Abstract:

Buruli ulcer (BU) remains a neglected tropical disease that disproportionately affects populations living in rural communities with frequent exposure to aquatic environments. Despite its debilitating physical, social, and economic consequences, evidence on the health-seeking behaviour of affected individuals remains limited in many endemic areas of Nigeria. This study assessed the health-seeking behaviour of Buruli ulcer patients in rural communities with water bodies in Rivers State, Nigeria, and identified factors associated with poor health-seeking behaviour. The study employed a community-based cross-sectional design among residents of selected rural Local Government Areas with water bodies. A multistage sampling technique was used to select 405 participants, and data were collected using a structured questionnaire adapted from World Health Organization (WHO) Buruli ulcer assessment tools and the WHO Quality of Life (WHOQOL-BREF) instrument. Data were analysed using descriptive statistics and modified Poisson regression, with adjusted prevalence ratios (APR) and 95% confidence intervals (CI) used to identify factors associated with poor health-seeking behaviour. The mean age of the respondents was 38.74 ± 17.20 years. Most respondents were currently unmarried (70.86%), had secondary education (47.04%), lived in households with seven or more members (54.07%), and resided in inland communities (62.47%). Overall, 96.6% of respondents demonstrated poor health-seeking behaviour, while only 3.4% exhibited good health-seeking behaviour. Respondents who were unsure of the distance to their water source were significantly more likely to have poor health-seeking behaviour compared with those living 100–500 m from their water source (APR = 1.16; 95% CI: 1.01–1.34; p = 0.04). Furthermore, respondents who practiced Christianity were significantly less likely to have Buruli ulcer than those practicing Islam (AOR = 0.21; 95% CI: 0.09–0.49; p < 0.001), while civil servants were less likely to have Buruli ulcer than students (AOR = 0.32; 95% CI: 0.10–1.00; p = 0.05). Conversely, respondents with fair knowledge were more likely to have Buruli ulcer than those with good knowledge (AOR = 4.04; 95% CI: 1.07–15.29; p < 0.05). Residence was significantly associated with poor health-seeking behaviour, as respondents living in riverside or swamp areas were less likely (APR = 0.88; 95% CI: 0.79–0.98, p = 0.02) to demonstrate poor health-seeking behaviour than those living inland. Respondents unsure about the distance to their water source were more likely (APR = 1.16; 95% CI: 1.01–1.34, p = 0.04) to have poor health-seeking behaviour than those living 100–500 m from their water source. Additionally, contact with saltwater bodies was associated with an increased likelihood of poor health-seeking behaviour (APR = 1.07; 95% CI: 1.00–1.14, p = 0.05). The study demonstrates that poor health-seeking behaviour remains widespread among Buruli ulcer patients in rural communities of Rivers State, with delayed presentation and reliance on non-formal treatment pathways contributing to the burden of the disease. Strengthening community awareness, improving access to affordable healthcare services, and addressing financial and geographical barriers to care are essential for promoting early diagnosis and treatment of Buruli ulcer in endemic communities.