Revealing the possible neglected environmental risk factors contributing to mycetoma in the White Nile state: Sudan

Background 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 dimensions at both the local and global levels. Challenging the prevailing singular focus on the injuries that have dominated biomedical reasoning for years. Methods This ethnographic study sheds light on diverse potential perceived causal factors and possible risk exposure pathways. Through participant observation, in-depth interviews and focused group discussions. Results we revealed that not only through pricks but also injuries from agricultural tools, bamboo sticks, 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, flooding, and concealing hazardous materials were found to increase the exposure risk to further injuries. Conclusion These findings necessitate a global re-evaluation of mycetoma 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, we open doors to prevention strategies that triumph over neglect.