By Gladys Kalibbala
Health experts are worried about the narrowing gap between two types of sleeping sickness from the eastern region of the country to the northern.
It is understood that the gap has narrowed to within 100 kilometres.
Uganda is apparently the only country with the two forms of sleeping sickness. T.b. Gambiense, also known as the chronic form is found in the West Nile region while T.b. Rhodesiense, also known as the acute form is based in the south eastern region.
While the chronic form is found in seven districts, the other form, Rhodesiense, is more spread out, present in 33 districts.
The fear now is that the merger of the two is likely to cause a state of drug resistance to the available drugs on the market.
“Each form is treated with a different drug so disaster may occur when the two forms meet,” explains Dr. Charles Wamboga, coordinator for National Sleeping Sickness Control Programme at the ministry of health.
Sleeping sickness, also known as Human African Trypanosomiasis (HAT) is an infectious disease caused by a parasite known as Trypanosome which is transmitted by infected tsetse flies. The infected flies cause Nagana disease in both livestock and wildlife.
At a conference recently at Paradise Hotel, Jinja where experts met to discuss strategies for the elimination of tsetse flies, Dr. Wamboga explained that sleeping sickness is among the neglected tropical diseases (NTD).
The disease, which mainly affects remote rural areas, contributes a lot to the entrenched cycle of poverty, ill health and stigma, he pointed out.
During the discussion, another participant, Dr. Abbas Kakembo revealed that the two unique forms of sleeping sickness were 150km apart eight (8) years ago.
“Increased movement of livestock trade in regions where restocking occurred has fuelled the expansion of the disease,” Kakembo explained, saying that it is the acute form invading upwards in areas like Teso and Lango where it never used to exist.
Burden of disease
All unreported cases die. “There is a big challenge of under-reporting where three cases are not reported for every one reported case,” said Dr. Wamboga.
Treating the disease comes at a cost ($300; sh750,000 per patient). Fortunately, it’s done for free in the affected areas.
Fredrick Luyimbazi shows different types of captured tsetse flies.PHOTO/Gladys Kalibbala
Approximately 10 million people are at a risk of getting the disease, with 2,124,000 for Gambiense while 7,877,000 for Rhodesiense.
“In 2012, we diagnosed 99 cases which were treated while in the last 13 years, 7,562 have been treated,” revealed Dr. Wamboga.
Plans are underway to start a case series clinical study of a drug known as ‘Fexinidazole’ at Lwala Hospital to tackle T.b Rhodesiense of both stages. This should start in early 2014.
Sleeping sickness has two stages. It is in the second stage that the brain is affected. According to Dr. Wamboga, tests aimed at doing away with the lumbar puncture may be ready by 2016.
Currently all patients undergo the lumbar puncture in order to ascertain the stage of the disease as it is very crucial.
A nursing sister at NALIRI, Tororo explains that the proposed abolition of lumbar puncture will be welcome, as some patients ran away from hospital because of it. “One time, we had to hunt for a woman who hid in the bushes for two days after running away from hospital for fear of this test [lumbar puncture],” she said.
In this test, the patient’s back is folded to allow a health worker get liquid from the spine.
If the planned research is successful, says Dr. Wamboga, the stages of the disease will be checked through a blood test instead of a lumbar puncture.
T.b. Gambiense sleeping sickness has been earmarked for elimination by 2020 both at country level and by World Health Organization (WHO).
A woman at Kalangala shows how she handled her daughter during the lumbar puncture test at Namungalwe hospital.
Sleeping sickness presents symptoms that include itching, joint pains, enlarged lymph nodes, anaemia, acute headache, fever, weight loss and altered sleep patterns and can kill if left untreated.
It has so far had three major epidemics in Uganda in the 20th century from 1896 -1906, 1920s -1960, 1970s up to now although it was almost eliminated in the 60s. Historically, sleeping sickness is an old disease known to slave traders and it is suspected to have killed the Sultan of Mali around 1373 – 1374 AD.
Dr. Kakembo explained that T.b. Rhodesiense (acute and severe) kills within six months if not treated while T.b. Gambiense (chronic) kills within two three years.
Jovino Akaki, the Chairman of Uganda Trypanosomiasis Control Council vows to increase community involvement in HAT control activities in order to eradicate the tsetse flies.
“Rhodesiense form is largely zoonotic with both domestic and wild hosts which complicate its control. We need to sensitize communities to allow work become easy,”Akaki says.
He calls upon government to strengthen capacity of health services to allow case management and its prevention.
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