Estimating the burden of mycetoma in Sudan for the period 1991–2018 using a model-based geostatistical approach

Abstract

Mycetoma is widespread in tropical and subtropical regions favouring arid areas with low humidity and a short rainy season. Sudan is one of the highly endemic countries for mycetoma. Estimating the population at risk and the number of cases is critical for delivering targeted and equitable prevention and treatment services. In this study, we have combined a large dataset of mycetoma cases recorded by the Mycetoma Research Centre (MRC) in Sudan over 28 years (1991–2018) with a collection of environmental and water and hygiene-related datasets in a geostatistical framework to produce estimates of the disease burden across the country. We developed geostatistical models to predict the number of cases of actinomycetoma and eumycetoma in areas considered environmentally suitable for the two mycetoma forms. Then used the raster dataset (gridded map) with the population estimates for 2020 to compute the potentially affected population since 1991. The geostatistical models confirmed this heterogeneous and distinct distribution of the estimated cases of eumycetoma and actinomycetoma across Sudan. For eumycetoma, these higher-risk areas were smaller and scattered across Al Jazirah, Khartoum, White Nile and Sennar states, while for actinomycetoma a higher risk for infection is shown across the rural districts of North and West Kurdufan. Nationally, we estimated 63,825 people (95%CI: 13,693 to 197,369) to have been suffering from mycetoma since 1991 in Sudan,51,541 people (95%CI: 9,893–166,073) with eumycetoma and 12,284 people (95%CI: 3,800–31,296) with actinomycetoma. In conclusion, the risk of mycetoma in Sudan is particularly high in certain restricted areas, but cases are ubiquitous across all states. Both prevention and treatment services are required to address the burden. Such work provides a guide for future control and prevention programs for mycetoma, highly endemic areas are clearly targeted, and resources are directed to areas with high demand.

Fungal infections in Sudan: An underestimated health problem

“…Abbott reported a total of 1,231 patients admitted to Sudanese hospitals in a period of 2.5 years [ 70 ]. Using a geostatistical model, Hassan et al [ 71 ] estimated the burden of the disease over 28 years to be 51,541 cases. Based on that, we calculate a total of 1,841 new cases annually.…”

“…After the recognition of mycetoma as a neglected tropical disease, the MRC has officially become a WHO Collaborating Center. Recently, researchers from the center have tried to estimate the burden of the disease for a period of 28 years; the overall number of people who have been suffering from mycetoma was 63,825 cases of which eumycetoma accounted for 51,541 (81%) cases [ 71 ]. However, comprehensive epidemiologic data on mortality or DALY expectancy related to this disabling condition is currently unavailable.…”

The impact of the Sudan armed conflict on Mycetoma control

“…More than 1 billion people worldwide are affected by NTDs, resulting in devastating health, economic, and social consequences. While progress has been achieved since 2010, with 500 million individuals no longer demanding interventions against NTDs and 42 countries eradicating at least 1 NTD, the WHO road map for NTDs 2021-2030 outlines global targets and strategies for preventing, controlling, eliminating, and eradicating these diseases over the next decade [1].Mycetoma exhibits all the NTD characteristics, recognised by WHO in 2016 as an NTD due to its debilitating complications [2]. Mycetoma typically appears as a painless lump with multiple sinuses that discharge grains encapsulating the causative microorganisms [2].…”

“…Without proper treatment, it can cause significant tissue damage, disfigurement, and disability that can impede a patient's ability to carry out their usual daily activities and can result in fatal outcomes [3]. This chronic disabling inflammatory disease is classified into eumycetoma, caused by fungi, and actinomycetoma, caused by filamentous bacteria [2]. Mycetoma is endemic in many countries, with actinomycetoma being more prevalent in the Americas and the Middle and Far East, while eumycetoma is more common in some central African countries.…”

“…Mycetoma mainly affects young adult males, but females and other age groups are also affected. Individuals who work as farmers or shepherds and live in underprivileged communities with limited access to healthcare, education, and sanitation are at higher risk of contracting the disease in endemic areas [2]. The specific treatment approach depends on factors such as the causative organism of the infection, its location, and how severe it is.…”