Benjamin Dahl: Sleeping Sickness is Major East African Killer When Undiagnosed

Human African Trypanosomiasis (HAT) is a parasitic disease transmitted through the bite of the tsetse fly and is found in 36 countries in sub-Saharan Africa, including Tanzania. HAT is commonly known as sleeping sickness. Many people are surprised to hear that it is still a problem and in many ways it has been forgotten since sleeping sickness now usually only sickens poor farmers or honey gathers living at the end of the road. Occasionally a tourist on safari will also get sick but that is rare. The name sleeping sickness may sound benign but in reality it is devastating disease, first often misdiagnosed as malaria, HIV/AIDS or mental illness. Untreated it is 100% fatal.

From 2002 until 2009 I worked with a hospital in Kaliua, Tanzania (about 90 km west of Tabora, in central TZ) to establish sub-regional surveillance for HAT. The area around Tabora is the historical foci for sleeping sickness in TZ though cases had dropped off dramatically from the epidemics seen in the first half of the 20th century. In the late 1990s there started to
be an increase in cases and by 2002 there were more cases than had been seen in a generation. The investigation showed that this was linked to people moving into areas where they had more contact with tsetse flies and the wild animals that are the host of the parasite in East Africa as well as a lack of control efforts against the tsetse.

The project demonstrated the need for more control and better efforts to treat those infected with the parasite. The Ministry of Health and the local health center have responded and the number of cases is starting to decline. This situation will have to monitored and health officials will have to remain vigilant in order to prevent new epidemics. The primary challenge will be that the rural population has limited access to the specialized treatment needed for HAT.

Benjamin Dahl is an epidemiologist with the US Centers for Disease Control, based in Atlanta, GA.

Habari — Liz Pavlovich: Going Blind “Quietly”

A disease that renders a person blind by the age of 30 or 40 typically begins its vanquish during childhood; the disease’s slow progression purports the nickname the “quiet disease.” In Tanzania, it is estimated that Trachoma has blinded nearly 50,000 people. Another two million adults have active cases of the neglected tropical disease that could result in the loss of sight if untreated.

As you can imagine, blindness makes a person feel helpless. A blind person is dependent on his family or others for food, shelter, water, and other necessities because he cannot work. This often leaves the person isolated and stigmatized.

The disease is categorized by slow disintegration of parts of the eye, mainly the cornea and conjunctiva, as a result of repeated infections and scar tissue build up. As the disease progresses, the eyelid will turn inwards (trichiasis) causing extreme discomfort. Loss of vision will become permanent shortly thereafter if surgical measures are not taken.

The disease is highly contagious and bacteria from the eye are transferred by hands, on clothing and through flies that land on people’s faces. The disease is particularly prevalent in places where people are not able to wash their hands and faces regularly in order to remove the infectious bacteria. It predominantly affects rural communities in poor countries because people live in close proximity to their livestock, which attract flies that can easily transmit the infection from one person to another.

The World Health Organization and organizations such as the International Trachoma Initiative have devised a strategy called “SAFE” to prevent, control and eradicate trachoma in the 55 affected countries. SAFE is an acronym that stands for:

S = Surgery- to correct advanced stages of the disease.

A = Antibiotics- to treat active infection by a single dose of Zithromax & tetracycline.

F = Face washing- to prevent disease transmission.

E = Environmental change- to increase access to clean water and improve sanitation.

With the SAFE strategy and the growing accessibility of health care workers in Tanzania, I hope that the population’s health knowledge will increase so that simple health-supporting behaviors are adopted, such as the consistent washing of children’s faces, and sight saving treatment and care from trained professionals. Working with the administration at Bugando university, a medical school in Tanzania, I am encouraged by the students training to become doctors, nurses and pharmacists who are dedicated to preventing and treating diseases like Trachoma.

Habari – News From Bugando – is a periodic blog posting by Liz Pavlovich, a Program Officer for the Touch Foundation based in Mwanza Tanzania. Since 2004, the Touch Foundation (touchfoundation.org) has been working with Tanzanian partners to address the healthcare worker shortage by expanding the Bugando regional medical training college and teaching hospital. Bugando’s University is the second largest of five institutions training medical doctors in the country. It also trains health workers in seven other disciplines – post-graduate MDs, nurses, assistant medical officers, radiographers, pharmacists and laboratory technologists. The school is now training 900 students.

Caption: In rural Tanzania, most people keep livestock very close to their homes. The animals attract flies and carry worms that can cause diseases such as Trachoma, in humans.

Habari — Liz Pavlovich: Fighting worm infection with community education

The environment in the areas surrounding Lake Victoria in northeastern Tanzania is ideal for the spread of the chronic disease, schistosomiasis. Human populations live in regular contact with fresh water.

The lifecycle of the three species of worms that cause schistosomiasis alternates between freshwater snails and human hosts. The disease burden around Lake Victoria, the region that Bugando’s hospital and university serve, is largely rural. The disease affects thousands of children, men and women, causing liver and spleen damage, genital lesions that increase the spread of HIV, and learning disabilities. Organizations such as CONTRAST are tackling this disease with preventive, diagnostic and curative techniques.

The economy of the communities around Lake Victoria is based on small-scale fishing and farming, putting people in constant contact with the potential water-borne diseases.

Earlier this month, I attended a presentation at the National Institute for Medical Research in Mwanza entitled “Socio-Economic Status of One Community Population Before and One Year After Schistosomiasis Control Intervention.”  The basic assumption of the presentation was that communities are less productive if they are riddled by diseases such as schistosomiasis and, therefore, a community health intervention would increase productivity and, likewise, wealth. Changes in simple behaviors tremendously reduce people’s risk and change their lives. In this study, community health workers taught the community about prevention strategies such as not bathing in the stagnant lake waters where one is more likely to be infested by the worms released by snails into the water. Wealth decisively increased amongst the 159 households surveyed after one year of education about schistosomiasis in the community, leading the researchers to conclude that the intervention had successfully affected the economic status of the community.

Like malaria and other infectious diseases that overwhelmingly plague the poorest populations in sub-Saharan Africa, schistosomiasis can be prevented at a low cost and with small behavioral changes. With education to target the communities and treatment readily available, we can stop the debilitation and morbidity caused by schistosomiasis.

Habari – News From Bugando – is a periodic blog posting by Liz Pavlovich, a Program Officer for the Touch Foundation who is based in Mwanza Tanzania. Since 2004, the Touch Foundation (www.touchfoundation.org) has been working with Tanzanian partners to address the health worker shortage by expanding the Bugando regional medical training college and teaching hospital. Bugando’s University is the second largest of five institutions training medical doctors in the country. It also trains health workers in seven other disciplines – post-graduate MDs, nurses, assistant medical officers, radiographers, pharmacists and laboratory technologists. The school is now training 900 students.

Emily Bell: Neglected Tropical Diseases Cause Debilitation and Death for Thousands of People in Tanzania

The Who Cares? Campaign blog is exploring Neglected Tropical Diseases for the month of February.

Neglected Tropical Diseases (NTDs) are taking a massive toll  in the world’s poorest communities, including in sub-Saharan Africa. The World Health Organization reported these staggering statistics about the impact of NTDs worldwide:

• About 1 billion people are affected by one or more NTDs.
• Over 1 billion people – one sixth of the world’s population – suffer from one or more neglected tropical diseases.
• Neglected tropical diseases kill an estimated 534, 000 people worldwide every year.
• Parasitic and bacterial diseases, known to be neglected, are among some of the most common infections affecting an estimated 2.7 billion people who live on less than US$ 2 a day.
• There are primarily 14 diseases currently listed as NTDs. Most can be prevented and eliminated. They thrive in places with unsafe water, poor sanitation, and limited access to basic health care. They cause severe pain and life-long disabilities and are often less visible and have a low priority.
• For example, about 120 million people are infected worldwide with lymphatic filariasis. The disease is the second leading cause of disability worldwide.’
• Approximately 80 million people are infected with blinding trachoma (of whom 6 million are blind) – the leading cause of blindness worldwide.

In Tanzania, where the Touch Foundation works, NTDs take thousands of lives and debilitate many more each year. Water born illnesses such are particularly common in the Lake Zone.

Vice President of Tanzania, Dr. Ali Mohamed Shein, noted that NTDs “debilitate, deform, blind and even kill many people in the endemic areas. These are serious diseases which inflict and weigh their heavy and corrosive burden on the lives of the affected individuals and communities as well as countries in most parts of Africa. They affect the poorest segment of the population, and their greatest impact is in the way they exacerbate poverty, stigmatize individuals and inhibit communities from being able to care for themselves and their families.”

Emily Bell is Head of Advocacy and Communications for the Touch Foundation.