title: Predictors of cure, amputation and follow-up dropout among patients with mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Sudan.
abstract: Complete cure of mycetoma is difficult to achieve and recurrence is common. The study objective was to determine the predictors of cure, amputation and follow-up dropout among the studied individuals with mycetoma. This prospective study included 1544 patients with confirmed mycetoma, of whom 1242 had eumycetoma and 302 actinomycetoma. They were treated and followed up regularly. Data were collected and analysed using logistic regression models to determine the predictors. In the eumycetoma group, longer treatment duration (OR=1.9; 95% CI 1.2-3.1) and absence of history of disease recurrence (OR=24.2; 95% CI 7.7-76.3) were significant predictors of increased odds of cure from mycetoma. A lesion size of 5-10 cm (OR=0.5; 95% CI 0.3-0.8) or >10 cm (OR=0.7; 95% CI 0.4-1.0) and combined medical treatment and surgery (OR=0.004; 95% CI 0.001-0.011) were each significant predictors of reduced odds of cure. Follow-up dropout among this group was high (54%). Large lesions (5-10 cm, OR=0.5, 95% CI 0.4-0.7; >10 cm, OR=0.6; 95% CI 0.5-0.9), amputations (OR=0.3; 95% CI 0.1-0.6) and longer treatment duration (OR=0.5; 95% CI 0.4-0.7) were significant predictors of reduced odds of follow-up dropout. In the actinomycetoma group, medical treatment was the only significant predictor of cure. Follow-up dropout among this group was also high (55.6%). Long treatment duration was a significant predictor of reduced odds of dropout (OR=0.5; 95% CI 0.3-0.8). There is a great demand for effective and efficient mycetoma treatment. Counselling and health education of patients is badly needed to encourage early reporting and treatment to reduce mycetoma's medical, social and economic impacts.
authors.affiliation: Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.
authors.forename: Hagir A M
authors.initials: HA
authors.lastname: Zein
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Fahal
authors.forename: El Shiekh
authors.initials: el S
authors.lastname: Mahgoub
authors.forename: Tasnam A
authors.initials: TA
authors.lastname: El Hassan
authors.forename: Manar E
authors.initials: ME
authors.lastname: Abdel-Rahman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use; D005492:Folic Acid / Q000627:therapeutic use; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D007654:Ketoconazole / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011446:Prospective Studies; D012008:Recurrence; D013397:Sudan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005296:Ferrous Compounds; D017964:Itraconazole; C020748:ferrous sulfate; D005492:Folic Acid; D007654:Ketoconazole