Buruli ulcer is a neglected tropic disease caused by the M. ulcerans, an environmental mycobacterium, and its symptoms are necrotizing cutaneous lesions. Buruli ulcer affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. For these populations, there is a need for adapted and efficient prevention strategies. To date, only open surface stagnant waters or slow running waters have been identified at risk. Research has, to date, provided little information, at individual level, about the reasons for which some individuals become contaminated whereas others do not. The epidemiological studies have, above all, used the water sources located close to domestic areas as a reference space for studying the risk factors, and the case-control studies are often retrospective and based on a small number of patients essentially encountered in hospitals. To gain a deeper understanding of the variation in incidence, we developed geographic health surveys in all the “living spaces” frequented by local populations. This approach is innovative in three ways : [1] the scale of the detailed analysis (a district or village) and the combination of GPS-based geolocalisation with a case-control study, [2] the combination of data collection methods derived from approaches developed in social and human sciences (SHS) with microbiological analysis [3] longitudinal follow-up of cases oriented towards direct observation. Based on a field-work in an area in Benin, the aim of this oral free paper is to show the benefits of changing approach and reasoning not according to instantaneous implantations, but on the basis of living spaces containing both “safe” points of access to water and other points of access to water at which humans may be exposed to the M. ulcerans bacterium, and visited for reasons other than the collection of water (agricultural work, children’s games …).

Buruli ulcer is a neglected tropic disease caused by the M. ulcerans, an environmental mycobacterium, and its symptoms are necrotizing cutaneous lesions. Buruli ulcer affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. For these populations, there is a need for adapted and efficient prevention strategies. To date, only open surface stagnant waters or slow running waters have been identified at risk. Research has, to date, provided little information, at individual level, about the reasons for which some individuals become contaminated whereas others do not. The epidemiological studies have, above all, used the water sources located close to domestic areas as a reference space for studying the risk factors, and the case-control studies are often retrospective and based on a small number of patients essentially encountered in hospitals. To gain a deeper understanding of the variation in incidence, we developed geographic health surveys in all the “living spaces” frequented by local populations. This approach is innovative in three ways : [1] the scale of the detailed analysis (a district or village) and the combination of GPS-based geolocalisation with a case-control study, [2] the combination of data collection methods derived from approaches developed in social and human sciences (SHS) with microbiological analysis [3] longitudinal follow-up of cases oriented towards direct observation. Based on a field-work in an area in Benin, the aim of this oral free paper is to show the benefits of changing approach and reasoning not according to instantaneous implantations, but on the basis of living spaces containing both “safe” points of access to water and other points of access to water at which humans may be exposed to the M. ulcerans bacterium, and visited for reasons other than the collection of water (agricultural work, children’s games …).