Estimating the burden of mycetoma in Sudan for the period 1991–2018 using a model-based geostatistical approach

Mycetoma is widespread in tropical and subtropical regions favouring arid areas with low humidity and a short rainy season. Sudan is one of the highly endemic countries for mycetoma. Estimating the population at risk and the number of cases is critical for delivering targeted and equitable prevention and treatment services. In this study, we have combined a large dataset of mycetoma cases recorded by the Mycetoma Research Centre (MRC) in Sudan over 28 years (1991–2018) with a collection of environmental and water and hygiene-related datasets in a geostatistical framework to produce estimates of the disease burden across the country. We developed geostatistical models to predict the number of cases of actinomycetoma and eumycetoma in areas considered environmentally suitable for the two mycetoma forms. Then used the raster dataset (gridded map) with the population estimates for 2020 to compute the potentially affected population since 1991. The geostatistical models confirmed this heterogeneous and distinct distribution of the estimated cases of eumycetoma and actinomycetoma across Sudan. For eumycetoma, these higher-risk areas were smaller and scattered across Al Jazirah, Khartoum, White Nile and Sennar states, while for actinomycetoma a higher risk for infection is shown across the rural districts of North and West Kurdufan. Nationally, we estimated 63,825 people (95%CI: 13,693 to 197,369) to have been suffering from mycetoma since 1991 in Sudan,51,541 people (95%CI: 9,893–166,073) with eumycetoma and 12,284 people (95%CI: 3,800–31,296) with actinomycetoma. In conclusion, the risk of mycetoma in Sudan is particularly high in certain restricted areas, but cases are ubiquitous across all states. Both prevention and treatment services are required to address the burden. Such work provides a guide for future control and prevention programs for mycetoma, highly endemic areas are clearly targeted, and resources are directed to areas with high demand.Author summary: Mycetoma is a chronic infection that is recently been labelled as a neglected tropical disease (NTD) by the World Health Organization (WHO). The epidemiological features of mycetoma are not well described. The prevalence of the disease are globally underestimated. In Sudan, there are few studies reporting prevalence. In order to estimate mycetoma burden, we combined a large dataset of mycetoma cases recorded by the Mycetoma Research Centre (MRC) in Sudan with a collection of environmental and water and hygiene-related datasets in a geostatistical framework to produce estimates of the disease burden across the country. Our geostatistical models fitted based on the eumycetoma and actinomycetoma cases recorded by the MRC in Sudan between 1991 and 2018, have shown a spatially heterogeneous and distinct distribution of both mycetoma forms across this endemic country. According to our predictions, most of the eumycetoma cases would have occurred around the Khartoum area and Al Jazirah state and most of the actinomycetoma cases would have concentrated in the rural North and West Kurdufan states. Our findings here have several implications for clinical and public health practices. Both prevention and treatment services are required to address the burden. Such work provides a guide for future control and prevention programs for mycetoma, highly endemic areas are clearly targeted, and resources are directed to areas with high demand. Moreover, medical personnel will have high levels of suspicion for mycetoma in areas with high burden and cases will be adequately diagnosed and managed within their communities without the need to seek medical treatment in centralized medical facilities, in turn reducing the financial burden for mycetoma patients.