Estimating the burden of rhodesiense sleeping sickness during an outbreak in Serere, eastern Uganda

Fèvre, Eric M.; Odiit, Martin; Coleman, Paul G.; Woolhouse, Mark E. J.; Welburn, Susan C.
January 2008
BMC Public Health;2008, Vol. 8 Issue 1, p96
Academic Journal
Background: Zoonotic sleeping sickness, or HAT (Human African Trypanosomiasis), caused by infection with Trypanosoma brucei rhodesiense, is an under-reported and neglected tropical disease. Previous assessments of the disease burden expressed as Disability-Adjusted Life Years (DALYs) for this infection have not distinguished T.b. rhodesiense from infection with the related, but clinically distinct Trypanosoma brucei gambiense form. T.b. rhodesiense occurs focally, and it is important to assess the burden at the scale at which resource-allocation decisions are made. Methods: The burden of T.b. rhodesiense was estimated during an outbreak of HAT in Serere, Uganda. We identified the unique characteristics affecting the burden of rhodesiense HAT such as age, severity, level of underreporting and duration of hospitalisation, and use field data and empirical estimates of these to model the burden imposed by this and other important diseases in this study population. While we modelled DALYs using standard methods, we also modelled uncertainty of our parameter estimates through a simulation approach. We distinguish between early and late stage HAT morbidity, and used disability weightings appropriate for the T.b. rhodesiense form of HAT. We also use a model of under-reporting of HAT to estimate the contribution of unreported mortality to the overall disease burden in this community, and estimate the cost-effectiveness of hospital-based HAT control. Results: Under-reporting accounts for 93% of the DALY estimate of rhodesiense HAT. The ratio of reported malaria cases to reported HAT cases in the same health unit was 133:1, however, the ratio of DALYs was 3:1. The age productive function curve had a close correspondence with the HAT case distribution, and HAT cases occupied more patient admission time in Serere during 1999 than all other infectious diseases other than malaria. The DALY estimate for HAT in Serere shows that the burden is much greater than might be expected from its relative incidence. Hospital based control in this setting appears to be highly cost-effective, highlighting the value of increasing coverage of therapy and reducing under-reporting. Conclusion: We show the utility of calculating DALYs for neglected diseases at the local decision making level, and emphasise the importance of improved reporting systems for acquiring a better understanding of the burden of neglected zoonotic diseases.


Related Articles

  • Gambiense sleeping sickness: re-emerging and soon untreatable? Van Nieuwenhove, Simon // Bulletin of the World Health Organization;2000, Vol. 78 Issue 11, p1283 

    Editorial. Comments on the return of sleeping sickness caused by Trypanosoma brucei gambiense. Deterioration and disruption of control activities; Problems on the implementation of active case detection and successful treatment; Gap between scientific progress and the implementation of...

  • Short-course eflornithine in Gambian trypanosomiasis: a multicentre randomized controlled trial. Pepin, Jacques; Khonde, Nzambi // Bulletin of the World Health Organization;2000, Vol. 78 Issue 11, p1284 

    Compares the effectiveness of 7 days of intravenous eflornithine with the standard 14-day regimen in the treatment of late-stage Trypanosoma brucei gambiense trypanosomiasis. Use of a randomized controlled trial; Death of some patients during treatment; Difference in response to treatment...

  • Eflornithine Is Safer than Melarsoprol for the Treatment of Second-Stage Trypanosoma brucei gambiense Human African Trypanosomiasis. Chappuis, François; Udayraj, Nitya; Stietenroth, Kai; Meussen, Ann; Bovier, Patrick A. // Clinical Infectious Diseases;9/1/2005, Vol. 41 Issue 5, p748 

    Patients with second-stage human African trypanosomiasis treated with eflornithine (n = 251) in 2003 in Kin, southern Sudan, had an adjusted relative risk of death of 0.2 and experienced significantly fewer cutaneous and neurological adverse effects than did patients who were treated with...

  • Trypanososma brucei rhodesiense Sleeping Sickness, Uganda. Berrang-Ford, Lea; Wamboga, Charles; Kakembo, Abbas S. L. // Emerging Infectious Diseases;Oct2012, Vol. 18 Issue 10, p1686 

    The article discusses a study which examined patients diagnosed with human African trypanosomiasis (HAT) in Uganda. The total number of Trypanosoma brucei rhodesiense HAT cases in the country over a 10-year period is 140. Results of the study showed that there is a tendency among patients in...

  • Sleeping bug: scientists identify drug resistance mechanism.  // Africa Health;Mar2012, Vol. 34 Issue 3, p12 

    The article focuses on the study conducted by the researchers in Greta Britain, which reveals several ways by which parasite Trypanosoma brucei can resist drugs used in treating sleeping sickness.

  • New Clues to Sleeping Sickness.  // JAMA: Journal of the American Medical Association;1/2/2013, Vol. 309 Issue 1, p20 

    The article informs that a new research conducted by the scientists of Germany, Sweden and the U.S. has explained the structure of a key enzyme named "Trypanosoma brucei cysteine protease cathepsin B," (TbCatB) from the parasite that causes African trypanosomiasis or sleeping sickness.

  • Estimates of the duration of the early and late stage of gambiense sleeping sickness. Checchi, Francesco; Filipe, João A. N.; Haydon, Daniel T.; Chandramohan, Daniel; Chappuis, François // BMC Infectious Diseases;2008, Vol. 8 Issue 1, Special section p1 

    Background: The durations of untreated stage 1 (early stage, haemo-lymphatic) and stage 2 (late stage, meningo-encephalitic) human African trypanosomiasis (sleeping sickness) due to Trypanosoma brucei gambiense are poorly quantified, but key to predicting the impact of screening on transmission....

  • African Trypanosomes: Will the Twain Meet? Deresinski, Stan // Clinical Infectious Diseases;3/15/2006, Vol. 42 Issue 6, preceding p739 

    The article reports about African Trypanosomes, a sleeping sickness dieses. The human African trypanosomiasis disease exists in two forms: One is caused by Trypanosoma brucei subspecies ganbienese. Western and Central Africa is mostly affected by this dieses. Second is caused by T. brucei...

  • Trypanosomes, Infection and Immunity. Kaminsky, Ronald; Vohr, Hans-Werner // Encyclopedic Reference of Immunotoxicology;2005, p666 

    The article provides an encyclopedia entry on trypanosomes. Trypanosomes are protozoan parasites. Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense are species of trypanosomes that are pathogenic to man. These species can also cause sleeping sickness. Moreover, the article also...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics