Mycetoma in Africa: A Neglected Crisis and Its Far-Reaching Impacts
Prof Ahmed Hassan Fahal
The Mycetoma Research Center
University of Khartoum
Despite being added to the World Health Organization’s NTD list in 2016, mycetoma remains critically underfunded, under-researched, and overlooked in global health agendas. Africa shoulders the highest burden, with Sudan reporting over 12,000 cases in the past decade alone, followed by Senegal, Chad, Mauritania, Uganda, Tanzania, Kenya, Somalia and Ethiopia. Rural populations, particularly subsistence farmers, herders, and manual labourers, are disproportionately affected due to frequent exposure to contaminated soil or thorny vegetation.
Health Impacts: Disability and Delayed Care
Mycetoma insidious progression inflicts profound physical suffering. Early symptoms, such as painless subcutaneous masses, are often ignored or misdiagnosed, leading to delays in treatment. By the time patients seek care, the disease has typically advanced, requiring aggressive surgical interventions or amputations to prevent fatal sepsis. In Sudan, approximately 30-40% of patients undergo limb amputations, a devastating outcome that could be prevented with timely diagnosis. Compounding this issue is the lack of accessible, affordable, point-of-care diagnostics in most endemic regions, forcing reliance on costly histopathology or imaging. Treatment options are equally limited; antifungal and antibiotic regimens are prolonged (more than 12 months), expensive, and ineffective at late stages. For many, the choice is between financial ruin or irreversible disability.
Economic Burden: Trapping Communities in Poverty
The economic toll of mycetoma is catastrophic. Affected individuals, often the primary earners in agrarian households, lose 30–40% of their annual income due to reduced productivity or permanent disability. In Sudan, where 70% of cases occur among breadwinners aged 15–40 years, entire families are pushed into poverty. The costs of treatment, including surgery and lifelong rehabilitation, further drain limited resources. Rural health systems, already strained by infectious diseases like NTDs, HIV and tuberculosis, lack the capacity to manage mycetoma, forcing patients to travel long distances to urban centers for care. This creates a vicious cycle: poverty increases vulnerability to mycetoma through occupational exposure, while the disease itself deepens economic hardship.
Social Stigma: Isolation and Marginalisation
Mycetoma visible deformities and misconceptions about contagion fuel intense social stigma. Patients, particularly women and children, face discrimination, abandonment, and exclusion from education, marriage, and community life. In Sudan, cultural beliefs attributing the disease to “divine punishment” exacerbate this marginalisation, leaving many to suffer in silence. The psychological trauma of disfigurement and social rejection compounds physical suffering, with depression and anxiety reported in over 50% of patients. These social barriers also deter early healthcare-seeking, perpetuating transmission and severe outcomes.
Systemic Neglect: A Cycle of Invisibility
Mycetoma’s classification as an NTD has not translated into meaningful action. It receives less than 0.1% of global NTD funding, and no novel therapies or vaccines have been developed in decades. Mycetoma is still an unreportable disease in most countries. Research gaps are stark: basic epidemiological data, such as true incidence rates and environmental reservoirs, remain unknown in most endemic countries. Health workers are rarely trained to recognise the disease, and it is excluded from national surveillance systems in many African nations. This neglect reflects broader inequities: mycetoma thrives in impoverished, rural areas with a limited political voice, allowing it to persist under the radar.
Mycetoma: A Crisis Demanding Immediate Attention
Mycetoma epitomises the intersection of poverty, neglect, and health inequity. Its impacts extend beyond individual suffering to destabilise families, strain economies, and perpetuate cycles of deprivation. Addressing this crisis requires urgent investment in affordable diagnostics, community education, and inclusive healthcare systems. Equally critical is global solidarity to amplify the voices of affected communities and prioritise mycetoma in NTD agendas. As said, “Neglecting mycetoma is neglecting the most vulnerable.” Until this disease is met with the resources and resolve it demands, thousands will continue to endure preventable suffering in the shadows of global health priorities. Mycetoma is a disease of poverty, but its solutions must be rooted in justice.