Table 1. Structure of the outreach education program.

Sections of outreach education program	Key messages conveyed	Issues downplayed or emphasized
Signs and symptoms of BU, how to recognize the disease and need to treat early	Visuals of physical signs of BU in different stages	Category I and II BU depicted, but not Category III as this evoked great fear.
	Visual and tactile cues suggesting that an abscess or ulcer may be BU
	Progression of disease if not treated
High risk environments and modes of transmission	High risk environments where one is more likely to be exposed to BU	Less time and attention was allotted to risk environments and possible modes of transmission as the science is inconclusive and behavior change related to exposure to water sources difficult given the local reality
	Attention was dedicated to addressing incorrect ideas about BU transmission and contagion
What clinic staff do to determine if the affliction is BU or some other disease	Why health staff take swabs, what they look for under the microscope, why medicine for BU is specific and not the same as medications used for other ulcers.	Step-by-step explanation of what staff do along with pictures—- to offset fears and rumors about what health staff is doing, and to increase trust
Effective and ineffective treatments for BU	Why 56 days of pills and injections are needed	Agricultural analogies used to convey the idea that medication is taken beyond cure of wound to get at the roots and seeds of BU as a systemic infection in the body
	Why herbal medicine for this disease does not lead to a cure even if a wound is dried
		Pictures used to show inappropriate treatment, how drying wound is not healing, and effectiveness of medication after herbal medicine has failed to treat the wound
Traditional healers and rapid referral to clinics	Positive messages about exemplar healers who recognize signs of BU and rapidly refer patients to clinic after spiritual protection is offered.	No message disrespecting local practices as superstitious.
Emphasis on rapid referral
		Respect for traditional healers’ role in offering spiritual protection for those for whom this is a concern.
Quality of care at the clinic	Quality of care offered by staff: pictures of what care in the clinic looks like, approachable staff, hygienic conditions, empathetic guardians, etc.	To offset fear and evoke confidence
Before and after pictures of BU related wounds successfully treated	Pictures of BU treatment, and the healing process at different stages	Pictures depict patients of different ages and gender
	Depict the healing of ulcers on different parts of the body
The presentation ends on a note of hope	Testimonials of patients who have been cured speaking of their experience and the quality of care they have received at the clinic.	Open microphone–some testimonials are planned and others are spontaneous
Questions from the audience	On any topic related to information presented or any other issue related to BU	Open microphone