{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T14:37:39Z","timestamp":1783953459151,"version":"3.55.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Mycetoma is a chronic disease caused either by fungi (eumycetoma) or bacteria (actinomycetoma). Treatment remains suboptimal and based on personal clinical experience. Recently, the Mycetoma Research Centre (MRC), a WHO Collaborating Centre on mycetoma, began the first-ever double-blind clinical trial. Here, we report the challenges and barriers faced in the recruitment and retention of patients in the MRC experience.<\/jats:p>\n               <jats:p>Patient recruitment and retention are critical determinants of clinical trial success and yet a substantial number of trials fail to reach their recruitment goals. Recruitment challenges are identified throughout the different stages of the clinical trial, starting from planning, participant screening and intervention, through to retaining participants for the entire study duration. The MRC made efforts to address these challenges to ensure the constant flow of patients. The recruitment committee at the MRC conducted training workshops for the medical staff in the endemic areas, along with regular meetings with health authorities and local leaders. Moreover, telemedicine technology was used to examine patients in endemic areas.<\/jats:p>\n               <jats:p>Challenges and barriers facing clinical trial conduct need to be examined thoroughly to ensure actionable, evidence-based recommendations for improving patient recruitment and retention. In conclusion, effective patient recruitment and retention are based on three pillars, which are proper clinical trial design and protocol development, realistic and feasible trial site selection, and objective communication with the trial stakeholders.<\/jats:p>","DOI":"10.1093\/trstmh\/traa165","type":"journal-article","created":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T12:24:54Z","timestamp":1606479894000},"page":"397-405","source":"Crossref","is-referenced-by-count":9,"title":["The challenges of recruitment in clinical trials in developing countries: the Mycetoma Research Centre experience"],"prefix":"10.1093","volume":"115","author":[{"given":"Rowa Fathelrahman","family":"Omer","sequence":"first","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiman Siddig","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buthyna Mamoun","family":"Ali","sequence":"additional","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana E","family":"Alhaj","sequence":"additional","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar Mubarak","family":"Bakhiet","sequence":"additional","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"},{"name":"Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El Samani Wadaa","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Strub-Wourgaft","sequence":"additional","affiliation":[{"name":"Drugs for Neglected Diseases initiative, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Hassan","family":"Fahal","sequence":"additional","affiliation":[{"name":"Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,23]]},"reference":[{"issue":"8","key":"2021041419233017500_bib1","first-page":"382","article-title":"The deep mycoses in Kenya: a histopathological study. 1. Mycetoma","volume":"50","author":"Cameron","year":"1973","journal-title":"East Afr Med J"},{"issue":"4","key":"2021041419233017500_bib2","first-page":"211","article-title":"Les myc\u00e9tomes en Afrique","volume":"5","author":"Develoux","year":"1995","journal-title":"Cahiers d'\u00e9tudes et de recherches francophones\/Sant\u00e9"},{"key":"2021041419233017500_bib3","first-page":"477","article-title":"Epidemiolog\u00eda del micetoma en M\u00e9xico: estudio de 2105 casos","volume":"128","author":"L\u00f3pez","year":"1992","journal-title":"Gac Med Mex"},{"issue":"3","key":"2021041419233017500_bib4","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3390\/tropicalmed3030097","article-title":"Mycetoma: the spectrum of clinical presentation","volume":"3","author":"Fahal","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"2021041419233017500_bib5","first-page":"169","article-title":"Mycetoma: an old and still neglected tropical disease","volume-title":"Trans R Soc Trop Med Hyg","author":"Hay","year":"2015"},{"issue":"11","key":"2021041419233017500_bib6","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1002\/bjs.1800791107","article-title":"Mycetoma","volume":"79","author":"Fahal","year":"1992","journal-title":"Br J Surg"},{"key":"2021041419233017500_bib7","volume-title":"Mycetoma\u2014Clinicopathological Monograph","author":"Fahal","year":"2006"},{"key":"2021041419233017500_bib8","first-page":"31","article-title":"Mycetoma: epidemiology, treatment challenges, and progress","volume":"6","author":"Mohamed","year":"2015","journal-title":"Res Rep Trop Med"},{"key":"2021041419233017500_bib9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/978-1-4614-4726-9_15","article-title":"Mycetoma caused by Madurella mycetomatis: a completely","volume":"764","author":"van Belkum","year":"2013","journal-title":"Adv Exp Med Biol"},{"key":"2021041419233017500_bib10","first-page":"923","article-title":"The association of HLA-DRB1 and HLA-DQB1 alleles","volume":"6","author":"Al Dawi","year":"2013","journal-title":"Khartoum Med J"},{"issue":"9","key":"2021041419233017500_bib11","doi-asserted-by":"crossref","first-page":"e0004061","DOI":"10.1371\/journal.pntd.0004061","article-title":"A polymorphism in the chitotriosidase gene associated with risk of mycetoma due to Madurella mycetomatis mycetoma\u2013a retrospective study","volume":"9","author":"Verwer","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"2021041419233017500_bib12","doi-asserted-by":"crossref","first-page":"e2667","DOI":"10.1371\/journal.pntd.0002667","article-title":"The mycetoma knowledge gap: identification of research priorities","volume":"8","author":"van de Sande","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"2021041419233017500_bib13","doi-asserted-by":"crossref","first-page":"e0003679","DOI":"10.1371\/journal.pntd.0003679","article-title":"Mycetoma in the Sudan: an update from the Mycetoma Research Centre, University of Khartoum, Sudan","volume":"9","author":"Fahal","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"2021041419233017500_bib14","doi-asserted-by":"crossref","first-page":"e0004862","DOI":"10.1371\/journal.pntd.0004862","article-title":"Th-1, Th-2 Cytokines profile among Madurella 526 mycetomatis eumycetoma patients","volume":"10","author":"Nasr","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"2021041419233017500_bib15","doi-asserted-by":"crossref","first-page":"e2550","DOI":"10.1371\/journal.pntd.0002550","article-title":"Global burden of human mycetoma: a systematic review and meta-analysis","volume":"7","author":"van de Sande","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"2021041419233017500_bib16","doi-asserted-by":"crossref","first-page":"e2918","DOI":"10.1371\/journal.pntd.0002918","article-title":"Merits and pitfalls of currently used diagnostic tools in mycetoma","volume":"8","author":"van de Sande","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"2021041419233017500_bib17","doi-asserted-by":"crossref","first-page":"e0007056","DOI":"10.1371\/journal.pntd.0007056","article-title":"The accuracy of histopathological and cytopathological techniques in the identification of the mycetoma causative agents","volume":"13","author":"Siddig","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"2021041419233017500_bib18","doi-asserted-by":"crossref","first-page":"e0004690","DOI":"10.1371\/journal.pntd.0004690","article-title":"The surgical treatment of mycetoma","volume":"10","author":"Suleiman","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"2021041419233017500_bib19","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S1473-3099(15)00359-X","article-title":"Mycetoma: a unique neglected tropical disease","volume":"16","author":"Zijlstra","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"10","key":"2021041419233017500_bib20","doi-asserted-by":"crossref","first-page":"e0005007","DOI":"10.1371\/journal.pntd.0005007","article-title":"Predictors of post-operative mycetoma recurrence using machine-learning algorithms: the mycetoma research center experience","volume":"10","author":"Wadal","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"2021041419233017500_bib21","doi-asserted-by":"crossref","first-page":"e3218","DOI":"10.1371\/journal.pntd.0003218","article-title":"Mycetoma medical therapy","volume":"8","author":"Welsh","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"2021041419233017500_bib22","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.trstmh.2012.07.003","article-title":"Predictors of cure, amputation and follow-up dropout among patients with mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Sudan","volume":"106","author":"Zein","year":"2012","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2021041419233017500_bib23","author":"Mycetoma Research Centre"},{"key":"2021041419233017500_bib24","author":"DNDi"},{"key":"2021041419233017500_bib25","author":"Clinical Trial.gov"},{"issue":"1","key":"2021041419233017500_bib26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1177\/1740774514558307","article-title":"Unsuccessful trial accrual and human subjects protections: an empirical analysis of recently closed trials","volume":"12","author":"Carlisle","year":"2015","journal-title":"Clinical Trials"},{"issue":"17-18","key":"2021041419233017500_bib27","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1111\/jocn.12145","article-title":"Clinical trial recruitment-a complex intervention?","volume":"22","author":"Tramm","year":"2013","journal-title":"J Clin Nurs"},{"issue":"3","key":"2021041419233017500_bib28","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.ygyno.2017.06.021","article-title":"Recruitment challenges in clinical research: Survey of potential participants in a diagnostic study of ovarian cancer","volume":"146","author":"Sun","year":"2017","journal-title":"Gynecol Oncol"},{"issue":"3","key":"2021041419233017500_bib29","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/2229-3485.184820","article-title":"Challenges in recruitment and retention of clinical trial subjects","volume":"7","author":"Kadam","year":"2016","journal-title":"Perspect Clin Res"},{"issue":"1","key":"2021041419233017500_bib30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1745-6215-15-399","article-title":"Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities","volume":"15","author":"Bower","year":"2014","journal-title":"Trials"},{"issue":"2","key":"2021041419233017500_bib31","doi-asserted-by":"crossref","first-page":"e002360","DOI":"10.1136\/bmjopen-2012-002360","article-title":"Methods to improve recruitment to randomised","volume":"3","author":"Treweek","year":"2013","journal-title":"BMJ Open"},{"issue":"1-2","key":"2021041419233017500_bib32","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/j.1365-2702.2009.03041.x","article-title":"Clinical trials: the challenge of recruitment and retention of participants","volume":"19","author":"Gul","year":"2010","journal-title":"J Clin Nurs"},{"issue":"1","key":"2021041419233017500_bib33","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0035-9203(03)00009-9","article-title":"Mycetoma: a thorn in the flesh","volume":"98","author":"Fahal","year":"2004","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"5","key":"2021041419233017500_bib34","doi-asserted-by":"crossref","first-page":"e0006391","DOI":"10.1371\/journal.pntd.0006391","article-title":"A holistic approach to the mycetoma management","volume":"12","author":"Bakhiet","year":"2018","journal-title":"PLoS NeglTrop Dis"},{"issue":"10","key":"2021041419233017500_bib35","doi-asserted-by":"crossref","first-page":"e3271","DOI":"10.1371\/journal.pntd.0003271","article-title":"A new model for management of mycetoma in the Sudan","volume":"8","author":"Fahal","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"2021041419233017500_bib36","author":"Youtube"},{"issue":"5","key":"2021041419233017500_bib37","doi-asserted-by":"crossref","first-page":"e0006391","DOI":"10.1371\/journal.pntd.0006391","article-title":"A holistic approach to the mycetoma management","volume":"12","author":"Bakhiet","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"2021041419233017500_bib38","volume-title":"Sudan Crisis: What You Need to Know","author":"BBC"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/115\/4\/397\/37060846\/traa165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/115\/4\/397\/37060846\/traa165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T20:28:49Z","timestamp":1618604929000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/115\/4\/397\/6117887"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,23]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,1,23]]},"published-print":{"date-parts":[[2021,4,14]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/traa165","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4]]},"published":{"date-parts":[[2021,1,23]]}}}