Paper short abstract:

The study is an exploration of links between the environment and Mycetoma within an environmentally based livelihood system in Sudan. Using in-depth interviews, observation, and focused group discussion, injury frequency while practising these activities is found to increase Mycetoma risk factors.

Paper long abstract:

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 like farming, wood cutting and collecting, and animal herding has obscured its cause and environmental dimensions both on a local and a global level. Challenging the prevailing singular focus on thorn injuries that over-flooded biomedical research for years, this ethnographic study sheds light on diverse potential causal factors and possible risk exposure pathways. Through participant observation, in-depth interviews and focused group discussions, we reveal that not only thorn pricks, but also injuries from agricultural tools, glass, seasonal cracks, and even stepping on gravel may introduce Mycetoma causative agents. Moreover, structural forces such as failed irrigation systems especially, during the rainy season, and flooding hazardous materials were found to also increase exposure risk to further injuries. These findings necessitate a global re-evaluation of Mycetoma's causality, shifting the paradigm beyond a single lens of thorn trauma and exploring potential new risk factors. They pave the way for a holistic understanding that integrates medical interventions with environmental and social determinants. By uncovering the hidden complexity of Mycetoma, we open doors to prevention strategies that triumph over neglect.