Management of Mycobacterium ulcerans disease (buruli ulcer) in the Territory of Songololo, Democratic Republic of Congo: Outcomes, challenges and prospects

Background: Sudan is in the yellow fever (YF) belt of Africa. In 2005 last outbreak of YF was detected in South Kordofan. In September 2012 Darfur States started to report the emerging of YF cases. The ongoing field investigation and management of YF outbreak was conducted to establish existence of outbreak,describe epidemiology of diseaseand to provide feedback for prevention and control Methods & Materials: A Field based assessment was conducted by, interviews, lab test, questionnaires and standard lab forms. Interviews conducted with key informants, patients, health personnel, family of deceased and nomads in the city and market. Blood samples taken. Quantitative and qualitative data analyzed using SPSS for interpretation of results. Results: From Sep 1st thru 28th Nov 2012 a total of 578 cases reported to Federal Ministry of health(FMOH) and resulted in 129 deaths, with CFR = 29%, AR 22.3. Common symptoms include; fever (98%), headache (71%), bleeding manifestation (50%), jaundice (39%). The most affected age group was 15-29.9 years (51%). All cases were notified from Darfur states, (Central 62%), East (0.5%), West (17%), North (11.5%) and South (9%), where 30 localities out of 57 were included. Male to female ratio 2:1. Similar sex and age distribution of exposure found among nomads and residents. Risk factors include; nomadic lifestyle, refugee camps, mountainous areas, presence of monkeys and vectors. Two samples out of first five were confirmed by IgM ELISA test and RT-PCR by the WHO reference laboratory for YF in Dakar, Senegal. Total of 67 samples from outbreak processed locally in National Public Health lab revealed 11 positive, 11 negative for YF, 2 negative 2 positive for flavivirus. Conclusion: FMOH detected YF outbreak in Darfur states and the causes of the disease are declining after measures were taken to control and prevent further outbreak which include cases management and isolation. Mass vaccination Parallel direct control measures: environmental-vector control, health education and community mobilization. Lack of infrastructure and the poor security situation in the area certainly complicate situation. Recent report received about the circulation of the mosquito to several parts of the country risking further spread of the disease