Buruli ulcer (BU) is one of the most neglected but treatable diseases in tropical countries. It is considered to be a disease of the poor because of its debilitating and disfiguring skin alterations that often create social stigmas. BU typically occurs near water bodies, especially near stagnant water, such as slow-flowing rivers, ponds, swamps, and lakes. In Ghana, more than 11,000 cases have been counted since 1993, the second highest rate in Africa. The large majority of BU cases are reported for children and women. While the clinical dimensions of the development of the ulcer on the human skin are well understood, the natural reservoir, activation, and transmission of the bacterium remain unknown, leading the World Health Organization (WHO) to label BU as an "intriguing disease." Several studies have confirmed the linkage between BU and disturbed environments, especially in association with flooding. Environmental disturbances and landscape modifications may play a major role in the creation of stagnant water and the occurrence of the disease, but little research has focused on the linkages between human-related land disturbance or fragmentation and BU outbreaks. This interdisciplinary research project will focus on Ghana as a case study and will explore role of environmental change and the emergence of BU at multiple temporal and spatial scales. The investigators hypothesize that BU outbreaks are triggered by increased systems vulnerability resulting from exogenous disturbance in the form of more extreme and frequent rainfall events and slow drivers of landscape change due to deforestation, agriculture, and mining activities. Project objectives are to enhance basic understanding of the role and types of land disturbance on BU outbreak; identify overlooked yet potentially critical nonlinearities and surprises resulting from the interaction of human and natural factors on the landscape and subsequent disease emergence; add to the ongoing debate on BU reservoirs, host(s), and transmission; and contribute to the growing body of literature and scientific discourse regarding emerging infectious disease and ecological change, with emphasis on climatic extremes. The investigators will use an innovative combination of environmental sampling, interviews and surveys, participatory mapping activities, and complex systems modeling to unravel the complexities of BU.
This project will have significant implications for the understanding of resilience in coupled human-environmental systems. It will address new and important questions regarding complex, emerging diseases in changing landscapes, with particular emphasis on types and scales of interactions, positive feedbacks, thresholds, and non-linear dynamics. The research will provide health benefits for the study populations in Ghana and education and training opportunities in the U.S. and Ghana. The U.S. investigators will work closely with researchers and practitioners at Ghanaian partner institutions (University of Mines and Technology, Kwameh Nkrumah University of Science and Technology, University of Ghana, Minerals Commission, and Ghana Health Services). Through its educational component involving cross-cultural, international "K-12 sister-schools," the project will demonstrate how human-modified landscapes and disease patterns are interconnected in both the United States and Africa. This project is supported by the NSF Dynamics of Coupled Natural and Human Systems (CNH) Program.
