03014nas a2200409   4500000000100000008004100001653001600042653002400058653001800082653000900100653001100109653001100120653002100131653001700152653002100169653001000190653002500200653001300225653001700238653001000255653001500265100001400280700001400294700001700308700002100325700001200346700001500358700001700373700001500390700001400405245013500419856007800554300001000632490000600642520194200648022001402590       2011                            d10aYoung Adult10aWounds and Injuries10aMosquito Nets10aMale10aHumans10aFemale10aEndemic Diseases10aDisinfection10aChild, Preschool10aChild10aCase-Control Studies10aCameroon10aBuruli ulcer10aAdult10aAdolescent1 aLandier J1 aBoisier P1 aFotso Piam F1 aNoumen-Djeunga B1 aSimé J1 aWantong FG1 aMarsollier L1 aFontanet A1 aEyangoh S00aAdequate wound care and use of bed nets as protective factors against Buruli Ulcer: results from a case control study in Cameroon.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210760/pdf/pntd.0001392.pdf  ae13920 v53 a<p><strong>BACKGROUND: </strong>Buruli ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans. Its exact transmission mechanism remains unknown. Several arguments indicate a possible role for insects in its transmission. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>We conducted a case-control study on 77 Buruli ulcer cases and 153 age-, gender- and village-matched controls. Participants were interviewed about their activities and habits. Multivariate conditional logistic regression analysis identified systematic use of a bed net (Odds-Ratio (OR) = 0.4, 95% Confidence Interval [95%CI] = [0.2-0.9], p-value (p) = 0.04), cleansing wounds with soap (OR [95%CI] = 0.1 [0.03-0.3], p&lt;0.0001) and growing cassava (OR [95%CI] = 0.3 [0.2-0.7], p = 0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI] = 6.9 [1.4-35], p = 0.02) and reporting scratch lesions after insect bites (OR [95%CI] = 2.7 [1.4-5.4], p = 0.004). The proportion of cases that could be prevented by systematic bed net use was 32%, and by adequate wound care was 34%.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>Our study confirms that two previously identified factors, adequate wound care and bed net use, significantly decreased the risk of Buruli ulcer. These associations withstand generalization to different geographic, climatic and epidemiologic settings. Involvement of insects in the household environment, and the relationship between wound hygiene and M. ulcerans infection should now be investigated.</p>
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