Background
Buruli ulcer (BU) is a neglected tropical disease caused by the bacteria Mycobacterium ulcerans. BU can cause severe morbidity and disability, especially among persons in remote settings with limited access to treatment. BU is endemic in the Asante-Akim North district (AAND) in the Ashanti region of Ghana, with a reported prevalence rate of 131.5 per 100,000. We analyzed the BU surveillance data of AAND to describe the distribution and trend to inform public health actions.

Methods
We extracted surveillance data from 2016-2020 from the District Health Information Management Systems (DHIMS) database and compared to monthly summaries of BU cases reported in clinical registers. BU yearly and sub-group incidence were calculated using their respective risk population. Data was further analyzed by person, place, and time. C2 threshold graph was used to identify likely outbreaks.

Results
Cumulatively, 115 BU cases were clinically diagnosed, of which 95.7% (110) were confirmed positive with PCR. Males constituted 52% (60/115) of cases, and children less than 15 years accounted for 46% (53/115). Overall BU incidence was 2.2 per 10,000 population with the highest incidence (3 per 10,000) occurring in 2016 while the lowest incidence (1 per 10,000) was recorded in 2020.
Comparatively, overall age-specific incidence was (3.1 per 10,000) in the less than 15-year group to 2.3 per 10,000 in those fifteen years and above. Ananekrom sub-municipal recorded an overall incidence (14.0 per 10,000 population) with Agogo sub-municipal (0.8 per 10,000).
A likely outbreak was detected in November of 2017.

Conclusion
Buruli ulcer incidence was higher in males and children fifteen years or less. Generally, there was a gradual reduction in disease incidence over the five years. The municipal BU control team has to intensify active case search and create public awareness of early case reporting and investigate any future outbreaks.