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Report on the Mycetoma Medical & Health Third Mission to Wad Onsa and Wad El Nimir villages, Sinner State 31st March - 1st April 2016

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Abstract and Figures

The Mycetoma Research Centre (MRC), University of Khartoum in collaboration with the Institute of Endemic Diseases (IEND), University of Khartoum and Sinner State Ministry of Health, had conducted the third medical and health field mission to Easter Sinner region which included Wad Onsa and Wad EL Nemir villages. Mission Objectives The main objectives were to: 1. Study the epidemiology of mycetoma in East Sinner region. 2. Determine the immune responses of the mycetoma patients in that region. 3. Determine the possible genetic association with mycetoma. 4. Determine the environmental characteristics of the East Sinner region. 5. Conduct mycetoma health education and advocacy in the community.
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Report on the Mycetoma Medical & Health Third Mission to
Wad Onsa and Wad El Nimir villages, Sinner State
31st March - 1st April 2016
The Mycetoma Research Centre (MRC), University of Khartoum in collaboration with the Institute
of Endemic Diseases (IEND), University of Khartoum and Sinner State Ministry of Health, had
conducted the third medical and health field mission to Easter Sinner region which included Wad
Onsa and Wad EL Nemir villages.
Mission Objectives
The main objectives were to:
1. Study the epidemiology of mycetoma in East Sinner region.
2. Determine the immune responses of the mycetoma patients in that region.
3. Determine the possible genetic association with mycetoma.
4. Determine the environmental characteristics of the East Sinner region.
5. Conduct mycetoma health education and advocacy in the community.
Mission Team:
1. Prof. Ahmed Hassan Fahal, Professor of Surgery, The Mycetoma Research Centre,
University of Khartoum. Khartoum, Sudan.
2. Prof. Ahmed Mudawi Musa, Director, Institute of Endemic Diseases, University of
Khartoum, Sudan.
3. Dr. Sahar Mubarak Bakhiet, Head of Molecular Biology Department, The Institute of
Endemic Diseases, University of Khartoum, Khartoum, Sudan.
4. Prof. Noma Mounkaila, University of Medical Sciences & Technology, Khartoum,
Sudan.
5. Dr. EL Rayah Mustafa, Consultant Radiologist, Soba University Hospital, University of
Khartoum.
6. Dr. Mustafa EL Nour, Consultant Radiologist, Soba University Hospital, University of
Khartoum.
7. Dr. Fadwa Awad, Research Assistant, The Mycetoma Research Centre, University of
Khartoum.
8. Dr. Roua Fath EL Rahman, Research Assistant, The Mycetoma Research Centre,
University of Khartoum.
9. Dr. Nagwa Joda, Senior Technologist, The Mycetoma Research Centre, University of
Khartoum.
10. Mr. Emmanuel Edward Siddig, Research Assistant, The Mycetoma Research Centre,
University of Khartoum.
11. Miss Amel Altayeb Ahmed, Research Assistant, The Mycetoma Research Centre,
University of Khartoum.
12. Dr. Mahmoud Koko, Research Assistant, The Institute of Endemic Diseases,
University of Khartoum.
13. Dr. Lamis Yahia Mohamed Elkheir, Lecturer, Department of Pharmaceutical
Chemistry, Faculty of Pharmacy, University of Khartoum.
14. Mr. A Razig Abdulla, Senior Nurse, The Mycetoma Research Centre, University of
Khartoum.
15. Mr. Yasser Adam, Medical Photographer, The Mycetoma Research Centre, University
of Khartoum.
16. Six health workers from Sinner State.
Study Area Wad Onsa and Wad EL Nemir
Wad Onsa is one of Sinner State villages, located on the northeastern part of the state, on the
west bank of the Aldindir River at a distance of 37 kilometers from Sinner town. It is considered as
one of the major Alsuki Foundation agricultural villages.
Wad El Nemir village located at the northeastern part of Sinner state, few kilometers from Wad
Onsa.
Map of the Sudan showing Sinner State locality
Maps of the Sinner State showing
Wad Onsa and Wad El Nemir location
The Mission Teams
That included the following teams:
Clinical management team
Environmental study team
Health Education team
Epidemiological study team
Immunological and genetic study team
The Teams Activities
The Clinical Management Team Activity:
The team organised an outpatient clinic were 202 registered patients with various medical
problems were seen, suspected mycetoma patients were referred for ultrasound
examination using portable ultrasound machine. Patients with ultrasonic evidence of
mycetoma (n=75) were booked for surgery in the coming few weeks at the Regional
Mycetoma Centre, Wad-Onsa.
Patients (n-48) with general surgical problems were referred to Wad AL Abbas regional
Hospital for further management.
Patients (n=11) who underwent surgery during the previous mission were followed up in the
clinical and were given free itraconazole. Only one patient had recurrence and he was not
taking this medication.
The Ultrasound Clinic
The Out-Patient Clinic
The Out-Patient Clinic
Prof. Musa examining a patient in the village
The Epidemiological Study Team Activities
A well trained epidemiological team conducted house-to-house survey at Wad-Onsa village
using a structured questionnaire for suspected mycetoma patients.
The collected data included the demographic information on all household members, the
household characteristics including: material of dwelling floor, roof and wall, fuel used for
cooking; household and individual assets; ownership of land and animals; animal sheds;
water and sanitation.
Environmental samples were collected from Wad-Onsa and Wad-EL Nemir villages.
Samples were collected from soil (two depths; surface and 30cm depth), thorns, trees,
walls and others. These samples will be processed for DNA extraction for meta-genomic
analysis.
The environmental samples collections
Data collection by a member of
the epidemiological study team.
The Immunology & Genetic Studies Team Activities:
The research team members visited all the confirmed mycetoma patients households in
Wad-Onsa village and their neighborhoods houses who were used as control. In addition,
random houses were visited. All participants were consented to obtain 5 ml of venous blood
which was divided into 2 ml heparin tube and 3 ml EDTA blood collection tubes.
The heparin tubes were coated previously with mycetoma antigen for stimulation of the
blood samples. The stimulation was done at 370C for 48 hour and then the supernatants
were separated and kept at -200C for cytokines analysis.
The EDTA tubes were processed and plasma was separated for serology.
The buffy coat was left for DNA extraction.
Blood samples collection and processing at the Centre laboratory
Mapping of the mycetoma patients households using GPS:
The households of mycetoma patients at Wad El-Nemir village (N=123) and at Wad Onsa.
(N=16) coordinates were located using the Global Position System. Two coordinates
readings in each household were obtained using two separate GPS devices for more
accuracy.
The coordinates were tabulated and plotted on the area map to highlight possible patterns
of mycetoma distribution. Environmental samples from the majority of these households
were collected as well.
Measuring the coordinates of each household
using two separate GPS devices
Health Education Sessions
The mission had conducted many health education sessions in the villages, and that
included face to face and group discussion. Prof Musa had addressed the villagers at the
Friday Prayer at the village mosque, and team members also had several interviews with
the local and national TV, radio broadcast.
A 26 minute-documentary film on mycetoma was shown at Regional Mycetoma Centre,
and it was well attended and that was followed by good discussion. Pre and post the
documentary show, data on the knowledge on mycetoma was collected.
Several educational posters mycetoma prevention have been distributed to the villagers.
Villagers attending the mycetoma
documentary film
Acknowledgments:
The villagers and local community leader kindly and generously sponsored the team meals
and accommodation and that was extraordinary in spite of their low socio-economic status
which exemplified the Sudanese generosity.
The Minister of Health, Sinner State, Mr. Mohamed Abdel Gadir had moved from the
Ministry headquarter at Senga to stay with the team during the whole visit, facilitating all
mission activities and had showed an extra-ordinary care, help and support to make the
mission a success.
The Ministry of Health senior staff and local community leader made their almost efforts to
support the team to accomplish their endeavors.
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