<p>We conducted spatial analysis and a community-based matched case-control study in Akwapim North-Okere (AKN-O), Akwapim South (AKS), Jasikan (JAS), and Biakoye (BIA) districts from July 2021 to March 2022. We performed an average nearest neighbor analysis and established a 1000m buffer around 263 extracted BUD records from 2017 to 2020. We estimated sample size of 70 cases, sampled them using a systematic random sampling, and matched them to 140 community controls by age, sex, and residence. Structured questionnaire on socio-demographic, behavioral, environmental, water-related, health, and injury management factors was administered. We used a conditional multivariate logistic regression to determine BUD risk factors.</p>