03167nas a2200337   4500000000100000008004100001653003900042653001300081653002200094653001000116653002800126653001400154100001500168700001300183700001200196700001600208700001200224700001300236700001400249700001600263700002300279700001500302700001800317700001500335245005200350856009800402300001300500490000700513520229500520022001402815       2018                            d10aNeglected tropical diseases (NTDs)10aMycetoma10aHolistic approach10aSudan10aCommunity participation10aTreatment1 aBakhiet SM1 aFahal AH1 aMusa AM1 aMohamed ESW1 aOmer RF1 aAhmed ES1 aEl Nour M1 aMustafa ERM1 aSheikh A Rahman ME1 aSuliman SH1 aEl Mamoun MGA1 aEl Amin HM00aA holistic approach to the mycetoma management.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006391&type=printable  ae00063910 v123 a<p>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.</p>
  a1935-2735