Mapping the global distribution of Buruli ulcer through a systematic review with an evidence consensus approach

Simpson, Hope, Deribe, Kebede, Nijih Tabah, Earnest, Peters, Adebayo, Maman, Issaka, Frimpong, Michael, Ampadu, Edwin, Phillips, Richard, Saunderson, Paul, Pullan, Rachel L and Cano, Jorge (2019) Mapping the global distribution of Buruli ulcer through a systematic review with an evidence consensus approach. Lancet Global Health, 7 (7). e912-e922. ISSN 2214-109X

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Abstract

Background
Buruli ulcer can cause disfigurement and long-term loss of function. It is underdiagnosed and under-reported, and its current distribution is unclear. We aimed to synthesise and evaluate data on Buruli ulcer prevalence and distribution.

Methods
We did a systematic review of Buruli ulcer prevalence and used an evidence consensus framework to describe and evaluate evidence for Buruli ulcer distribution worldwide. We searched PubMed and Web of Science databases from inception to Aug 6, 2018, for records of Buruli ulcer and Mycobacterium ulcerans detection, with no limits on study type, publication date, participant population, or location. English, French, and Spanish language publications were included. We included population-based surveys presenting Buruli ulcer prevalence estimates, or data that allowed prevalence to be estimated, in the systematic review. We extracted geographical data on the occurrence of Buruli ulcer cases and M ulcerans detection from studies of any type for the evidence consensus framework; articles that did not report original data were excluded. For the main analysis, we extracted prevalence estimates from included surveys and calculated 95% CIs using Byar's method. We included occurrence records, reports to WHO and the Global Infectious Diseases and Epidemiology Network, and surveillance data from Buruli ulcer control programmes in the evidence consensus framework to grade the strength of evidence for Buruli ulcer endemicity. This study is registered with PROSPERO, number CRD42018116260.

Findings
2763 titles met the search criteria. We extracted prevalence estimates from ten studies and occurrence data from 208 studies and five unpublished surveillance datasets. Prevalence estimates within study areas ranged from 3·2 (95% CI 3·1–3·3) cases per 10 000 population in Côte d'Ivoire to 26·9 (23·5–30·7) cases per 10 000 population in Benin. There was evidence of Buruli ulcer in 32 countries and consensus on presence in 12.

Interpretation
The global distribution of Buruli ulcer is uncertain and potentially wider than currently recognised. Our findings represent the strongest available evidence on Buruli ulcer distribution so far and have many potential applications, from directing surveillance activities to informing burden estimates.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Brighton and Sussex Medical School > Global Health and Infection
Research Centres and Groups: Brighton and Sussex Centre for Global Health Research
Subjects: R Medicine
Depositing User: Deborah Miller
Date Deposited: 09 May 2019 14:14
Last Modified: 01 Jul 2019 12:15
URI: http://sro.sussex.ac.uk/id/eprint/83621

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Project NameSussex Project NumberFunderFunder Ref
The Global Atlas of PodoconiosisG1974WELLCOME TRUST201900/Z/16/Z