Environmental and structural risk factors for mycetoma in the White Nile State, Sudan: an ethnographic study

For decades, poor Sudanese communities in rural areas have silently battled mycetoma, a stigmatizing, disabling, neglected tropical disease. Its linkage to specific, ecology-dependent livelihoods such as farming, woodcutting and collecting and animal herding has obscured its cause and environmental and structural dimensions at both the local and global levels. This ethnographic study challenges the prevailing singular focus on the injuries that have dominated biomedical reasoning for years. We deployed an ethnographic approach utilizing participant observation, in-depth interviews with 20 clinically confirmed mycetoma patients, and focus group discussions with eight animal herders, eight farmers, eight women, eight woodcutters, and collectors to explore lived experiences, exposure, and livelihood. These data were complemented by key informant interviews with two health-care providers, two traditional healers, two community leaders, and two local authorities to situate findings within broader institutional and sociocultural contexts. The data were thematically analyzed using Invivo 11 software. The study revealed that agro-pastoral livelihoods along with woodcutting put people at greater risk of injuries, which might introduce the mycetoma causative agent to the human body. Additionally, this study found that both women and men are equally exposed to mycetoma risk factors due to practicing diverse livelihood modalities. It also revealed that risk extends beyond thorn pricks to include multiple environmental exposures shaped by livelihood systems and structural factors such as failed irrigation systems, especially during the rainy season, and flooding. Concealing hazardous materials was found to increase the exposure risk to further injuries like broken glass and stepping on stones and gravel, for instance. This study necessitates a global re-evaluation of mycetoma’s perceived causality, shifting the paradigm beyond a single lens of trauma and exploring potential new risk factors. They pave the way for a more holistic understanding that integrates medical interventions with environmental and social determinants. By uncovering the hidden complexity of mycetoma, the study opens doors to prevention strategies that triumph over neglect.