Therapeutic itineraries of patients with ulcerated forms of Mycobacterium ulcerans (Buruli ulcer) disease in a rural health zone in the Democratic Republic of Congo

OBJECTIVE To describe lay perceptions of the ulcerated forms of Mycobacterium ulcerans, commonly called Buruli ulcer (BU), and therapeutic itineraries of BU patients in a rural area of the Democratic Republic of Congo. METHODS Qualitative research consisting of semi-structured interviews of 19 patients with clinical signs of BU and 12 in-depth interviews of confirmed cases allowing for a detailed reconstruction of the itineraries followed. RESULTS The first symptoms of BU are perceived as mild. The perceived seriousness of the disease increases as the ulceration persists, increases in size or results in complications. Knowledge about the biomedical aetiology of the disease is scarce; it is commonly believed to be due to witches' attacks or bad fate. Four therapeutic paths are taken: self-medication, traditional therapy, the church and the health centre. However lay perception, recourse to traditional treatments and self-medication only partially explain the long delays in diagnosis (on average 6 months); the main problem lies with health providers, particularly the lack of proper diagnostic capability. CONCLUSIONS Diagnostic capabilities at health centre level need to be strengthened through training and supervision. Engaging with the population and the traditional healers would render health promotion messages on BU more relevant and culturally acceptable.