Mycetoma Initiative in Sudan
Mycetoma is a morbid, destructive disfiguring chronic inflammatory disease with many adverse impacts on patients, communities and health authorities. Mycetoma has a worldwide distribution but that is extremely uneven. It prevails in what is known as the mycetoma belt. No age is exempted but mycetoma commonly affects young adults between 15-30 years of age and these are the earning members of the society especially in developing countries. Mycetoma is seen more conventionally in young students, cultivators, field labourers and in herdsmen and most of them are of low socio-economic status.
As it is neglected diseases, the true incidence and prevalence of mycetoma world-wide are not precisely known and most of the reported mycetoma data are related, in most reports, to hospital patients with advanced disease. This is attributed to the nature of mycetoma which is usually painless, slowly progressive and the late presentation of the majority of patients.
The Sudan is consider the mycetoma homeland with a prevalence of 8.5/1000 population in one endemic village. At the mycetoma research Centre, University of Khartoum, a WHO Collaborating Centre in mycetoma more than 7500 patients are registered.
In the affected areas, the massive lack of health education, poor health and medical facilities and financial constraints contribute to the late presentation with massive disease in the majority of patients.
The diagnostic tests are expensive, not sensitive nor specific and not available in endemic regions.
The antifungal treatment duration for mycetoma is long (mean duration of 18 months), and this is associated with many medical, socio-economic adverse impacts on patients and health authorities.
The current treatment outcome is suboptimal, characterised by low cure rate (25.8%), high recurrence (27%) and amputation rates (10%).
Patients’ compliance to the available treatment is poor and high dropout is a common phenomenon due to its ineffectiveness, high cost, long duration and side effects.
Currently, FDA & EMEA have restricted the use of ketoconazole, the current mycetoma drug of choice, due to its hepatic toxicity and the only available antifungals are Itraconazole and Voriconazole.
The average cost of antifungal is 6540 US$ per year per patients, that proved to be expensive for patients and health authorities in endemic areas. The mean annual income in the Sudan is 1800 US$.
Being a neglected medical and health problem, there are no preventive or control measurements or programs for Mycetoma across the world currently.
SAMA Donations from Medshare reach WadOunsa Mycetoma satellite unit in East Sennar, Sennar, Sudan
Mycetoma is a disabling fungal infection, prevalent in Sudan that can lead to limb amputation in its’ advanced stages.
Mycetoma Research Center (MRC) in Soba University Hospital, Khartoum, conducts mobile surgical missions that provide surgical treatment in East Sennar County.
SAMA has successfully secured donations in consumable surgical supplies from Medshare to support these missions.
The donations of consumable surgical supplies were packed in SAMA Storage Space in Dubuque, IA. They were then transported to the newly established WadOunsa Mycetoma satellite unit.
Wad Ounsa is a town located on the western bank of Aldinder river, in East Sennar county in Sennar State. East Sennar county has a population of 500,000 predominantly farmers of low socioeconomic status. The capital of the county is Wadalabbas, it has a hospital and connected by a paved road from the main highway from Medani to Sennar City. Located in the heart of the “Mycetoma Belt” Wad Ounsa has a high prevalence of Mycetoma with more than 100 amputees registered
Established by the Sennar Ministry of Health, Wad Ounsa Mycetoma satellite unit is equipped with 2 operating rooms
From right to left, Prof Ahmed Hassan Fahal, Founding Director of the Mycetoma Research Center, Khartoum;
Dr. Seifeldeen, Medical Officer, Wad Ounsa Mycetoma satellite unit.
From left to right, Dr. Amar Mahgoub, Gastroenterologist/Transplant Hepatologist, University of Minnesota in Minneapolis, MN,
Member, SAMA Humanitarian Committee, Dr. Salaheldin Abusin, Interventional Cardiologist in Dubuque, IA,
A Professor of Surgery in the University of Khartoum, Professor Ahmed Hassan Fahal led the surgical team in its’ fourth mission in 2 years to East Sennar County. Surgeries in the last 3 missions were performed in Wad Alabbas Hospital. The August 2016 mission was performed in WadOunsa for the first time. More than 70 surgical procedures were performed in this mission.
Most people in East Sennar county are farmers of low socioeconomic status, they have limited access to care and present late with mycetoma infection and hence have a high amputation rate. The surgical missions allow local delivery of care reducing the financial burden on the patients and allows for earlier case detection and potentially better outcomes.
Wad Ounsa center is equipped with telemedicine facility, in the picture shown Prof Fahal (standing) communicates with the Mycetoma Research Center in Soba University Hospital in Khartoum. This significantly improves the capacity of the WadOunsa satellite unit in patient care.
Dr. Elrayah Mustafa (right), Consultant Radiologist came from Khartoum to perform muscloskeletal ultrasound examination as part of the mission. This is Dr. Elrayah’s fourth mission to East Sennar County.