Ghana's ministry of Health, in conjunction with the US Centre for Disease Control, is researching into the mode of transmission of Buruli ulcer and how to prevent it.

Various tests have been conducted by the Noguchi Memorial Institute for Medical Research in Accra and counterpart institutions in the US to establish whether or not the disease is waterborne.

Dr Frank Bonsu, Programme Manager of the Ghana National Tuberculosis and Buruli Ulcer Control Programme, Monday said this would give medical experts an idea as to where to tackle the problem.

Dr Bonsu said although the mode of transmission is not entirely known, changes in the environment such as construction of irrigation systems, seem to play a role in the re-emergence of the disease in some communities and countries.

The disease was first detected as far back as the 18th Century and in Ghana it became known in the early 1990s, although many cases were recorded in Agogo in the 1970s.

Dr Bonsu said the disease is caused by mycobacterium ulcerans, a bacterium belonging to the same family of organisms that cause tuberculosis and leprosy.

"Its incubation period is between two months and several years but the disease often starts as a painless nodule on the skin which, if left untreated, leads to massive ulceration with debilitating deformities."

He said the bacterium produces a toxin that destroys the skin and bone, and suppresses the immune system.

Children under the age of 15 who live in poor areas of rivers, wetlands and stagnant bodies of water, are the most vulnerable and research has shown that it mostly affects the exposed parts of the body.

Buruli Ulcer has rapidly emerged as an important cause of human illness world-wide, Dr Bonsu said, adding that in Africa, countries affected include Angola, Benin, Cote d' Ivoire, Liberia, Nigeria, Togo, Sudan, Sierra Leone, Uganda, Gabon and DR Congo.

In Ghana, a national case search conducted in 1999 recorded a total of 6,330 cases with Greater Accra (Ga district) topping the list with 1,110 cases.

Dr Bonsu said the only way of controlling the disease is to strengthen health services in general and make surgical services available to patients.

Currently, the strategy promoted by the Global Buruli Ulcer Initiative consists of intensifying information, training health care providers, ensuring early detection, strengthening health services and rehabilitating people already deformed by the disease.

He said a situational analysis in endemic countries is being carried out, awareness is being raised at all levels and pilot projects are going on to ensure detection and treatment of the disease.

There is also a promotion of research into the effectiveness of existing anti microbial drugs and vaccine development as part of the on-going actions taken against the disease.

Dr Bonsu appealed to people in endemic areas to wear protective clothing, maintain personal hygiene and report all nodules to the nearest health facility for treatment.