Geographic distribution was defined in terms of regional, district, subdistrict, and community distribution of cases. The burden of disease was considered in terms of number of cases affected, age and sex distribution, clinical presentation (preulcerative, ulcer, or deformity), and site of lesion. Preulcerative lesions include nodular, plaque, papular, and nonulcerative edematous forms, as described by the WHO Global Buruli Ulcer Programme (3) . Deformities include scars, constriction of limbs, ankylosis of joints, or amputations.
The case search covered every district and known community in Ghana from June to July 1999. A team of 20 national facilitators was trained in the use of the survey instruments and in the clinical presentation of the disease in an endemic focus. Two facilitators were then sent to each region to train regional teams (three from the regional level and two from each district). Seven teams of two persons each from the subdistrict and communities performed the case search.
The permission of the local political and traditional authorities was sought in advance, and the purpose of the search was explained to them and to all participants. The data collectors used a pictorial document designed by the WHO Global Buruli Ulcer Initiative (3) . At each village and community, they showed the pictures of Buruli ulcer disease at different stages of development to as many people as possible and asked whether anyone in the village had a similar condition. All persons with lesions that met the WHO standard case definition were interviewed with a simple questionnaire. There was no laboratory confirmation of the cases. A prepackaged dressing was given to each person identified as having ulcers, and the particulars of all the cases were provided to local health authorities for follow-up. The process was repeated in each village until the whole district was covered.
A team from the national level, including a dermatologist familiar with the disease, later validated findings in two randomly selected districts from a region where the disease had not previously been endemic. All cases reported there were found to be consistent with the clinical case definitions used.
The case search covered every district and known community in Ghana from June to July 1999. A team of 20 national facilitators was trained in the use of the survey instruments and in the clinical presentation of the disease in an endemic focus. Two facilitators were then sent to each region to train regional teams (three from the regional level and two from each district). Seven teams of two persons each from the subdistrict and communities performed the case search.
The permission of the local political and traditional authorities was sought in advance, and the purpose of the search was explained to them and to all participants. The data collectors used a pictorial document designed by the WHO Global Buruli Ulcer Initiative (3) . At each village and community, they showed the pictures of Buruli ulcer disease at different stages of development to as many people as possible and asked whether anyone in the village had a similar condition. All persons with lesions that met the WHO standard case definition were interviewed with a simple questionnaire. There was no laboratory confirmation of the cases. A prepackaged dressing was given to each person identified as having ulcers, and the particulars of all the cases were provided to local health authorities for follow-up. The process was repeated in each village until the whole district was covered.
A team from the national level, including a dermatologist familiar with the disease, later validated findings in two randomly selected districts from a region where the disease had not previously been endemic. All cases reported there were found to be consistent with the clinical case definitions used.
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