{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:32:24Z","timestamp":1791174744313,"version":"4.1.0"},"reference-count":69,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Buruli ulcer disease (BUD) remains a poorly understood neglected tropical disease (NTD). The 2021\u20132030 WHO NTD Roadmap prioritises addressing knowledge gaps in BUD transmission and calls for the need to better understand the factors contributing to disease occurrence. In Ghana, reported BUD cases declined from over 600 in 2018 to 81 in 2023. While previous case-control studies in Ghana have used a 1:1 matching ratio, this study examined potential risk factors for BUD in four endemic districts using an improved methodological approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A community-based 1:2 matched case-control study was conducted in four BUD-endemic districts (Akwapim South, Akwapim North-Okere, Jasikan, and Biakoye) in the Eastern and Oti Regions of Ghana. Seventy (70) BUD cases and 140 community controls were recruited and matched by age (\u00b15 years), sex, and place of residence. Data on socio-demographic, behavioural, environmental, water use, and injury management factors were collected by trained research assistants using semi-structured questionnaires designed with KoboCollect. Multivariable conditional logistic regression produced adjusted odds ratios (aORs) with 95% confidence intervals at p\u2009&lt;\u20090.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the multivariable analysis, farming without adequate protective clothing (aOR = 3.02, 95% CI: 1.03\u20138.89) and living near waterbodies (aOR = 4.45, 95% CI: 1.46\u201313.55) were associated with increased odds of BUD. Being married (aOR = 0.32, 95% CI: 0.13\u20130.78) and applying alcohol to injury sustained (aOR = 0.17, 95% CI: 0.03\u20130.83) reduced the odds of BUD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Farming without adequate protective clothing and proximity to waterbodies were the main risk factors for BUD in endemic districts in Ghana. In contrast, being married and practising injury care using alcohol appeared protective. The Ghana Health Service should promote the consistent use of protective clothing during agricultural activities, raise awareness among communities living near waterbodies, and encourage proper injury care practices to reduce the risk of BUD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013684","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:28:05Z","timestamp":1762885685000},"page":"e0013684","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors for Buruli ulcer disease in Ghana: A matched case-control study in four selected endemic districts of Eastern and Oti Regions"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4357-3509","authenticated-orcid":true,"given":"Mawuli","family":"Gohoho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Adolf","family":"Bosoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Sarpong","family":"Agyemang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorengmen Amos","family":"Ziema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Alorwu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hudatu","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Atsu","family":"Gohoho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Annobil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana Konama","family":"Kotey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Owusu","family":"Gyapong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"pntd.0013684.ref001","article-title":"Current state and future directions of interventions for neglected tropical diseases","author":"JO Gyapong","year":"2025","journal-title":"Nat Hum Behav"},{"key":"pntd.0013684.ref002","first-page":"196","volume-title":"Ending the neglect to attain the sustainable development goals: a road map for neglected tropical diseases 2021\u20132030","author":"WHO","year":"2020"},{"issue":"2","key":"pntd.0013684.ref003","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3201\/eid0802.010119","article-title":"Buruli ulcer in Ghana: results of a national case search","volume":"8","author":"G Amofah","year":"2002","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pntd.0013684.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003443","article-title":"Buruli ulcer in South Western Nigeria: a retrospective cohort study of patients treated in Benin","volume":"9","author":"E Marion","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013684.ref005","volume-title":"Buruli ulcer (Mycobacterium ulcerans infection) [Internet]","author":"WHO","year":"2023"},{"issue":"4","key":"pntd.0013684.ref006","first-page":"536","article-title":"Risk factors for Buruli ulcer in C\u00f4te d\u2019Ivoire: Results of a case-control study","volume":"8","author":"L Ahoua","year":"2009","journal-title":"Afr J Biotechnol"},{"issue":"9","key":"pntd.0013684.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003123","article-title":"Spatio-temporal patterns and landscape-associated risk of Buruli ulcer in Akonolinga, Cameroon","volume":"8","author":"J Landier","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013684.ref008","unstructured":"WHO. 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