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Improving the treatment of chromoblastomycosis in rural Madagascar

November 07 2016

Even in the more economically developed countries, where multiple treatment options are available and affordable, chromoblastomycosis can be a challenge to diagnose and treat. In less economically developed countries, this challenge becomes many times greater. Madagascar has the highest number of cases of chromoblastomycosis in the world, but limited expertise and access to affordable treatment options. This means that the most effective methods to prevent adverse health outcomes, decrease disfigurement and prevent marginalisation are often unavailable for the patient. In a recently published paper, Aaron Santmyire, reports on a project to implement and evaluate a practice change in the treatment of chromoblastomycosis in the SAVA province in northeast Madagascar. 

 (a)     (b)
(a) Severe facial and ear chromoblastomycosis in a man from Papua New Guinea
(b). A 34 year old male with a 12-year history of a red plaque in the left knee (By Ran Yuping et al. https://commons.wikimedia.org/w/index.php?curid=52253338)
 

A systematic review was conducted before the start of the project, using the keywords chromoblastomycosis, terbinafine, skin infections, mycosis and treatment. The review supported the prevailing opinion that there are two recommended medications for the treatment of chromoblastomycosis, and physical treatment. Physical treatment options can be used on their own, or in combination with oral medications. In Madagascar, one of these medications is not available, and physical treatment options are unavailable, unaffordable, or impractical. Further work is therefore needed to find methods that are effective and accessible in the areas where infection is most prevalent.

The project aimed to increase doctor knowledge and subsequent use of treatment recommendations for diagnosis, staging/scoring, treatment and patient education of chromoblastomycosis. This was carried out using multifocal training over a two day period, including presentations on leprosy, skin and soft tissue infections, chromoblastomycosis, tropical dermatological skin infections and treatment of dermatological conditions in pregnant and breastfeeding women. The training was tested for effectiveness using a pre- and post-test scoring system. A 3 month follow up was used to assess whether knowledge was retained during the 3 months following training. 

34 doctors participated in the multi-focal training. Post-test scores were significantly greater than pre-test scores, while the 3 month follow up evaluation demonstrated that knowledge was retained. Furthermore, at least 8 doctors applied the training to their practice, switching from ineffective treatment to effective treatment. It is worth noting however that less than half of the participants completed the 3 month follow up questionnaire (15/34). The author concludes that multifocal training can be used successfully to increase doctor’s knowledge of treatment recommendations, but that there is a significant need for research into treatment options that are available and affordable in developing countries such as Madagascar. 

Article: Santmyire A. 2016