Fig 1.
Clinical manifestations of BU cases seen in Cameroon.
A. Papule: a swollen and non painful cutanous lesion of 003C1cm in diameter; B. Nodule: a swollen and non painful lesion extending from the skin to the sub-cutanous tissue, with a diameter of 1–2cm; C. Plaque: a firm and non painful induration of the skin with well delimited borders, usually with desqamation of the affected skin surface; D. Oedema: a diffuse and extended and non pitting swelling which is firm, non painful and has no clearly defined borders; E. Category I ulcer: a small ulcerated and mildly painful lesion of <5cm of diameter with undermined borders; F. Category II ulcer: an ulcerated lesion with undermined borders and a diameter of 5–15cm; G. Category III ulcer: a large ulcerated lesion of >15cm of diameter with indurated undermined borders, commonly has necrotic tissue on the ulcer bed; H. Disseminated BU lesions; I. Sequelae of BU: a viscious healing of a poorly treated BU lesion with complete retraction of the hand in an extesion position.
Fig 2.
Trend in BU case notification between 2001 and 2014 in Cameroon.
A cumulative number of 3700 BU cases were notified between 2001 and 2014, with an annual average case notification of 264 cases. The peak in 2004 is attributed to the national BU survey in that year. There is a progressive reduction in case notification since 2005. The annual BU detection rate increased from 0.99 in 2001 to 3.89 per 100 000 inhabitants in 2005 and dropped progressively to reach 1.45 per 100 000 inhabitants cases in 2014.
Fig 3.
Comparison between the Cameroon national and the global trend in BU cases from 2002 to 2014.
The trend in the global BU cases was similar to that of Cameroon with a rise from 3245 cases in 2002 to a peak at 5937 in 2004, followed by a progressive reduction to reach 2250 in 2014.The global BU data was downloaded from the WHO website at http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=2448
Fig 4.
Trends in key BU control indicators from 2006 to 2014.
Notice that during this period, the ulcerative form of BU constituted about 83% of lesions and 90% of all lesions were located on the limbs. On average, children below 15 years of age constituted 45% of cases. The proportion of category 3 lesions rose from 9% in 2008 to 52% in 2014 and the proportion of BU cases confirmed by PCR dropped from 57% in 2010 to 20% in 2014.
Fig 5.
Evolution of confirmed BU endemic health districts between 2001 and 2014.
During the period 2001–2002 (A), the only known BU endemic health districts were Ayos and Akonolinga in the Nyong basin of central Cameroon [19]. The first 2 BU-DTCs were created in these districts in 2002 to begin BU care in Cameroon. The national BU survey in 2004 following the creation of the NBUCP revealed the presence of BU in 19 other health districts (B). Three new BU-DTCs were created in 2006 in the 3 most endemic of the 19 health districts namely Bankim in the Adamawa region, Mbonge in the South west Region and Ngoantet-Mbalmayo in the Centre Region. From 2006–2014, the 5 BU-DTCs in the country have treated BU cases originating from sixty-four health districts (C).
Fig 6.
Milestones in the evolution of BU control activities in Cameroon, 1969–2014.
Although institutional BU control Cameroon only began 30 years after the first cases were reported in 1969, a number of milestones have been attained. These will serve as stepping stones for charting the way forward and improving upon control activities in the country.