02632nas a2200301   4500000000100000008004100001653001700042653002100059653001500080653001000095653001700105653003900122100002000161700001300181700001500194700001500209700001300224700001200237700001300249700001200262700001400274245016000288856009800448300001300546490000700559520175000566022001402316       2018                            d10aHealth staff10aHealth Education10aWound care10aBenin10aBuruli ulcer10aNeglected tropical diseases (NTDs)1 aAmoussouhoui AS1 aSopoh GE1 aWadagni AC1 aJohnson RC1 aAoulou P1 aAgbo IE1 aHouezo J1 aBoyer M1 aNichter M00aImplementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006291&type=printable  ae00062910 v123 a<p><strong>BACKGROUND: </strong>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.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>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.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>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.</p>
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