Health geography strategies for the prevention of Buruli ulcer disease : The COPTER-UB project in southern Benin

According to WHO criteria, Buruli Ulcer is a neglected tropic disease. It is caused by the M. ulcerans, an environmental mycobacterium, and its symptoms are necrotizing cutaneous lesions. Buruli ulcer affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. The principal risk factor for exposure to M. ulcerans identified to dateis direct contact with a slow-flowing or stagnant water source(since such configurations are reservoirs for the waterbugs which are considered to be the vector of the disease).This is reflected spatially by differentiated variations in incidence between villages in the same geographical area, and between neighborhoods in endemic villages. The Ouémé/Plateau region in southeastern Benin is particularly affected by these health inequalities(1). For these populations, there is a need for adapted and efficient prevention strategies. To gain a deeper understanding of the variation in incidence, our team used mixed methods research: the definition and observation of sources of water as well as water bodies and streams used by the communities, field observations, case-control studies, spatial analysis, and the analysis of environmental samples.This e-poster traces the evolution of our research strategies since 2016 to reach our current project named COPTER UB, particularly the health geography methods. Several teams are working in this program: ESO (geography) and ATOMycA (microbiology) in Angers, the CIFRED (public health) and the CDTLUB (hospital) in Benin. For the mapping we benefit of the help of the University of Reunion island specialized in remote sensing.  

Coupled analysis of socio-environmental data has already shown that well drillings and their use cannot alone explain these intra-village fluctuations in incidence (2). Today, the analysis of these mixed methods provides a set of new clues on the simultaneous role of social and environmental determinants responsible for the dynamics of the disease (3). Based on the results of GéAnt project (2018-2020), it appeared necessary to shift the focus from water supply points used for domestic activities (traditionally recognized as the main cause of many water-borne diseases) to the search for all spaces favorable to the vectors of the disease, which we did with the Dailyrisk MU project (2021-2022)and the geographic health surveys. These spaces at risk of transmission can be generated or perpetuated by the spatial practices and water resource management of the communities. In order to reduce the risks of exposure, we now assume that solutions and adaptation scenarios must be based on the experiences of local communities, on their traditional organization of space and on local knowledge. To this end, our methodology is evolving with the aim of bringing out collective rules, thought-out zonings of space, improved and refined by and for locals. This is inspired by the participatory learning tools applied to the ComMod (Companion modelling) approach.