Sleeping Sickness- Early diagnosis improves survival chances

Jul 26, 2009

IT is a hot afternoon, but Muhammad Wanjala, 47, is covered with a warm blanket and his head rests on a thick leather jacket. With his body shaking uncontrollably, Wanjala attempts to raise his hand, but it collapses.

By George Bita and Irene Nabusoba

IT is a hot afternoon, but Muhammad Wanjala, 47, is covered with a warm blanket and his head rests on a thick leather jacket. With his body shaking uncontrollably, Wanjala attempts to raise his hand, but it collapses.

“He has been doing this for sometime. I cannot make out what he wants because he is in a semi-conscious state,” his son, Siraji Wandera, says as he rushes to attend to his equally ailing mother, Zaituna Nabirye, 43.

She is lying on the opposite side of the room at the national sleeping sickness referral health centre in Namungalwe, Iganga district.

Miles away from their home, the ailing couple sought medical care a little late because they thought it was witchcraft. They were saved by a whisker after a knowledgeable person spotted the scar left behind by a tsetse fly bite.

Gregory Babalanda, a nursing officer at the health centre, says Wanjala brings to four, the number of patients admitted since the beginning of this year.

He says Amina Babirye, Nabirye’s 10-year-old daughter, died the morning after her mother was hospitalised.

Hailing from Bulesa sub-county in Bugiri district, Nabirye and Wanjala are victims of sleeping sickness, a fatal and neglected disease in many parts of Africa.

Understanding sleeping sickness
Sleeping sickness is a vector-borne parasitic disease transmitted by a tsetse fly, which harbours the t. gambiense parasite. The parasites multiply in tissue under the skin, blood and lymph.

Doctors Without Borders/Médecins Sans Frontières, an international NGO, says tsetse flies are found in sub-Saharan Africa, but only certain species transmit the disease.

“Different species have different habitats. They are mainly found in vegetation by rivers and lakes, in gallery-forests and in vast stretches of wooded savannah,” reveals the WHO site.

“Inhabiting the vast savannah across sub-Saharan Africa, tsetse flies come into contact with man, cattle and wild animals, all acting as reservoirs for the parasites,” the site adds.

Dr. Dawson Mbulamberi, the assistant commissioner of health services in charge of vector control at the health ministry, says sleeping sickness takes two forms, depending on the parasite involved: Trypanosoma brucei gambiense, found in western and central Africa or trypanosoma brucei rhodesiense which is characteristic of eastern and southern Africa.

Mbulamberi says trypanosoma brucei gambiense represents more than 90% of reported cases of sleeping sickness and is chronic.

“A person can be infected for months or even years without major signs or symptoms of the disease. When symptoms emerge, the disease is often in an advanced stage where the central nervous system is affected,” he argues.

“Trypanosoma brucei rhodesiense represents less than 10% of reported cases and causes acute infection. First signs and symptoms are observed within weeks or few months after a bite. The disease develops rapidly and invades the central nervous system,” he says.

The disease is spread when an infected tsetse fly bites a human being or animal (causing nagana).

Prevalence
WHO says tsetse flies are found in 36 countries in sub-Saharan Africa, putting 60 million people at risk. “Sleeping sickness affects 50,000 to 70,000 people each year,” the health body notes, regretting that the disease, which was nearly eliminated in the 1960s, has made a comeback due to war, population movements and the collapse of health systems over the past two decades.

Mbulamberi cannot provide specific figures on prevalence in Uganda because of limited research and national surveys, but observes that the disease has plagued much of West Nile and Teso regions (Soroti, Kaberamaido, Dokolo, Lira, Apac, Arua, Yumbe, Moyo, Maracha, Koboko and Adjumani).

Other regions are the greater Busoga region (Bugiri, Kamuli, Iganga, Mayuge, Busembatya, Namutumba, Jinja, Bukwe, Buvuma Islands and as close as parts of Mukono district).

“The outbreak started in 1976 in Busoga during Idi Amin’s time when people abandoned agriculture and resorted to smuggling.

Busoga was one of the leading producers of cotton, but left the fields to suffocate with weed, particularly lantana camara, commonly known as kapanga which is favourable for tsetse flies,” he narrates.

“The flies started multiplying and eventually got infected because they flew across borders. The situation was worsened by returnees who had fled sleeping sickness-stricken Southern Sudan after the National Resistance Movement took power.

It is the reason the West Nile strain is chronic, while the one in the eastern region is acute,” he explains.

Mbulamberi also discloses that the disease was under control courtesy of the East African Triponomiasis Research Organistaion which also collapsed during the turbulent period.

“This made the disease spread fast. It was a big problem until 1986 when the health ministry contained the disease.
The National Sleeping Sickness Control Programme is based in Jinja, but the capacity to contain the epidemic is constrained.

Most of the health workers trained to manage sleeping sickness died. Funding is also constrained,” he says.

Transmission and symptoms
The commonest form of transmission is through a bite from an infected tsetse fly. “The trypanosome can also cross the placenta and infect the foetus,” Dr. Dawson Mbulamberi, the assistant commissioner of health services in charge of vector control at the health ministry says.

“Accidental infections have occurred in laboratories due to pricks from contaminated needles,” he says.

Symptoms include persistent headache, fever, drowsiness, pain in muscles and joint discomfort. Others are enlargement of lymph nodes in the groin and armpits, failure of the sphincter muscles to hold urine, aggressiveness, making noise and stripping naked.

“This first stage is difficult to diagnose, but relatively easy to treat. If no treatment is given, the parasite invades the central nervous system and the second stage sets in.

“This stage may be characterised by confusion, violent behaviour or convulsions. Patients with sleeping sickness experience inability to sleep during the night, but are overcome by sleep during the day.

If left untreated, the disease inevitably leads to coma and death,” he says.

(adsbygoogle = window.adsbygoogle || []).push({});