Improving Buruli ulcer control: steps towards decentralized care

The studies presented in this thesis were conducted in Benin, one of the countries in West Africa most affected by Buruli ulcer. We contributed in various ways to improve detection and management of Buruli ulcer, and describe the evolution of the epidemiology and pathogenicity of Buruli ulcer in Benin. We present the results of the evaluation of a novel diagnostic confirmation test for Buruli ulcer, as well as the effectiveness of a pilot project of decentralization of care as a strategy for the control of Buruli ulcer. We discuss the role of surgery in the treatment of Buruli ulcer through a randomized clinical trial to assess the effect of postponing the decision to include surgical treatment in the management of Buruli ulcer, and through a survey on surgical practice in different hospitals providing care for Buruli ulcer patients.