Mycetoma victims find help in Sudan

Updated 18 August 2013
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Mycetoma victims find help in Sudan

Behind the brick walls of the Mycetoma Research Center trying to unravel the mysteries of the infection is a rare story of medical success in impoverished Sudan.
With bandages on their swollen, deformed feet, patients from across the vast country arrive at the spotless facility set in a garden in the southern Khartoum district of Soba.
For more than 40 years, British-educated researcher Elsheikh Mahgoub has been searching for answers to the mysteries of mycetoma, a bacterial and fungal infection which can spread throughout the body resulting in gross deformity and even death.
Sudan is particularly affected by mycetoma, which is also endemic in a geographic belt including regional neighbors Chad, Niger, Nigeria, Ethiopia, Somalia, parts of Saudi Arabia and Yemen, experts say.
The belt also stretches to India and parts of Latin America.
Mycetoma is “a badly neglected disease,” the United Nations’ World Health Organization (WHO) says on its website.
Yet in Sudan, researchers have been studying the condition since British colonial times, and the Khartoum center has been globally recognized for its work.
Such acknowledgement in the health field is unusual for a country which ranks near the bottom of a UN human development index measuring income, health and education.
Mycetoma is characterised by swelling of the feet but it can eat away bone and spread throughout the body, causing grotesque barnacle-like growths, club-like hands and bulging eyes.
The traditional treatment was amputation — something the Sudanese center tries to avoid.
“Most patients who get it are farmers, or animal herders, and these are poor people,” says Mahgoub, 78.
“They are poor, and they get poorer.”
Mahgoub says he established Sudan’s first mycetoma center in 1968, working with a British nurse and a British technician.
“Many people thought: Why should I be concerned about this disease which is not common, which is difficult to diagnose, and difficult to treat?” he told reporters on a tour of the facility, which opened at its current location in the 1990s.
The center offers diagnosis, treatment, training and research as part of Soba University Hospital under the University of Khartoum, which funds it along with some donors.
It has its own laboratory, two wards, and is served by seven part-time doctors as well as Mahgoub, the research supervisor, and its director A.H. Fahal, a professor of surgery.
Though its resources are limited, they have been used effectively, Fahal has written.
Patients come and go — with 6,400 registered so far — but Fahal remains and so does Mahgoub, challenged by the puzzle of why mycetoma is so prevalent in Sudan and neighboring countries.
“I think there’s two things,” Mahgoub explains, pointing first to the organism’s presence in soil.
He says people who make their living from the land are more likely to get pricked by thorns, for example, from the Acacia trees which are widespread in the mycetoma-prone region and provide a route for infection.
Secondly, the patients have been found with weakened immune systems. Some not only have mycetoma but also AIDS, leprosy, tuberculosis or other conditions, Mahgoub says.
“Why? Why these people? Is it nutritional, because of malnutrition? Is it because of the other diseases they get at the same time?“
He does not yet have the answers.
“But we know that they have got some deficiency in their cell-mediated immunity.”
Mohammed Al-Amien Ahmad is a typical case.
The farmer tells Mahgoub that a thorn jabbed him about 20 years ago.
“This thorn came out and it seemed to be OK. Later on the swelling came up. It was a bit itchy,” says the goateed farmer, who is in his 60s and wears a traditional white jalabiya robe.
Ahmad, his enlarged left foot oozing pus, has traveled more than 500 kilometers by bus from Umm Rawaba where he farms about 70 acres (28 hectares) of sorghum.
His condition worsened over the past two years, he says, forcing him to reduce the amount of land he can work, and cutting into his annual income of 30,000-40,000 Sudanese pounds ($4,300-$5,700).
In a majority of cases mycetoma is painless, meaning patients like Ahmad delay seeking medical care.
This makes treatment more difficult, Mahgoub says.
“The main thing we tell them is to come early... Because if the swelling is small it can be excised in total,” with follow-up medication, he says.
The Mycetoma Research Center provides diagnosis and any surgery patients may need for free. But patients may require months of anti-fungal medication, which they must buy themselves.
Some who cannot bear the financial burden stop taking their medicine, Mahgoub says.
“In that case the disease will just go back to where it started. That’s a real problem,” he says.
Drug prices in Sudan have climbed over the past two years as Sudan’s currency plunged in value and inflation soared.
Sudan’s health ministry has expressed concern about the emigration of doctors and other health professionals seeking better salaries and working conditions abroad.
Nationwide, there were 1.3 health workers per 1,000 people in 2011, against the WHO benchmark of 2.3.
Many primary health care facilities in Sudan “lack appropriate medical equipment and supplies, have inadequate infrastructure or are understaffed,” the United Nations said this year.
In contrast, the Mycetoma Research Center “is recognized globally as a world leader,” an informal group of experts on the disease wrote after their first meeting this year in Geneva.
The group added that Fahal, the Sudanese center’s director, is a “leading global expert.”
Mahgoub said retirement or emigration are not options for him and his colleague, who remain committed to giving this “neglected” disease their full attention.
“Neither myself or Fahal are leaving,” he said.


Take a healthy approach to the issue of nutritional supplements

Updated 21 April 2018
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Take a healthy approach to the issue of nutritional supplements

JEDDAH: There is a growing need for dietary supplements in Saudi Arabia, given the increasing popularity of junk food and the effective role supplements can play in treating diseases caused by mineral and vitamin deficiencies.

A recent study found that 22 percent of Saudi people take nutritional supplements. It is no surprise, then, that many Saudi businesses have forged partnerships with international dietary-supplement companies.

Dr. Rowaidah Idriss, a Saudi dietitian with a Ph.D. in nutrition, said dietary supplements can be defined as substances that provide the human body with a nutrient missing from a person’s regular diet. However, she stressed that they are not intended to replace healthy eating.

She also warned against taking them without first talking to a doctor or dietitian, as some products can have side effects, especially if taken before surgery or with other medicines. 

“They can also cause problems if someone has a history of certain health issues,” she added.

A blood test can determine which nutrients we are not getting enough of in our diet, and therefore which supplements might be beneficial. Nutritional supplements are also used to help treat certain health conditions. 

“Vitamin C, for example, is often used to reduce cold symptoms,” said Idriss. “Fish oil is taken to lower elevated blood triglycerides.”

She suggested four daily essentials that can bridge nutritional gaps in our diet: a multivitamin, vitamin D, calcium and omega-3 fatty acids. 

“I routinely recommend a daily multivitamin and mineral supplement to my clients after consulting with their doctors,” she said. 

“For menstruating women, who require 18 milligrams of iron each day, a daily supplement helps boost iron intake.”

She said people over the age of 50 are advised to take a multivitamin to ensure they are getting enough B12, which plays a key role in the functioning of the nervous system and the development of red blood cells. 

“Older adults are more vulnerable to B12 deficiency because they are more likely to have decreased production of stomach acid, which is needed to release B12 from the proteins in food.” said Idriss. 

“It is also a good idea to take a daily multivitamin if one is following a low-calorie diet.”

She also pointed out that a high intake of DHA and EPA, the two omega-3 fatty acids found in fish oil, are linked with a lower risk of heart disease and Type 2 diabetes. A deficiency of DHA might also increase the risk of Alzheimer’s. 

“A daily intake of 1,000 milligrams of both DHA and EPA is equivalent to eating 12 ounces of salmon a week,” said Idriss.

The dietitian believes that the Saudis who take food supplements often do so more to benefit their appearance than their health. 

“Saudi women consume more dietary supplements than other people in Saudi Arabia,” she said. 

“They do so either to lose weight or to care for their hair and nails. Bodybuilders also take large amounts of supplements.”

However, both groups, according to Idriss, tend to take supplements on the recommendation of friends and trainers, not doctors. 

She warned that commercials and social-media rumors can persuade people to buy supplements online that may not be approved as safe by the Saudi Food and Drug Authority, and advised people to get as much of their daily nutrient needs as possible from healthy eating.

Dr. Rowaidah Idriss

“Along with vitamins and minerals, a healthy diet provides fiber and hundreds of protective phytochemicals, something a supplement cannot do,” she said, adding that the body absorbs natural food more effectively than supplements.

In addition, combining supplements with medications can have dangerous, even life-threatening, effects. 

“Drugs for heart disease and depression, treatments for organ transplants, and birth-control pills are less effective when taken with herbal supplements,” she said.

“Taking an anticoagulant, aspirin, and a vitamin E supplement together may increase the potential for internal bleeding or even stroke.”

 

Natural sources

With the spread of fast-food restaurants and their alluring ads, the long-term health of the Saudi people is in danger, as children and young people snub natural sources of nutrients, such as fruit and vegetables. 

“This can lead to many deficiency diseases. Moreover, vegetarians can develop similar illnesses due to the absence of meat in their diet,” she said.
Dr. Ashraf Ameer, a family-medicine consultant, said the importance of nutritional supplements lies in treating mineral and vitamin deficiency, especially for pregnant women, growing children, diabetics, people with chronic diseases, and the elderly. 

“However, these products should come from reliable companies and meet Saudi food and drug requirements,”he added.

Mohammed Yaseen, who has a food supplements business, said his company works with a leading British health-care company to provide the Saudi market with high quality products.

“With this we hope we can contribute to the national transformation program by raising private-sector spending in health care from 25 percent to 35 percent, which in turn would lead to the sector’s financial sustainability and boost economic and social development in the Kingdom,” Yaseen said.

Decoder

Vitamin Terms

DHA stands for docosahexaenoic acid. EPA stands for eicosapentaenoic acid.  Phytochemical is a biologically active compound found in plants.