A holistic approach for mycetoma management

Mycetoma can be caused by any of 70 fungi or actinomycetes bacteria. In all cases, chronic and progressive infection and inflammation cause masses under the skin which can spread to deeper structures including bone. Sudan has one of the highest rates of mycetoma endemicity in the world, though the disease is found throughout the tropics and subtropics. Mycetoma patients are often hindered from timely and appropriate treatment by financial limitations and geographic remoteness from regional health facilities.

In this new work, Ahmed Fahal, of the University of Khartoum, Sudan, and colleagues at the Myectoma Research Centre (MRC) adopted a holistic approach to decentralize patient care, improve disease awareness and advocacy, and provide free treatment at the village level. A study of the approach was carried out in Eastern Sennar Governate, a region of Sudan with 292 villages, a population of 219,800, and high rates of mycetoma. In the study, 19 villages were visited by four medical and health mobile missions. More than 300 care providers were trained on various aspects of the disease, and meetings were held with local village leaders and activists to gain support.

During the study period, 758 mycetoma suspected patients were identified in Eastern Sennar Governate. 220 had ultrasonic evidence of mycetoma and qualified for surgery. Immediate access to free treatment reduced patients' delay in starting treatment and reduced the normally high follow-up dropout rate. In addition, a random sample of individuals showed improvement in their knowledge, attitude, and practice toward mycetoma after seeing a dramatic film involving the disease.

"The holistic and comprehensive management approach implemented in this study has improved the mycetoma patients' quality of care in the studied endemic area," the researchers say. "The MRC, as a WHO Collaborating Centre on Mycetoma, will communicate this experience to the WHO to share it with other mycetoma endemic countries and assist in better management, prevention and control of the disease."