Mycetoma as a major cause of limb amputation in Northeastern Ethiopia: A facility-based retrospective study

Background Mycetoma is a chronic, progressively destructive infection that can result in severe disability and limb loss. In Ethiopia, diagnostic capacity and access to effective treatment remain limited, and the burden of mycetoma is poorly characterized. Recent clinical observations from the Afar Region suggest a high frequency of advanced disease and amputation, yet systematic evidence on the burden is lacking. This study aimed to describe the clinical burden of mycetoma, diagnostic and treatment practices, care-seeking patterns, and the extent of limb amputation at Dubti General Hospital in Afar region, northeastern Ethiopia. We conducted a facility-based retrospective review of all patients with a clinical diagnosis of mycetoma managed at Dubti General Hospital between September 2020 and August 2025. Demographic characteristics, clinical presentation, diagnostic investigations, treatment modalities, disability status, and surgical outcomes were summarized descriptively. Factors associated with delayed presentation (>12 months from symptom onset) were assessed using multivariable logistic regression. A total of 143 patients were identified, with a mean age of 30.9 years (SD ± 11.7); 79% were male, 85.3% resided in rural areas, and 46% were pastoralists. All cases involved the lower limb and presented with localized swelling. Pain (90.9%), warmth (54.5%), sinus formation (42.7%), and discharge (40.6%) were common. Diagnosis relied primarily on clinical assessment alone (58.7%), with limited use of imaging and biopsy. The mean duration of illness before first presentation was 33.8 months (SD ± 29), and 89.5% of patients presented after more than 12 months of symptoms. Compared with farmers, merchants had lower odds of delayed presentation (AOR = 0.89, 95% CI: 0.27-0.59). Nineteen patients (13.3%) underwent limb amputation, accounting for 23.5% of all orthopaedic amputations performed at the hospital during the study period. Disability at presentation was frequent, with 14.0% of patients experiencing severe motor impairment. Mycetoma in Afar predominantly affects young rural men and presents almost exclusively with advanced lower-limb disease. Profound diagnostic limitations, delayed care-seeking, and restricted surgical options contribute to poor outcomes. Integrating mycetoma into national neglected tropical disease strategies, strengthening early detection and diagnostic services, ensuring consistent access to essential medications, and expanding limb-sparing surgical capacity are critical to reducing preventable disability and aligning Ethiopia's response with global NTD control targets.