Territorial and gender-linked risk factors for Buruli ulcer in Southern Benin: A case-control study using geographic and behavioral surveying

Objectives The manuscript examines the risk factors associated with Buruli ulcer in endemic regions of Benin, focusing on community practices, agricultural activities, and age and gender disparities. Methods The study, conducted from November 2021 to June 2024, used a prospective case-control approach combined with a geographic health survey. The study involved home interviews followed by guided tours of areas frequented by participants, allowing the precise identification of practices at risk of Buruli ulcer. Univariate analysis and stepwise backward stepwise logistic regression were carried out. Results Overall, 117 patients and 234 controls were included. Multivariate analysis showed that activities such as bathing (OR = 3.2, p = .04), farming in flooded areas (OR = 3.8, p = .02), and frequenting irrigation canals (OR = 5.0, p = .003) were independent risk factors for Buruli ulcer. The originality of this study was that these risks were not distributed in the same way across territory and depended on age and gender. Conclusion The findings suggest that public health interventions need to consider gender, age, territorial features, and local agricultural practices. Furthermore, integrating geographical and spatial data into epidemiological studies offers valuable insights helping to prevent the spread of this neglected tropical disease.