Mixed Research Methods for Buruli Ulcer Prevention in Southern Benin Using Geographic Health Surveys

Buruli ulcer meets the WHO (World Health Organization) criteria for a neglected tropic disease. This disease, characterised by necrotising cutaneous lesions, is caused by M. ulcerans, an environmental mycobacterium. Buruli ulcer affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. This is reflected spatially by differences in incidence between villages in the same geographic area and between neighbourhoods in villages endemic for the disease. Adapted and efficient prevention strategies are needed for the affected populations. We investigated the variation of incidence in depth, by performing geographic health surveys in all the “living spaces” frequented by local populations. This approach is innovative in three ways: (1) the scale of the detailed analysis (a borough or village) and the combination of GPS-based geolocalisation with a case-control study, (2) the combination of data collection methods derived from approaches developed in social and human sciences (SHS) with microbiological analysis and (3) longitudinal follow-up of cases oriented towards direct observation. Based on field work performed in the Ouémé/Plateau region in Southeast Benin, this chapter traces the development of our research strategies since 2016, culminating in our current research project: COPTER UB.