@article{fdi:010063246,
  title = {{S}patio-temporal patterns and landscape-associated risk of {B}uruli ulcer in {A}konolinga, {C}ameroon},
  author = {{L}andier, {J}. and {G}uadart, {J}. and {C}arolan, {K}evin and {L}o {S}een {D}. and {G}u{\'e}gan, {J}ean-{F}ran{\c{c}}ois and {E}yangoh, {S}. and {F}ontanet, {A}. and {T}exier, {G}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {B}uruli ulcer ({BU}) is an extensively damaging skin infection caused by {M}ycobacterium ulcerans, whose transmission mode is still unknown. {T}he focal distribution of {BU} and the absence of interpersonal transmission suggest a major role of environmental factors, which remain unidentified. {T}his study provides the first description of the spatio-temporal variations of {BU} in an endemic {A}frican region, in {A}konolinga, {C}ameroon. {W}e quantify landscape-associated risk of {BU}, and reveal local patterns of endemicity. {M}ethodology/{P}rincipal {F}indings: {F}rom {J}anuary 2002 to {M}ay 2012, 787 new {BU} cases were recorded in 154 villages of the district of {A}konolinga. {I}ncidence per village ranged from 0 (n = 59 villages) to 10.4 cases/1000 person. years (py); median incidence was 0.4 cases/1,000py. {V}illages neighbouring the {N}yong {R}iver flood plain near {A}konolinga town were identified as the highest risk zone using the {SPODT} algorithm. {W}e found a decreasing risk with increasing distance to the {N}yong and identified 4 time phases with changes in spatial distribution. {W}e classified the villages into 8 groups according to landscape characteristics using principal component analysis and hierarchical clustering. {W}e estimated the incidence ratio ({IR}) associated with each landscape using a generalised linear model. {BU} risk was highest in landscapes with abundant wetlands, especially cultivated ones ({IR} = 15.7, 95% confidence interval [95% {CI}] = 15.7[4.2-59.2]), and lowest in reference landscape where primary and secondary forest cover was abundant. {I}n intermediate-risk landscapes, risk decreased with agriculture pressure (from {IR}[95% {CI}] = 7.9[2.2-28.8] to 2.0[0.6-6.6]). {W}e identified landscapes where endemicity was stable and landscapes where incidence increased with time. {C}onclusion/{S}ignificance: {O}ur study on the largest series of {BU} cases recorded in a single endemic region illustrates the local evolution of {BU} and identifies the {N}yong {R}iver as the major driver of {BU} incidence. {L}ocal differences along the river are explained by wetland abundance and human modification of the environment.},
  keywords = {{BACTERIOSE} ; {EPIDEMIOLOGIE} ; {FACTEUR} {ECOLOGIQUE} ; {PAYSAGE} ; {COUVERT} {VEGETAL} ; {ZONE} {HUMIDE} ; {COURS} {D}'{EAU} ; {FORET} ; {UTILISATION} {DU} {SOL} ; {SOL} {CULTIVE} ; {SAVANE} ; {MILIEU} {URBAIN} ; {MILIEU} {RURAL} ; {VARIATION} {MENSUELLE} ; {ULCERE} {DE} {BURULI} ; {CAMEROUN} ; {AKONOLINGA}},
  booktitle = {},
  journal = {{PL}os {N}eglected {T}ropical {D}iseases},
  volume = {8},
  numero = {9},
  pages = {art. e3123 [11 ]},
  year = {2014},
  DOI = {10.1371/journal.pntd.0003123},
  URL = {https://www.documentation.ird.fr/hor/fdi:010063246},
}