Traditional healing and mycetoma management in East Sennar State (Sudan): a qualitative exploration

Mycetoma is a neglected tropical disease with significant physical, social, and economic consequences. In Sudan, biomedical services dominate health policy and funding, often marginalising coexisting traditional healing systems. Understanding the interplay between these parallel systems is essential for improving patient outcomes.

To explore the role of traditional healers in mycetoma management in Sudan, examine patients' health-seeking behaviours, and analyse the power dynamics shaping healthcare pathways.

We conducted a qualitative study using a critical medical anthropology framework. Data were collected through in-depth interviews, focus group discussions, and environmental observations, including analysis of health promotion materials. Participants included individuals with mycetoma, their families, carers, biomedical practitioners, and traditional healers. Data were thematically analysed to identify patterns in help-seeking, treatment experiences, and inter-system relationships.

Traditional healers were found to be the first point of contact for most people with mycetoma. Reliance on healers was influenced not only by economic barriers but also by cultural trust, social support, and systemic inequities. Biomedical practitioners frequently perceived healers as a cause of treatment delays, reflecting entrenched power asymmetries between health systems. Health promotion materials reinforced biomedical dominance and contributed to the marginalisation of traditional healing. Patients' experiences were shaped by both interpersonal and institutional power relations.

Traditional healers play a crucial role in sustaining access to care for people with mycetoma in Sudan. Effective collaboration between health systems will require addressing the structural and relational power imbalances that currently hinder integration. Recognising traditional healers as healthcare stakeholders is essential for culturally appropriate and equitable health interventions.