Exploring the Buruli Ulcer Incidence across a socio-ecological landscape in Ghana

The Buruli Ulcer (BU) disease is one of the most prevalent, but poorly understood mycobacterial infections in the world. Fundamental ecological aspects of the disease causing bacteria (Mycobacterium ulcerans) are not understood completely, but its emergence is attributed to unidentified thresholds in human and natural systems. We explored the network of these interactions across socio-ecological landscapes of Ghana to understand the movement of bacteria and the emergence of BU in response to climate, disturbance, social and economic factors. We chose five communities, three endemic and two control, and explored the correlations of disease incidence with climate, landscape disturbance, water quality and social factors using path analysis. Our results show that water quality is strongly linked to disease emergence with high alkalinity, PO43-, NH4+, F, Mn, S, Cd, Fe, Pb, and Se were associated with higher disease incidents and high Cu concentration was associated with low or healthy communities. Contrary to previous studies, arsenic concentration in water was not linked to higher disease incidence. Water quality was linked to climate, type of mining, and agricultural practices. Higher annual precipitation and lower air temperature were found linked to higher disease incidence across communities. Our exploratory work provides insight into how human land use, social practices, demographics, and climatic factors influence the BU disease spread.