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Background: Mycetoma is a chronic, progressively destructive disease of subcutaneous tissues and bones caused by certain species of bacteria or fungi. We conducted a cross-sectional community-based study alongside mapping of mycetoma in five administrative units with high mycetoma endemicity in the Eastern Sennar Locality, Sennar State, Sudan. Methods: A household survey was administered which included questions about the household members, household characteristics, economic activity and history of mycetoma. A clinical examination was conducted on all members of the household. If mycetoma was suspected, an individual questionnaire was completed collecting demographic, clinical and epidemiological data as well as information on the use of health care and associated costs. Geographical coordinates and photos of the lesions were taken, and the affected persons were referred to the medical centre for confirmation of the diagnosis and treatment. We compared the characteristics of households with confirmed cases of mycetoma with those without confirmed cases, and individuals with confirmed mycetoma with those in whom mycetoma was not confirmed. Results: In total 7,798 households in 60 villages were surveyed; 515 suspected cases were identified and 359 cases of mycetoma were confirmed. Approximately 15% of households with mycetoma had more than one household member affected by this disease. Households with mycetoma were worse off with respect to water supply, toilet facilities, electricity and electrical appliances compared to the survey households. Only 23% of study participants with mycetoma had sought professional help. Of these, 77% of patients travelled an average of six hours to visit a medical facility. More than half of patients had to pay towards their treatment. The estimated average cost of treatment was 26,957 Sudanese pounds per year (566 US dollars, exchange rate 2018). Conclusions: Results of this survey suggest that agricultural practices and reduced access to sanitation and clean water can be risk factors in developing mycetoma. Poor access to health care and substantial financial costs were barriers to seeking treatment for mycetoma. Author summary: Mycetoma is a neglected tropical disease caused by certain species of bacteria or fungi. The pathogens enter the body through a break in the skin and infect underlying soft tissues, leading to tissue destruction, loss of function, amputations and disability. Early diagnosis of mycetoma requires a clear understanding of disease prevalence, distribution and the contributing risk factors. In this study, we describe the results from a cross-sectional community-based study conducted in five administrative units with high mycetoma endemicity in the Eastern Sennar Locality, Sennar State, Sudan. 7,798 households in 60 villages were randomly selected across the entire locality. A household survey was administered and household members underwent clinical examination. In case of suspected mycetoma, geographical coordinates and photos of the lesions were taken, further demographic and clinical data were collected as was information on the use of health care and associated costs, and the individual was referred to the medical centre for confirmation of the diagnosis and treatment. This study aimed to identify socioeconomic risk factors contributing to mycetoma. We compared the characteristics of the households with confirmed cases of mycetoma with those without cases and individuals with confirmed mycetoma with those in whom mycetoma was not confirmed. Our results suggest that agricultural practices and reduced access to clean water and sanitation may be risk factors in developing mycetoma. Poor access to health care and substantial financial costs may be barriers to seeking treatment for mycetoma. [ABSTRACT FROM AUTHOR]

Background Mycetoma is a neglected tropical disease that is reported worldwide and Sudan has the highest reported number of mycetoma infections across the globe. The incidence, prevalence and burden of mycetoma globally are not precisely known and its risk factors remain largely unelucidated. Methods This study aimed to identify the environmental predictors of fungal and bacterial mycetoma in Sudan and to identify areas of the country where these niche predictors are met. Demographic and clinical data from confirmed mycetoma patients seen at the Mycetoma Research Centre from 1991 to 2018 were included in this study. Regression and machine learning techniques were used to model the relationships between mycetoma occurrence in Sudan and environmental predictors. Results The strongest predictors of mycetoma occurrence were aridity, proximity to water, low soil calcium and sodium concentrations and the distribution of various species of thorny trees. The models predicted the occurrence of eumycetoma and actinomycetoma in the central and southeastern states of Sudan and along the Nile river valley and its tributaries. Conclusion Our results showed that the risk of mycetoma in Sudan varies geographically and is linked to identifiable environmental risk factors. Suitability maps are intended to guide health authorities, academic institutes and organisations involved in planning national scale surveys for early case detection and management, leading to better patient treatment, prevention and control of mycetoma. [ABSTRACT FROM AUTHOR]