Knowledge, attitudes and practices about human African trypanosomiasis and their implications in designing intervention strategies for Yei county, South Sudan.

BACKGROUND: A clear understanding of the knowledge, attitudes and practices (KAP) of a particular community is necessary in order to improve control of human African trypanosomiasis (HAT).New screening and diagnostic tools and strategies were introduced into South Sudan, as part of integrated delivery of primary healthcare. Knowledge and awareness on HAT, its new/improved screening and diagnostic tools, the places and processes of getting a confirmatory diagnosis and treatment are crucial to the success of this strategy. METHODOLOGY: A KAP survey was carried out in Yei County, South Sudan, to identify gaps in community KAP and determine the preferred channels and sources of information on the disease. The cross-sectional KAP survey utilized questionnaires, complemented with key informant interviews and a focus group discussion to elicit communal as well as individual KAP on HAT. FINDINGS: Most (90%) of the respondents had general knowledge on HAT. Lower levels of education, gender and geographic locations without a history of HAT interventions were associated with incorrect knowledge and/or negative perceptions about the treatability of HAT. Symptoms appearing in the late stage were best known. A majority (97.2%) would seek treatment for HAT only in a health centre. However, qualitative data indicates that existing myths circulating in the popular imagination could influence people's practices. Seventy-one percent of the respondents said they would offer social support to patients with HAT but qualitative data highlights that stigma still exists. Misconceptions and stigma can negatively influence the health seeking behaviour of HAT cases. In relation to communication, the top preferred and effective source of communication was radio (24%). CONCLUSION: Gaps in relation to KAP on HAT still exist in the community. Perceptions on HAT, specifically myths and stigma, were key gaps that need to be bridged through effective education and communication strategies for HAT control alongside other interventions.

Climate change and cattle vector-borne diseases: Use of participatory epidemiology to investigate experiences in pastoral communities in Northern Tanzania.

Climate change is predicted to increase incidence of vector-borne diseases in humans, however, little is known about the impact of such diseases in livestock. In the absence of historical data with which to examine the inter-relation between climate and disease, participatory epidemiological (PE) methods were used with Maasai pastoralists of Monduli District, northern Tanzania to establish local observations on two major vector-borne diseases of cattle, namely East Coast fever (ECF) and African animal trypanosomiasis (AAT). Data collection involving gender segregated groups (10 men groups and 9 women groups) occurred in 10 randomly selected villages between November 2014 and March 2015. ECF and AAT were ranked amongst the top 5 most important cattle diseases with strong agreement across informant groups (Kendall's W=0.40 for men and 0.45 for women; p<0.01). Matrix scoring for both men and women groups confirmed that Masaai easily recognize these diseases. All groups associated ECF with the wet and cool dry seasons. AAT was more variable throughout the year, with more cases reported in the long dry season. Likewise, pastoralists reported differences in seasonal occurrence of disease vectors (Rhipicephalus appendiculatus and Glossina spp.) by village. Comparing 2014-1984, participant groups consistently reported declines in rainfall, vegetation cover and quality pasture, as well as increases in severe droughts. Experiences with ECF/AAT and vector abundance between these time periods was more variable across villages, and likely relates to changes in climate and animal management practices over the last 30 years. This baseline study is the first to document the inter-relation between climate and cattle vector-borne disease from the pastoralist perspective. Findings from this study reveal a complex interplay between human, animal and environmental factors, understanding of which is urgently required to devise approaches to mitigate effects of climate change in these vulnerable areas.

Assessment of the burden of human African trypanosomiasis by rapid participatory appraisal in three high-risk villages in Urambo District, Northwest Tanzania.

BACKGROUND: The public health and socio-economic burden of Human African Trypanosomiasis (HAT) in East Africa is not well documented. Understanding the epidemiology and impact of HAT in such settings is difficult due to a lack of robust surveillance and reporting systems, restricting evidence-based policy development and contributing to the continued neglect of this disease. OBJECTIVE: To investigate the burden of HAT in Urambo District, Tanzania in order to inform future public health policy. METHODS: A rapid participatory appraisal (RPA) using a combination of qualitative and quantitative methods was conducted, that included key informant interviews, hospital record analysis, and tools adapted from participatory learning and action. RESULTS: Three villages adjacent to Ugala Game Reserve appeared to be the most affected. High levels of under-reporting were noted due to a lack of diagnostic tools at peripheral health care facilities and limited access to specialist services. Community stakeholders perceived the health and socio-economic burden of HAT to be similar to that of malaria. CONCLUSION: The burden of HAT in remote rural communities is difficult to capture through routine surveillance systems alone. The RPA represents an efficient mechanism for engaging communities in public health action for trypanosomiasis control in northwest Tanzania.

Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo.

INTRODUCTION: Active case-finding programmes by mobile teams are the cornerstone of West African Human African Trypanosomiasis (HAT) control. Low attendance rates of screening and low uptake of treatment after diagnosis are major problems. The objectives of this survey were to explore community perception of HAT, to assess acceptability of control activities and to identify barriers amenable to intervention. METHODS: In September 2004, we conducted 33 focus group discussions with beneficiaries of the HAT control programme among various ethnic groups in two ecological settings (savannah and fluvial) of the Democratic Republic of Congo. RESULTS: The population had a very detailed knowledge and understanding of HAT transmission, utility of screening, symptoms and treatment. Melarsoprol treatment was feared for its side effects. The sudden death of previously asymptomatic people during treatment was attributed to witchcraft, to which one becomes more vulnerable when the diagnosis is disclosed in public. Lack of confidentiality was also a problem because HAT carries a stigma as a mental disease. Lumbar punctures, especially when performed in public, were disliked but less feared. Financial barriers were a major obstacle for many patients. CONCLUSION: Less toxic drugs, lowering financial barriers and improving confidentiality would have considerable impact on the participation in population screening for HAT.

Assessing the patterns of health-seeking behaviour and awareness among sleeping-sickness patients in eastern Uganda.

For those with sleeping sickness, the consequences of delayed diagnosis include poor prognosis at treatment and an increased risk of tsetse infection. Data on their socio-demographic and clinical characteristics, health-seeking behaviour and delays in presentation and diagnosis were collected from 119 diagnosed cases of rhodesiense sleeping sickness in eastern Uganda. The median total delay, from onset of the illness to diagnosis, was 60 days. The median service-provider delay (30 days) was markedly longer than the median patient delay (17 days). Each of these delays was, however, considerable and independently associated with patients presenting with late-stage sleepiness, giving odds ratios and (95% confidence intervals) of 7.29 (3.10-17.14) and 2.98 (1.38-6.43), respectively. A blood examination at the first visit was also associated with the service-provider delay (odds ratio = 0.45; 95% confidence interval = 0.22-0.95). Most of the patients (77.4%) had either been referred to the local sleeping-sickness hospital by other members of their community or presented at the hospital on their own initiative; few had been referred by other components of the local health system. The results are disappointing, not only in showing long delays in diagnosis (and therefore in treatment) but also in indicating that much of the delay is attributable to the service provider failing to diagnose sleeping sickness among symptomatic individuals.

Clinical follow-up in the rat experimental model of African trypanosomiasis.

Animal models of Human African Trypanosomiasis (HAT) have been developed to understand the pathogenic mechanisms leading to the passage into the neurological phase, most of them referring to histological aspects but not clinical or behavioral data. Our study aimed at defining simple clinical and/or behavioral markers of the passage between the hemolymphatic phase and the meningo-encephalitic stage of the disease. Sprague-Dawley rats (n=24) were infected with Trypanosoma brucei brucei AnTat 1.1E. Food intake and body weight were measured daily from the day of infection until death. Hematocrit was measured twice a week. Behavioral disturbances were evaluated through an Open-field test. A sudden weight loss occurred on the twelfth day after infection, due to a significant drop of food intake starting two days before. The rats developed an anemic state shown by the hematocrit measurements. The Open-field test showed them to be less active and reactive as soon as the second week after infestation. A complementary histological study observed trypanosomes and inflammatory cells in the choroid plexus at the same period. These results are in favor of central nervous system functional disturbances. The observed weight loss is discussed as being a parameter of the entry in the meningo-encephalitic phase. The rat model reproduces neurological symptoms observed in the human disease and may prove to be useful for further neurohistological and therapeutic studies.

Influence of a past history of Gambian sleeping sickness on physical growth, sexual maturity and academic performance of children in Fontem, Cameroon.

Little has been published on the long-term complications of Gambian sleeping sickness (GSS) following treatment. A case-control study to compare physical growth, sexual maturity and academic performance of children with and without a past history of GSS was therefore conducted. The study took place over a period of 6 months, in the 10 villages of the Fontem GSS focus, which is known to be very endemic for the disease. Overall, 100 young subjects (aged 6-20 years) with a past history of GSS were pair-matched for age (+/- 5 months), sex, place of residence, and socio-economic and cultural backgrounds with 100 other, control subjects who had no history of GSS and who were sero-negative for GSS when checked with a card agglutination test (Testryp-CATT). On average, the cases weighed 4.25 kg less, were 3 cm shorter and had 1.15-cm smaller mid-upper-arm circumferences than the controls (P < 0.05 for each). The mean sexual-maturity rating of the two groups was similar but the controls tended to have attained puberty earlier than the cases. When the cases were subdivided into those treated with melarsoprol and those given pentamidine, only the melarsoprol-treated sub-group was significantly different from the corresponding controls in terms of physical growth and sexual maturity.

Melatonin and its new agonist S-20098 restore synchronized sleep fragmented by experimental trypanosome infection in the rat.

The experimental infection with the parasite Trypanosoma brucei in the rat provides a unique model of dysfunction of the sleep regulatory mechanisms, because the length of synchronized sleep episodes is selectively and dramatically reduced in the advanced stages of the disease. In the present study, melatonin was acutely administered (3 mg/kg SC) to trypanosome-infected rats, before the sleep onset. This treatment resulted in a significant increase of the length of synchronized sleep episodes in respect to the infected animals and to those that had received only the vehicle. Thus, melatonin restored a normal sleep pattern during the infection. Similar findings were obtained with the new melatonin agonist S-20098. The sleep parameters were not significantly modified by either melatonin or S-20098 acute administration to noninfected animals. These findings indicate that exogenous melatonin and S-20098 exert a selective regulatory action on sleep fragmentation during experimental trypanosomiasis.