Buruli ulcer: prevention of disability (POD).

Buruli ulcer (BU) can cause permanent disability and deformity, which may severely limit a person’s ability to carry out normal daily activities. The stigma associated with the disease may have the additional effect of greatly restricting the social participation of affected persons. Early detection and adequate medical and surgical treatment are important in helping to minimize future disability. However, there are additional, more specific interventions that can prevent or reduce the disability and deformity caused by BU.

The purpose of this manual is to describe these essential interventions, which can become a normal part of the management of those affected by Buruli ulcer. Prevention of disability (POD) is a process involving health workers, the individuals affected by BU and their families, and communities. This process should start as soon as the diagnosis of Buruli ulcer is made. Rehabilitation aims to reduce the impact of disability, enabling the individual to achieve independence, social integration, and a better quality of life.

POD is an integral part of BU case management, and has three main objectives:

1. to maintain or improve skin conditions to prevent soft tissue (ligament, tendon, and muscle) contractures, which can lead to joint contractures and deformity (soft tissue and joints require good “antideformity” positioning and early mobilization before and after surgical excision and during the wound-healing process);

2. to minimize or reduce oedema, infection, pain, adhesions, and thick scarring during the wound-healing process; and

3. to encourage, enable, and empower.