion of cases healed with deformity.
National and local-level indicators
 number of IEC campaigns carried out;
 proportion of patients completing the 8-week antibiotic





treatment (compliance);
proportion of positive results out of total number of
samples examined;
number of health workers, schoolteachers and village
health workers trained;
coverage – number of health facilities equipped to
manage cases and implementing at least antibiotic
treatment;
number of districts and health facilities using forms BU
01 and 02;
number of monitoring visits carried out by the national
programme.
Working groups and networks
1.
2.
3.
4.
5.
6.
7.
8.
Advocacy, communication and social mobilization
Country monitoring and evaluation team (assists countries
to build or strengthen national programmes)
Surgery (aimed at promoting and developing national
capacities in surgery)
POD (aimed at promoting and developing national
capacities)
Socioeconomic research (network to promote and
coordinate work in this area)
Drug development (working group to research into new
treatment options)
Basic science (network to promote and coordinate
research on diagnostics, vaccines and pathogenesis)
Epidemiology/transmission – (network to coordinate
epidemiological and transmission studies)
Country monitoring and evaluation team
Establishment of an international monitoring and evaluation
team (comprising WHO and selected TAG members) to:
 Assist countries to develop, implement and sustain BU
control using the 8-point strategy adopted in March 2005.
 Continuously review the status of implementation, measure
progress in countries and stimulate action when necessary.
 Share the results of country evaluation visits with national
authorities, relevant partners, experts and others so that the
appropriate response can be mobilized to help the country
concerned.