Intersecting cultural beliefs and structural barriers: Healthcare-Seeking for buruli ulcer in Imo State, Nigeria

<h2>Abstract</h2><h3>Problem</h3> Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease endemic to parts of Nigeria. Despite its public health impact, healthcare-seeking behavior in rural communities' remains poorly understood, limiting targeted interventions. <h3>Methods</h3> A cross-sectional mixed-methods study was conducted in four endemic LGAs of Imo State. Quantitative data were collected from 300 respondents using structured questionnaires, while qualitative data were generated through 30 in-depth interviews with patients and caregivers, 12 interviews with traditional healers, 9 key informant interviews with health workers, and 7 focus group discussions. Quantitative analysis employed descriptive statistics and logistic regression, while qualitative transcripts were analyzed thematically using the Socio-Ecological Model <h3>Results</h3> Only 27.4% of respondents sought biomedical care within two weeks of symptom onset, while 34.7% consulted traditional healers first. Delayed hospital presentation was associated with low education (AOR=2.14; 95% CI: 1.4–3.8), belief in spiritual causation (AOR=1.88; 95% CI: 1.1–3.3), residing more than 5km from the nearest health facility (AOR=1.76; 95% CI: 1.5–4.5), and lack of health insurance (AOR=1.54; 95% CI: 1.1–2.8). Qualitative data revealed spiritual interpretations, poverty, gender inequities, stigma, and mistrust of health facilities as barriers <h3>Conclusion</h3> Healthcare-seeking for BU in Imo State is constrained by the intersection of cultural beliefs and structural barriers. Interventions should combine culturally sensitive education, stigma reduction, financial protection, and decentralized service delivery to improve timely access to care.