Sleeping Sickness
The World Health Organization (WHO) has commended Ghana for its tremendous and successful efforts in eliminating a number of neglected tropical diseases (NTDs). The country has gotten extremely close to eradicating sleeping sickness, or human African trypanosomosis, a parasitic disease transmitted to humans through tsetse flies. Ghana has been following a global plan to try to eliminate all neglected tropical diseases by 2030 and has found recent success in eliminating three of the 20 most common tropical diseases.

About Sleeping Sickness

Sleeping sickness, which is a parasitic disease that infected tsetse flies carry, is an epidemic in 36 African countries. If not treated, the condition is almost always fatal. Sleeping sickness disproportionately affects those who live in rural areas because the residents of those areas rely heavily on agriculture, fishing and hunting, which exposes them to these infected flies. Once someone has sleeping sickness, those infected experience fevers, headaches, enlarged lymph nodes, pain in their joints and itching during the early stages of infection. If left untreated, sleeping sickness begins to affect the central nervous system. This begins to affect the patient’s neurological condition where they start to lose coordination, see changes in behavior and personality, confusion and the symptom where the disease gets its name, an interrupted sleep cycle.

Ghana’s Success

Many, including the World Health Organization (WHO), have commended the success that Ghana has had in eliminating sleeping sickness. Ghana has eliminated sleeping sickness while also successfully eradicating two other neglected tropical diseases, guinea worm disease and trachoma. The World Health Organization director-general Dr. Tedros Adhomnom Ghebreyesus commended the government and health workers, saying “This is a historic achievement, proving once again that with dedication and teamwork, we can,” on Twitter.

The fight to eliminate these neglected tropical diseases was elevated when more funding was provided after there was a sharp decline in those receiving proper drugs to help prevent these tropical diseases from 2019 to 2020, where they saw a 34% decline. Ghana received around 19 billion units of medicine and more than $1 billion through foundations in order to help eradicate these diseases.

The Importance

The president of Ghana, Nana Akufo-Addo, said in a statement in regard to the benefits of investing in programs that help alleviate these diseases that these programs, “leads to better education, health and employment outcomes, an Africa free from neglected tropical diseases is possible.” Making sure that these programs exist to help fund proper medicine to help fight these diseases while also providing proper education and awareness about these illnesses in order to counteract the stigma associated with them. President Akufo-Addo also explained the domino effect that these programs have, saying, “it leads to better education, health, and employment outcomes, and transforms lives and communities.” These programs help alleviate the hardships that these diseases cause on the people while also having everlasting impacts on these areas for the better.

Olivia MacGregor
Photo: Flickr

Sleeping Sickness in the CongoThe Democratic Republic of the Congo (DRC) is home to over 82 million people. Half of the population lives in rural poverty, causing the improbable prevention of life-threatening diseases. Human African trypanosomiasis, also referred to as sleeping sickness, is a parasite-transmitted disease that harshly attacks the central nervous system until the human host expires. While on the decline as of 2015, sleeping sickness in the Congo continues to be a concern, with 1,000 new cases reported annually.

Sleeping Sickness has two forms: Trypanosoma brucei gambiense, which accounts for 98 percent of Africa’s population, or Trypanosoma brucei rhodesiense, which accounts for two percent of Africa’s population.

Based on the parasite involved, the DRC is affected by the rhodesiense form. This form is an acute infection, in which symptoms appear quickly and the severity of the infection increases the likelihood of death within a short period of time.

Infection begins when a parasite, called the tsetse fly, bites a human. The infected tsetse fly transmits the disease into the host, distributing the poison into their bloodstream within seconds. Although the infection process has begun, symptoms may not appear until one to two weeks after the bite.

In most cases, a painless chancre, or ulcer, will appear topically on the skin where the bite was administered. Various other symptoms can be presented such as enlarged lymph nodes, fever, muscle and joint pain, itching and diseases in affected organs such as the liver.

In the second stage of sleeping sickness, neurological symptoms may be present. This can include changes in personality. The second stage also explains the reason behind its name: infected hosts will begin to feel weak and lethargic a majority of the day, causing them to sleep more than usual.

At night, infected individuals experience what is called nocturnal insomnia, which causes an imbalance in their circadian rhythm. Weakness and problems moving accompany these symptoms. As the central nervous system continues to deteriorate, bodily systems begin to shut down. Left untreated, and in rare cases even if treated, fatality is an end result.

Disease control measures have been in place to help in the prevention and treatment of sleeping sickness in the Congo, including the routine delivery of required treatments that focus on prevention instead of the reaction stages. The World Health Organization provides routine surveillance and free medicine to countries affected.

Further operations on disease control for sleeping sickness in the Congo is costly, therefore a process called Development Impact Bonds, or DIBS, can be an option to cut costs and save more lives.

Development Impact Bonds (DIBS) is a further model of social impact bonds. DIBS is expanding its use from the United Kingdom to include international development and global health interventions. According to Rita Perakis of the Center for Global Development, the model can be described as “flexible, innovative, and cost-effective”.

Although this is a risky financial strategy, it can reap sufficient benefits.
DIBS involves a donor agency, a developing country government, private sector investors and a private service provider. By bringing all of their specialties to the table, they agree upon a common goal and the most effective means of achievement. With the focus on social priorities, investors are able to provide input on financing and performance management. As a result, service providers are then able to use the information discussed to implement an experiment according to societal needs.

After establishing a common goal, for example finding a way to work together to reduce sleeping sickness in Congo, the private investors loan the entirety of funds needed to implement the experiment. Throughout the development program, investors monitor progress to ensure successful achievement will be met. If the development program is successful, investors receive a return on their original investment plus additional interest. If a program is not successful, investors lose some or all of their loan.

In this instance, the World Health Organization has been able to implement intervention programs for countries affected by sleeping sickness. These programs create more accessibility to diagnosis and treatment and continue monitoring of treatment. They also ensure that properly-skilled staff are sent to improve conditions and continue experimentation and research to improve treatment tools already in effect. Their goal is to continue these programs on a larger scale, reaching as far as possible to other African countries.

The impact DIBS has, in comparison to any other investment strategy, is the ability to pay for all costs upfront. This reduces delays in research and delivery and has a stronger possibility of saving more lives. Without DIBS, funding is secured at a much slower pace, delaying the production rate.

By using Development Impact Bonds, the World Health Organization can not only maintain their effective disease control but they can become several steps closer to the eradication of sleeping sickness in the Congo. DIBS is currently being used for disease control measures in Uganda, and with its success will come further measures to other parts of Eastern and Central Africa, including Congo.

The World Health Organization aims to eliminate African sleeping sickness by 2030. Their goal is achievable, and with the support of a financial strategy such as Development Impact Bonds, they have a greater chance of success.

– Brianna Summ

Photo: Flickr

A new experimental drug treatment given to cattle in Uganda has cut the sleeping sickness cattle infection rate by 75 percent, which means fewer humans are getting infected. The drug is a dual treatment that kills both the parasites that cause sleeping sickness and the flies that carry them.

The sleeping sickness, also known as African Trypanosomiasis, is transmitted through bites from tsetse flies, which are prevalent in the rural areas of sub-Saharan African countries.

The human pathogenic parasites that cause the sleeping sickness can be harbored by both humans and animals. However, only certain tsetse flies can carry the parasite.

The campaign to end the epidemic of sleeping sickness in northern Uganda started in 2006 and was led by Dr. Susan Welburn, a zoonotic disease specialist at the University of Edinburgh, Scotland. At the time, two types of trypanosome parasites overlapped geographically, killing more than 100 people per day.

Dr. Welburn and her researchers, in partnership with the veterinary school of Uganda’s Makerere University, injected more than 400,000 cows in seven rural districts with the anti-parasitic drug Veridium. To prevent fly bites they sprayed the legs, bellies and ears of the cattle with a long-lasting insecticide called Vectocid.

The researchers have set up small-scale local businesses that provide the preventative treatment for farmers. Dr. Welburn admits it has been a challenge to convince farmers to herd their cows to get treatment, as cattle infected with sleeping sickness parasites do not show symptoms.

“The disease has moved into eight new districts in Uganda in as many years as people travel more and sell their cattle across the country,” Dr. Welburn said.

Dr. Welburn predicts that eradicating sleeping sickness will take eight years of constant treatment. “It would require dedicated management from the government,” she said. “That’s why this project needs to break away from scientists and be owned by the community.”

The team plans to expand its treatment across Uganda to 2.7 million cattle.

Marie Helene Ngom

Sources: NYtimes, WHO, SciDevNet
Photo: Flickr

For rural Sub-Saharan Africans, a walk to the riverbank to wash clothes, gather firewood or collect water is a risky business. About 1 in 1,000 Tsetse flies, which swarm by the river’s edge, are carriers of a parasitic disease called sleeping sickness, which eventually infects the victim’s brains, driving them mad before killing them. In 2013, at least 7,000 cases of this rabies-like disease were reported.

Due to vague early symptoms such as headache, joint pain and bouts of fever, the disease is difficult to diagnose in the beginning. Although it is curable with drugs, patients are often experiencing its later stages before they realize they have been infected. True to its name, patients find it impossible to sleep during the night and impossible to remain awake during the daylight in its later stages.

Those living in rural areas may not make it to hospitals because of the far distance, but thankfully today, researchers have found that the number of individuals suffering from sleeping disease in the region of Uganda has been cut by 90 percent. The reason? Scientists have discovered a weakness for these insects with a lethal bite: the color blue. Because these flies search for something to bite which contrasts with green vegetation, bright colors, especially bright blue, drives them crazy.

With this newfound knowledge, along the riverbanks in the West Nile region in Uganda, handkerchief-sized blue squares attached to wooden stakes netted with insecticide are staked about every 50 yards. It only takes 3 minutes before these flies will drop dead. These life-saving fly traps are relatively cheap and have significantly contributed to a decrease in the number of people being affected by the disease. Last year, fewer than 10,000 cases were reported versus about 300,000 cases reported by the World Health Organization (WHO) during the height of its epidemic in the late 1990s.

WHO hopes to eliminate flies carrying the disease within five to six years. Ministry of Health worker Dr. Charles Wamboga has seen fewer cases and believes that a future free from this deadly disease is possible for a people whose very lifeline flows within their rivers.

– Nikki Schaffer

Sources: NPR, WHO
Photo: Flickr

The people of sub-Sahara Africa may no longer need to fear the bite of the tsetse fly. In an April 24, 2014, Business Weekly article, “Net Closing On Serial Killer Parasite,” Kate Sweeney reported, “Cambridge genome scientists and international colleagues are closing in on new weapons to eradicate deadly diseases spread by the tsetse fly.”

According to the World Health Organization, tsetse flies, blood-sucking insects, transmit Trypanosomiasis, commonly known as sleeping sickness, as well as other diseases to humans and animals in over 30 African nations. Sleeping sickness initially causes joint stiffness, weakness and fever. Over time though, it results in neurological damage and eventually, death. If one identifies the disease early enough, there are drugs to cure sleeping sickness in its initial stages. In 2001, the World Health Organization initiated a large campaign against the disease via early detection and reduced the number of reported cases significantly. In 2010, the number of cases reported dropped below 10,000 for the first time in 50 years.

In 2014, scientists believe a better understanding of the tsetse fly will help eliminate African sleeping sickness completely. The Cambridge genome scientists contribute to a team of 146 scientists from 78 research institutes. The Business Weekly article stated that this international team, “analyzed the genome of the tsetse fly and its 12,000 genes that control protein activity.” This analysis found that tsetse flies have very actives tsal genes in their salivary glands that crave blood.

According to The New York Times’ article, “New Tool to Fight Deadly Tsetse Fly”, a team at Yale University, one of the 78 universities, “found several spots on the genome they hope will eventually lead to better insecticides or repellents.” When studying other insects, such as fruit flies and mosquitos, scientists created repellants after determining weaknesses in their genetic composition. Therefore, this new understanding of the tsetse fly’s tsal genes could lead to new repellant technologies.

As stated in the Huffington Post article, “Tsetse Fly Genome Decoded, May Hold Clues to Fighting African Sleeping Sickness” John Reeder, head of the World Health Organization’s program for research and training in tropical diseases, said, “Sleeping sickness threatens millions of people in 36 countries in sub-Saharan Africa. Many of the affected populations live in remote areas with limited access to adequate health services, which complicates the surveillance and therefore the diagnosis and treatment of cases.” His words illustrate the importance of tsetse fly genome decoding for Africa. A repellant or insecticide to fight tsetse flies would be a more feasible solution compared to the difficult detection of the disease and distribution of drugs to cure it in Africa.

– Jaclyn Ambrecht

Sources: The Huffington Post, The New York Times, Business Weekly, WHO