Medical and Health Mission to Um Gar Island Region,
- Published: 08 December 2017
Report on the Mycetoma Research Centre, University of Khartoum
Medical and Health Mission to Um Gar Island Region,
the White Nile State, Sudan
15-17th November 2017
The Mycetoma Research Centre (MRC), University of Khartoum, a WHO Collaborating Centre on Mycetoma in collaboration with the Ministry of Health, White Nile State, the Association of Aid & Relief, Japan (AAR), the Institute of Endemic Diseases (IEND), University of Khartoum, Bakht EL Ruda University and Yanabee Alard Foundation had conducted a medical and health mission to Um Garr island region, the White Nile State, Sudan in the period 15-17th November. This is the sixth mission to the region.
The mission objectives were to conduct the following activities at Umm Garr Island Region:
1. Early mycetoma case detection and treatment
2. Geographical mapping of mycetoma
3. Mycetoma awareness and advocacy improvement
4. Assessment of Mycetoma burden
The White Nile State is a large state, bordered by Khartoum State in the north, North Kordofan State in the west, South Kordofan State and the Upper Nile State in Southern Sudan in the southeastern and Al-Gazira and Sennar States in the east. Its area is 39,701 square kilometres, and the climate is characterised by hot, humid, rainy summers and warm dry in winter. The most important crops are Durra, sesame, groundnuts, millet and wheat and the animal resources are 7,875,673 heads. The most important towns are Kosti, Al-Dweim, Al-Kawwa and Rabak which is the capital of the State. Um Gaar island is 12 Km to the North of Al-Kawwa and ElShetabe and 35 Km to the North of Al-Dweim.
Map of the Sudan showing White Nile State locality Study Activities:
The medical care and treatment
Out-patients clinic was established at Euaawa Medical Centre where 172 mycetoma suspected patients were seen and examined for evidence of mycetoma. Ultrasound examinations of the suspected lesions were done for 160 patients by mobile ultrasound machine were done, and 72 patients had lesions suspected to be mycetoma. The 72 suspected patients underwent wide local excisions under spinal or local anaesthesia.
33 patients had operative evidence of black grains eumycetoma. All patients had uneventful postoperative recovery with no complications. All mycetoma patients had post-operative oral Itraconazole in a dose of 200mg BD daily.
All investigations and medical and surgical treatment were offered free of charge. All the surgical biopsies were sent for histopathological examinations to confirm the diagnosis of mycetoma.
Age distribution of the Mycetoma patients:
Gender distribution of the mycetoma patients
The Mycetoma duration
Mycetoma lesions sites
The patients undergoing surgical treatment at Euaawa Medical Centre:
The Ultrasound Clinical Euaawa Medical Centre:
For early case detection and management, house to house total coverage survey of 10 villages at Umm Garr island was done. The data were collected by well-trained teams of medical officers, house officers, medical students, health care providers and community activists using digital pre-designed validated closed-ended questionnaires in smart tablets. Computer Assisted Patients Identifier (CAPI) computer application designed for this study was used. The collected data included the suspected patient’s demographic characteristics, lesions photographs, the suspected patient’s locality geographic coordinates (latitude, longitude, altitude) and the neighbourhood photographs. The CAPI was connected to the MRC, Data Centre system for data analysis.
To study the disease burden at Euaawa village, a survey was conducted using a close-ended structured questionnaire. The collected data included the basic demographic information on all household members, information on the household characteristics, environmental parameters and mycetoma cases.
The Health Education Team was led by social workers from the Association for Aid and Relief, Japan, Khartoum Office and Mr. Khalid Hamid, a fine artist. Several health awareness events were conducted using various methods and health education materials. The material included distribution of note-books on mycetoma for the pupils and children, leaflets and posters. Mr. Khalid Hamid had conducted several performances and open interactive theatre shows.
During the visit, the medical social officer had conducted many social services works, and 15 patients with amputations were registered for prosthesis donated by the Agent of Aid and Relief, Japan that will help to improve their life qualities.
The GIS team managed to collect coordinates of the island in general and the targeted villages as well. Many data were collected during this visit for the environmental indicators; soil and vegetation, which will be analysed in spatial dimension to illustrate the situation at each area and to correlate that with mycetoma distribution.
Environmental samples were collected from Umm Garr island villages. 300 samples were collected from soil (two depths; surface and 30cm depth), thorns, trees, house walls, animals dung and others. These samples will be processed for DNA extraction for meta-genomic analysis.
The MRC would like to express its almost thanks and gratitude to his Excellency Mr. Tarig Berag, the State Minister of Health, The White Nile State, Dr. Babiker EL Mammoun, Director General, the Ministry of Health, The White Nile State, Prof. Gadalla Abdalla , Bahkt EL Ruda University Vice-Chancellor, the Faculty of Medicine at Bakht EL Ruda University staff in particular Mr. Samir Ismail consultant Surgeon, Dr. Mohayed Osman Deputy Dean for their kind support and help
Special thanks to Yanabee Alard Foundation, in particular, Dr. Yagoub Abdelmagid Mohammed, Dr. Sami Alsammani Ibrahim and Dr. Murtada Altayeb Mohammed for supporting the accommodation, and meals for the whole mission members.