The Director-General of the World Health Organization (WHO) has called for more focus on research to improve current tools and medicines to effectively prevent and treat mycetoma – a chronic disease of the foot that affects poor people, mainly manual workers, labourers and herdsmen.
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During a high-level visit to the Mycetoma Research Centre (MRC) in Khartoum, Sudan, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, pledged the Organization’s commitment to work with and support the MRC in developing better diagnostics, treatment and prevention tools for mycetoma. He also thanked the MRC for its excellent work and confirmed WHO’s continued support to it.
“This visit by the Director-General and other senior staff illustrates the current vision of WHO to promote health, keep the world safe and serve the vulnerable” said Professor Ahmed Hassan Fahal, Director of the MRC. “It not only boosts the morale of the staff but opens a new chapter of collaborative research and a thrust to find innovative treatment for this mostly forgotten disease.”
Dr Tedros’ pledge is opportune, as the MRC prepares to host the Sixth International Conference on Mycetoma (15–17 February 2019) and with WHO’s support, organize a major training workshop (10–14 February 2019).
The high-level delegation included Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, Dr Naoko Yamamoto, WHO Assistant Director-General for Universal Health Coverage and Health Systems, and Dr Lubna Abdulrahman Alansari, Assistant Director-General for Metrics and Measurement, all of whom are in Khartoum to attend the Sixty-fifth Session of the Regional Committee for the Eastern Mediterranean.
The MRC is the only WHO Collaborating Centre dedicated to mycetoma worldwide and has collaborated with other leading research institutions to develop standard operating procedures for diagnosis and treatment.
“The Centre runs regular free clinics where patients affected by mycetoma are examined by a multi-disciplinary team with medical and surgical expertise” said Professor Fahal. “In addition, we provide health education sessions for people at risk and train health workers so that they can provide the much needed care to people in remote, rural areas.”
The MRC was established in 1991 at Soba University Hospital under the umbrella of Sudan’s University of Khartoum and as a public institution forms part of the Ministry of Higher Education. In 2015, the MRC was designated a WHO Collaborating Centre and was instrumental in supporting the Federal Ministry of Health to draft a resolution that was adopted by the World Health Assembly in 2016 (WHA69.21).
The WHO Regional Office for Eastern Mediterranean, the WHO Country Office for Sudan and the Special Programme for Research and Training in Tropical Diseases support the MRC in building capacity and providing assistance to research development (burden assessment, decentralization of health services). In February 2018 – and as part of her first country visit after being appointed WHO Deputy Director-General – Dr Soumya Swaminathan also visited the centre.
The disease
Mycetoma is a progressively destructive infectious disease of the subcutaneous tissues that affects the skin, muscle and bone. The disease is caused by infection with different species of microorganisms, but almost always by bacteria or fungus.
It commonly affects young adults, mostly males aged between 15 and 30 years in developing countries. Its global burden is not known, but the disease is endemic in and has been reported from countries in Africa, Asia, Europe and Latin America. Sudan reports the highest number of mycetoma cases worldwide.
Treatment options depend on the causative organisms responsible for bacterial mycetoma and involve long-term antibiotic combination therapy, whereas for the fungal type treatment relies on combined antifungal drugs and surgery. Current treatment is unsatisfactory, has many side-effects, is expensive and is not available in endemic areas.
Mycetoma has numerous adverse medical, health and socioeconomic impacts on patients, communities and health authorities. Accurate data on its incidence and prevalence are not available. However, early detection and treatment are important to reduce morbidity and improve treatment outcomes.
The disease was first reported in the mid-19th century in Madurai, India and was initially called “Madura foot”.