Availability and affordability of treatment for Human African Trypanosomiasis.

Human African Trypanosomiasis (HAT) is a re-emerging disease whose usual treatments are becoming less efficient because of the increasing parasite resistance. Availability of HAT drugs is poor and their production in danger because of technical, ecological and economic constraints. In view of this dramatic situation, a network involving experts from NGOs, WHO and pharmaceutical producers was commissioned with updating estimates of need for each HAT drug for the coming years; negotiations with potential producers of new drugs such as eflornithine; securing sustainable manufacturing of existing drugs; clinical research into new combinations of these drugs for first and second-line treatments; centralizing drug purchases and their distribution through a unique non-profit entity; and addressing regulatory and legal issues concerning new drugs.

[Trypanosomiasis from Trypanosoma brucei gambiense in the center of north-west Uganda. Evaluation of 5 years of control (1987-1991)]. / La trypanosomiase a Trypanosoma brucei gambiense dans le foyer du nord-ouest de l'Ouganda. Bilan de 5 années de lutte (1987-1991).

In Uganda, a case-finding and treatment programme has been implemented by Médecine Sans Frontières (MSF) and the Ministry of Health in the North of West-Nile province. Data collected in the hospital of Moyo from January 1987 to June 1991 were analyzed. Forty eight hundred and twenty two cases of trypanosomiasis due to T. B. gambiense has been recorded. Cumulative incidence rate for this period was 5.6%. Passive and active case-finding strategies were used, both based on Card Agglutination Test (CATT) as screening tool, followed by parasitological examinations. The mobile teams identified 1906 of the 4,822 cases (39.5%). Case fatality rate was 2.6%. This study confirmed the association between social and political disruptions, large movements of population and extension of trypanosomiasis. Active case-finding seems to quickly reduce disease prevalence in hyper-endemic areas. An integrated programme is then necessary to control sleeping sickness transmission.

An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi.

Between February and October 1990, 18,276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285,942 Mozambican refugees in Malawi. Overall, 6.3% of the refugee population developed pellagra and the attack rate was 7.8 times higher among women than men. This outbreak followed a 5-month cessation of groundnut distribution (the major source of niacin) to refugees. A matched-pair case-control study confirmed the protective role of the daily consumption of groundnuts (Odds Ratio [OR] = 0.08), as well as the independent role of garden ownership (OR = 0.34), and home maize milling (OR = 0.3). Recommended corrective action included early case finding and treatment, distribution of niacin tablets, prompt identification of groundnut supply on the world market, fortification with niacin of the food ration and diversification of the food basket through access to local markets.

PIP: Between February and October 1990, health workers in Malawi noted 18,276 cases of pellagra among 285,942 Mozambican refugees. This represented a significant increase in pellagra cases (compared with just 1169 cases in 1989). 5 months before each outbreak, the UN High Commission for Refugees and the World Food Program could not obtain groundnuts, a source of niacin, to include in food rations. The food ration distributed to refugees had an average of just 4 mg available niacin equivalent (or 2 mg/1000 kcal) which was considerably less than the recommended daily allowance of 6.6 mg/1000 kcal. The overall attack rate stood at 6.4% (4.9-13.2%. It was higher among refugees living in camps than it was among those living in Malawian villages near the border (10.1% vs. 0.8%). The attack rate was 7.8 times higher in females than males (6.1/1000 vs. 0.78/1000). It was lowest among children under 5 years old (1.7% vs. 7.5% for = or 5 year olds). No infant had pellagra. Researchers compared 126 pellagra cases with 126 controls. The conditional logistic regression indicated that pellagra cases were less likely to eat groundnuts and fish at least once a day within the last 6 months (odds ratio [OR] = .07 and .56, respectively). They tended not to have a garden (OR = .32) and to mill maize at home (OR = .26). Thus, eating groundnuts, milling maize at home, and garden ownership protected the refugees from developing pellagra. In August 1990, relief workers distributed niacin tablets to refugees. The health workers recommended other corrective actions such as early case finding and treatment, identification of groundnut supply on the world market, and diversification of the food basket through access to local markets.

Practical field epidemiology to investigate a cholera outbreak in a Mozambican refugee camp in Malawi, 1988.

Of all populations affected by cholera, refugees are at particular risk of infection due to overcrowding and poor sanitation. Between 15 March and 17 May 1988, 951 cases of cholera were registered at the cholera treatment centre in a Mozambican refugee camp in Malawi. The epidemic duration was 65 days. Vibrio cholerae biotype E1 Tor serotype Inaba was isolated. To identify high-risk groups and potential risk of acquiring the disease, an epidemiologic investigation was conducted. The attack rate of recorded cases was 2.6% with a range from 0.9 to 5.1% for different sections of the camp. The case fatality rate was 3.3% and decreased from week 1 to week 6. The epidemic started in the section near the market place and radiated out. A matched-pair case-control study of food and water consumption was performed early in the outbreak. It showed that cases were more likely to use shallow wells (surface wells) instead of boreholes compared to controls (OR = 4.5, CI = 1.0-20.8, P = 0.04) and that cases were more likely to have had contact with the market than controls (OR = 3.5, CI = 0.7-16.8, P = 0.09). None of the food items available at the market was more likely to be preferred by cases than controls. Recommendations included early case finding and treatment, temporary closure of the market, tetracycline prophylaxis of contacts, and water chlorination.

Practical field epidemiology to investigate a cholera outbreak in a Mozambican refugee camp in Malawi; 1988

Of all populations affected by cholera; refugees are at particular risk of infection due to overcrowding and poor sanitation. Between 15 March and 17 May 1988; 951 cases of cholera were registered at the cholera treatment centre in a Mozambican refugee camp in Malawi. The epidemic duration was 65 days. Vibrio cholerae biotype E1 Tor serotype Inaba was isolated. To identify high-risk groups and potential risk of acquiring the disease; an epidemiologic investigation was conducted. The attack rate of recorded cases was 2.6 percent with a range from 0.9 to 5.1 percent for different sections of the camp. The case fatality rate was 3.3 percent and decreased from week 1 to week 6. The epidemic started in the section near the market place and radiated out. A matched-pair case-control study of food and water consumption was performed early in the outbreak. It showed that cases were more likely to use shallow wells (surface wells) instead of boreholes compared to controls (OR = 4.5; CI = 1.0-20.8; P = 0.04) and that cases were more likely to have had contact with the market than controls (OR = 3.5; CI = 0.7-16.8; P = 0.09). None of the food items available at the market was more likely to be preferred by cases than controls. Recommendations included early case finding and treatment; temporary closure of the market; tetracycline prophylaxis of contacts; and water chlorination