A holistic approach to the mycetoma management

Abstract

Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients' socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients' management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.

Fig 1. Photograph showing a surveyor using a computer tablet with the CAPI programme to collect information on a suspected patient.

Fig 2. Photograph showing Wad Onsa regional mycetoma centre at East Sennar Governate.

Fig 3. Suspected patients’ referral card.

Fig 4

(A) Photograph showing the poor community environment, animals in proximity with the villagers within the houses, animals’ dungs and dirt. (B) The villagers removing the thorny animals’ enclosures, dirt, animals’ dungs and burring them to improve the local environment and hygiene.

Fig 5. The villagers attending health education session, watching video films on mycetoma awareness.

Fig 6

(A) The classical animals made of thorny trees and bushes covered with animals’ dungs, dirt and rubbish. (B)The new modern animals’ cages outside the village.

Fig 7. Community leaders, villagers and health and medical staff training material.