New Vision (Kampala)

11 May 2008

Uganda: Sleeping Sickness Reaching Alarming Levels

Kampala — IT starts with a headache, joint pains and fever. It is the kind you would expect to get over quickly. But after a while, things get worse. You fall asleep most of the time, are confused and get intense pains and convulsions.

If you do not get treatment, your body begins to waste away. Eventually, you slip into coma and die. This is human African trypanosommiasis, better known as sleeping sickness. If untreated, it kills 100% of its victims in a very short time.

Despite the dangers, scientists say policy makers are neglecting the disease and consequences could soon become disastrous.

The disease, endemic in southeast Uganda and western Kenya, is caused by parasites and transmitted to humans by tsetse flies. It kills more than 40,000 Africans each year and the animal form of the disease (nagana) kills two million cattle each year.

The economic cost of both the animal and human diseases is $5m (sh8b) each year, according to the World Health Organisation (WHO).

According to the Vector Control Division, about 10 million people in Uganda are at risk of acquiring the disease. Additionally, Uganda is the only country affected by both forms of the disease, chronic (gambiense) in the northwest and acute (rhodesiense) in the southeast.

Both types are complicated and take long to detect, diagnose and treat.

While the source for the chronic type of sleeping sickness is still unknown, cattle have been found to be a principal source for the acute type, now steadily spreading northwards.

From 1999 to 2007, cases of the acute type have been found in Soroti, Kaberamaido, Lira and Apac districts.

Sporadic epidemics have also been recorded in Hoima, Masindi and all islands of Lake Victoria.

Experts believe it may have even gone further, perhaps to Gulu and Pader districts, raising concern that it could merge with the chronic type to produce a new drug resistant strain.

The two types, according to Dr. Abbas Kakembo and Dr. Charles Wamboga of Vector Control Division, are only 150km apart. The doctors predict a possible fusion would be catastrophic for a country where death from the disease is common due to inadequate resources, personnel and logistics.

"Inevitably this would result into a new strain, compromising the already difficult detection, diagnosis, treatment and control procedures," they say.

The role cattle

While historically, sleeping sickness was confined to some areas, the disease is now moving to unaffected areas due the increased movement of infected cattle.

Latest figures from the Ministry of Agriculture, Animal Industries and Fisheries (MAAIF) reveal nearly all cattle in affected areas may be carrying sleeping sickness parasites without showing symptoms.

It has also been calculated that a person is a 1,000 times more likely to acquire sleeping sickness via the bite of a tsetse fly coming from a cow than from another infected person.

The first case of sleeping sickness was detected in Soroti in December 1998 and since then, more than 100 cases have been recorded.

Scientists attribute these cases in once unaffected areas of Teso to the sh250m livestock-restocking programme intended to revitalise livestock production in the region.

For instance, early cases at Soroti Hospital originated from the main cattle market. Investigations at the Livestock Research Institute at Tororo also determined that the type of the parasite circulating in Soroti was the same predominant type in the area from which over 50% of the cattle originated.

"In two years, the disease had spread over 80km from the original focus in Busoga," notes Wamboga. "It is now present in the previously untouched areas towards West Nile where there is a chronic type."

What is being done?

Treating cattle to eliminate the human-infective parasites. "If there are no sleeping sickness parasites in cattle, there will be no new cases of sleeping sickness in people," says Dr. William Olaho-Mukani, the director of Animal Resources in the MAAIF.

"Hence helping livestock keepers apply insecticide only to the parts of the body of animals where tsetse flies like to feed, is a low cost sustainable way to fight these parasites."

Tsetse flies can be prevented by treating the legs and belly of the cattle that the flies. The so-called Restricted Application Method costs just $0.02 (sh33) per animal each month, does not require expensive spraying equipment and is also safer for the environment, notes Dr. Mukani.

This method, he says, is being used to treat approximately 200,000 cattle in Uganda, as part of the Stamp Out Sleeping-sickness Campaign, a public-private partnership, which aims at providing a lasting solution to the disease.

If this approach proves successful, researchers say, it could also be applied to other parts of Africa affected by acute sleeping sickness, eliminating the disease from East and Southern Africa.

Despite efforts to fight tsetse flies, nagana and sleeping sickness by different governments over the years, very little has been achieved.

Eng. Hillary Onek, the agriculture minister, says the biggest hindrance to the eradication of tsetse flies is re-infestation because of the breakdown of control measures due to insufficient funds, natural and man-made disasters and discoordinated efforts.

He also cites parasites becoming resistant to the drugs, which are getting scarce as the firms threaten to close the manufacturing due to non-profitability.

The treatment cost of a single sleeping sickness patient is about $300 (sh500,000).

In Uganda, treatment is provided free by the Ministry of Health with assistance from WHO.

Equity call

Even though it relatively costs less to prevent sleeping sickness, scientists say, they do not have sufficient resources to achieve that.

Some accuse the Government and charities for focusing on HIV, malaria and tuberculosis and leaving millions of poor people without treatment for diseases including sleeping sickness.

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