Report on: The First International Training Workshop on Mycetoma, Khartoum, Sudan, 10–14 February 2019


The First International Training Workshop on Mycetoma was organised in Khartoum, Sudan in the period 10–14th February 2019. It was organised by the Mycetoma Research Centre, (MRC), University of Khartoum, WHO Collaborating Centre on Mycetoma and the World Health Organization (WHO).
It aimed to facilitate the implementation of the Resolution WHA69.21 through the strengthening of country-level capacities on diagnosis and treatment of mycetoma. Furthermore, to provide medical and health workers with a logical and systematic approach to the diagnosis and management of mycetoma and its public-health aspects. 

The Venue
The training workshop was organised at the Mycetoma Research Center and Soba Educational, Training and Examination Centre, Soba University Hospital, Khartoum, Sudan.

The Workshop Rationale
•    Mycetoma has a wide distribution globally, but most cases are found in tropical and subtropical regions in the “mycetoma belt”, which extends between latitudes 15° south and 30° north and includes countries of Argentina, Brazil, Chad, Ethiopia, India, Mauritania, Mexico, Senegal, Somalia, Sudan, Venezuela, Yemen and others. A global response is required to address its burden.
•    Mycetoma mainly affects poor and underserved populations. There is thus a need to strengthen access to diagnosis and treatment within the framework of universal health coverage.
•    Only limited information on the transmission of mycetoma and its burden are available, which limits the arsenal of available control tools and warrants more environmental and epidemiological studies in areas where the disease is endemic. More field research is needed.
•    Currently, there is no standardised approach to surveillance, diagnosis and treatment of mycetoma. More consensus and strategic direction are required.
•    There is limited capacity to manage mycetoma at the country level, and neither preventive nor public-health control programmes are in place globally.
•    Effective South-to-South and North-to-South collaboration must be established, knowledge must be transferred, and capacity must be built. 
•    Challenges include collecting quantitative and qualitative information on cases of mycetoma, with the aim of estimating the burden of the disease and understanding its clinical presentation and treatment outcomes. Better surveillance and a global mycetoma registry are needed.
•    Mycetoma is “neglected” in terms of the priority afforded to the disease by health and social sectors across the world. There is a great need for improved communication, awareness, advocacy and resource mobilisation to increase the visibility of mycetoma.

The Objectives
The main objectives were to:
•    Provide an opportunity for clinicians, care providers and public health workers for group discussions and share their experiences;
•    Discuss disease causation, presentation, diagnosis and treatment, patients’ care and referral indications;
•    Improve knowledge, attitude and practice, including ultrasound diagnosis;
•    Discuss the delivery of community health education and disease advocacy;
•    Improve the overall practical management of the disease.

Workshop activities
The workshop had provided training on:
•    Patient referral, specimen collection, diagnosis, treatment and follow-up of mycetoma;
•    Various laboratory and clinical management protocols;
•    Molecular diagnosis of mycetoma
•    Integrated and holistic management of mycetoma
•    The establishment of a global mycetoma registry to collect epidemiological and ecological characteristics of each case and delineate the spatial distribution of the disease globally;
•    Collaborative epidemiological studies and research in different endemic countries;
•    Establishment of national and international guidelines on the management of mycetoma;
•    National prevention and control programmes design.

The Training Workshop Participants
Seventy-nine participants from 32 countries had attended the training workshop and that included Argentina, Austria, Brazil, Cameron, Chad, Cuba, Ethiopia, Germany, India, Iran, Italy, Japan, Kenya, Madagascar, Mauritania, Mexico, Nepal, Netherlands, Nigeria, Pakistan, Philippian, Senegal, Somalia, Sudan, Tanzania, Tunisia, Switzerland, Uganda, United Kingdom, United States, Yemen.

Instruction Methods
That included:
•    Plenary sessions
•    Hands-on-experience
•    Group discussions
•    Group work
•    Meet-the-experts
•    Clinical sessions

The Instruction Language
The training workshop language was English.

The Outcomes

1.    The training workshop had strengthened the participants’ capacities in the following areas
       - Appropriate case management,

       - Basic laboratory diagnosis of mycetoma,
       - Surveillance for mycetoma,
       - Creation of a global mycetoma registry,
       - Designing national and international protocols on the management of mycetoma,
       - Designing national prevention and control programmes.
2.    It had established a good collaboration and links among the participants from the endemic countries and with the global institutions working on mycetoma.
3.    It had increased communication, awareness and advocacy on mycetoma.

The Feedback
The training workshop participants gave feedback both oral and written
In general, it was positive, and it showed demand for further training activities at the country level and the different regions.

•    More regional workshops
•    Establishment of regional mycetoma expert’s groups

•    Prof Ahmed Mohamed EL Hassan, Emeritus Professor of Pathology, University of Khartoum, Sudan.
•    Prof EL Sheikh Mahgoub, Professor of Microbiology, The Mycetoma Research Centre, University of Khartoum.
•    Prof. Roderick Hay, Professor of Dermatology, International Foundation for Dermatology, London, United Kingdom
•    Prof. Ahmed Hassan Fahal, Professor of Surgery, Mycetoma Research Center, University of Khartoum, Sudan.
•    Prof Alexandro Bonifaz, Professor of Dermatology, National Autonomous University of Mexico, Mexico City, Mexico.
•    Dr Badr EL Din Margani, Consultant Histopathologist, Soba University Hospital, Khartoum, Sudan.
•    Dr EL Rayah Mustafa, Consultant Radiologist, Soba University Hospital, Khartoum, Sudan.
•    Dr Mustafa EL Nour, A. Professor of Radiology, University of Khartoum.
•    Dr Sahar Moubark Bakhiet, A. Professor of Molecular Biology, Mycetoma Research Center, University of Khartoum, Sudan.
•    Dr Wendy van de Sande, A. Professor of Medical Microbiology, Erasmus Medical Centre, University of Rotterdam, Rotterdam, the Netherlands
•    Dr Karlyn Beer, Consultant Epidemiologist, Centers for Disease Control and Prevention, Atlanta, USA
•    Dr David Blaney, Consultant Epidemiologist, Centers for Disease Control and Prevention, Atlanta, USA
•    Dr Kevin Onyango, Clinical Trials Coordinator, Drugs for Neglected Diseases initiative (DNDi), Keyna
•    Dr Borna Nyaoke, Clinical Trials Director, Drugs for Neglected Diseases initiative (DNDi), Keyna
•    Dr Albis Francesco Gabrielli, Team Leader, Capacity Building & Communications, Neglected Tropical Diseases, World Health Organization, Geneva

The Budget
The WHO, Head-Quarter and EMRO Office had contributed tremendously to the training workshop budget

The Workshop Photos

Workshop Organisers
  - Prof. Ahmed Hassan Fahal
    Professor of Surgery,
    Director, The Mycetoma Research Centre, University of Khartoum
  - Dr Albis Francesco Gabrielle,
   Team Leader, Capacity Building & Communications
   Neglected Tropical Diseases
   World Health Organization, Geneva
  - Dr Laxmikant Chavan
   Technical Consultant, Communicable Diseases & Epidemiology,
   World Health Organization, Sudan
  - Dr Ashok Moloo
   Communications Officer, World Health Organization, Geneva

•    The workshop programme
•    Participants list