1. BURULI ULCER- A devastating skin disease Enhancing early wound healing- Use of HYDROGEL Edwin Ampadu; MD, MPH, FAPWCA

2. Introduction BU treatment developmental trend Why the further topical application – Hence the topic of my presentation enhancing wound healing Preliminary observations made on the field Challenges to implementations Possible way forward

3. BU treatment development trend Treatment – surgery with wide and extensive excision, wound dressing and Split Skin Graft

4. Challenges Program continues to record massive lesions Cat lll

5. Antibiotics treatment Recommendation – WHO Results very encouraging However; operational challenges – geographically difficult to offer community treatment, –cost implications, –Battling with superstitions in the communities about the disease

6. Before treatment After treatment After 12 month follow-up

7. lesions with antibiotics only

8. Further improving case management Indication to use hydrogel –Further reduce the wound healing time whiles continue treatment with antibiotics for 8 weeks –Early healing than before

9. Why the further topical application M ake treatment more acceptable / friendly to client and communities -[ wound heal duration<; can be administered by patients, cost effective

10. Preliminary observations made on the field

11. Hydro gel application Trial parameters 2 endemic sites were selected Total patients affected- 15 Male 3 Female12 Children 7 Adults 9 Period of application – 6 weeks Average days of change of dressing – 3-5days

12. Wound Healing catches on well with a whole communityWound Healing catches on well with a whole community Observations

13. Initial Week 2 Week 4

15. Initial Week 2 Week 4

16. Initial Week 2 Week 4 Week 6

17. Week 4 Initial Week 6 Week 2

18. Initial Week 2 Week 4 Week 6

19. Initial Week 2 Week 4

20. Initial Week 1 Week 3

21. Initial Week 2 Week 4

22. Initial Week 2 Week 4

23. Implementation challenges Access to patients in communities Improve health education on the disease Picture of vehicle Late attending to patients night

24. Reaching patients in difficult areas

25. Other supports Ministry of health – Dressings, transport, personnel WHO- educational materials, audio- visual tools for community education, transport Support with the Gel from McCard foundation

26. Way forward Strengthen support to reach patients in rural communities Gradual scale up of the application Improving knowledge to enhance wound healing in our challenging world

27. Thank you

28. Other challenging lesions

29. Initial Week 2 Week 4

30. Initial Week 1 Week 3

31. Initial Week 1 Week 3

32. Initial Week 2 Week 4

33. Initial Week 2 Week 4