Transcript CONFLICT AND HEALTH; Civil conflict and sleeping sickness in Africa Esther Shisoka, MPH student Walden University PH 6165-5 Instructor: Dr.

CONFLICT AND HEALTH; Civil conflict and sleeping
sickness in Africa
Esther Shisoka, MPH student Walden University
PH 6165-5
Instructor: Dr. Jalal Ghaemghami
Winter Quarter, 2009/2010
CIVIL CONFLICT AND SLEEPING
SICKNESS IN AFRICA
TABLE OF CONTENTS
 Introduction
 Hurdles to Intervention
 Disease Definition
 Mode of Transmission
 Disease Symptom
 Treatment
 Geographical Distribution
 Case In Point; South-Eastern
Uganda





and Prevention
Solutions
Breakthrough Treatment
Conclusion
Further Reading
References
IINTRODUCTION
 Sustained political instability
 The association between
and violence have massive
impacts on the health of the
people affected.
 Studies show that more die
from treatable diseases
during conflict than they do
from conflict-related
casualties.
 Poor state of healthcare
facilities often deteriorates to
a point where diseases that
require only basic treatment
such as malaria or diarrhea
cannot be cured.
conflict and infectious
disease are particularly
prevalent in Africa.
 Ongoing civil conflict, and
infectious disease remain
important contributors to
national mortality.
Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
INTRODUCTION
 Conflict and war are
recognized as
determinants of infectious
disease risk.
 Sleeping sickness reemerged in sub-Saharan
Africa since the 1970’s.
 It has coincided with
extensive civil conflict in
affected regions.
refugees.org
news.bbc.co.uk

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and Uganda
in particular; Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
boblivolsi.com
alphabetics.info
INTRODUCTION
 Factors that increase the
incidence of outbreaks during
outbreaks include;
 decreased hygiene
 dietary deficiencies
 decline of health services
 travel insecurity
refugees.org
 reduced access of humanitarian
support
 reduced veterinary and
zoonoses control
 internal displacement of
populations into marginal areas.

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general
and Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/17521505-1-6
refugees.org
DISEASE DEFINITION
 A protozoan parasitic
disease.
 It affects humans,
livestock and a large
number of sylvatic
species in much of subSaharan Africa

flickr.com
infosdelaplanete.org
Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and
Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
goryfiles.blogspot.com
baggas.com
MODE OF TRANSMISSION
 Transmitted by the tsetse
fly vector
trypanosomiasis.
T.b.gambiense
 There are two sub-
species of humaninfectious trypanosomes;
 T.b. gambiense
 T.b. rhodesiense

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and
Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
T.b. rhodesiense
grahamazon.com
grahamazon.com
DISEASE SYMPTOMS
 Stage one symptoms
include; fever, headaches
and joint pains.
 These symptoms are
often mis-diagnosed as
malaria.
 If untreated, the disease
parasite passes through
the blood-brain barrier
and into the nervous
system.

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and
Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
biochem.arizona.edu
DISEASE SYMPTOMS
 Stage two symptoms
include;
 confusion
 reduced coordination
 disturbed sleep cycle
with bouts of fatigue
 manic periods,daytime
slumber and night-time
insomnia.

sleepzine.com
Medecins Sans Frontiers; Switched off: sleeping sickness in conflict
http://www.msf.org.uk/two_doctors_20091030.news
dfid-ahp.org.uk
doctorswithoutborders.org
research4development
TREATMENT
 Sleeping sickness
treatment is expensive,
complicated and can be
dangerous for the patient.
 The dominant treatment
for late-stage sleeping
sickness is melarsopol.
 This is, an organ arsenic
compound with high
toxicity and varying rates
of treatment failure.

medilinkz.org
miyazaki-med.ac.jp
Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and
Uganda in particular;
answers.com
medilinkz.org
11
TREATMENT
 Sleeping sickness is problematic
because laboratory facilities are
required to diagnose the disease
 A lumbar puncture may also be
needed to differentiate between
stages 1 and 2
 Treatment is relatively less
complicated and still effective
for patients at stage 1. but very
difficult at stage 2.

Medecins Sans Frontiers; Switched off: sleeping sickness in conflict
http://www.msf.org.uk/two_doctors_20091030.news


Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
Africa: Detecting stealth sleeping sickness; http://www.irinnews.org/PrintReport.aspx
world-countries.net
msf.org
pubs.acs.org
msf.ie
GEOGRAPHICAL DISTRIBUTION
 First identified and characterized in Africa
in the last part of the 19th century.
 Widespread and severe epidemics of the

medilinkz.org
disease in Kenya, Tanzania, Uganda,
Nigeria, and the Democratic Republic of
the Congo.
 The disease generally brought under
control by the 1960s in much of Africa but
has re-emerged in many countries since the
1970s.
 Re-emergence is due to post-independence
turbulence, unstable governments, limited
public health resources, and re-allocation
of domestic and international funding
towards malaria, HIV/AIDS, and
tuberculosis.
 In areas of Sudan, the Democratic Republic
of the Congo, and Angola, sleeping sickness
occurs in epidemic proportions and is the
greatest cause of mortality

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and Uganda in particular; Conflict
and Health 2007, 1:6 doi:10.1186/1752-1505-1-6
medilinkz.org
CASE IN POINT
 SOUTH-EASTERN UGANDA
 T.b.rhodesiense epidemic in 1976-1990s
coincided with political instability and
civil war during and after the rule of Idi
Amin.
 The civil war influenced the
transmission of sleeping sickness by;
Breakdown of veterinary and public
health services
 Collapse of vector control, re-growth of
bushy tsetse habitat in abandoned
agricultural fields
 Increasing displacement of human and
animal populations into marginal or
swampy areas where they are more likely
to be bitten by flies


Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general
and Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/17521505-1-6
wildgooseministries.org
HURDLES TO INTERVENTION AND
PREVENTION
 Transmission determinants of
sleeping sickness include the
following;
 Land cover change i.e. increased
vegetation growth around
homesteads and the resulting
movement of tsetse flies into
peridomestic environments.
 Collapse of essential health
services, and veterinary and
vector control
 Reduced surveillance and
treatment in both humans and
animal reservoirs of infection.

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general
and Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/17521505-1-6
 Insecurity due to conflict
constrains the capacity of both
national governments and
external organizations to
respond to outbreak situations.
 Lack of harmonization and
integration of activities between
organizations trying to control
the disease.
 Absence of appropriate
administrative infrastructures
for program implementation.
SOLUTIONS
 Efforts to prevent and control sleeping sickness must;
 Identify and integrate knowledge of the processes by
which conflict affects disease
 Increase drug development
 Re-establish essential health services and active
surveillance and treatment
 Target outbreak locations and areas bordering
countries with high incidence
BREAKTHROUGH TREATMENT
 NECT (Nifurtimox-Eflornithine
Combination Therapy), the first
new treatment in 25 years
against Human African
trypanosomiasis is now
available.
 Endemic countries have now
begun the process of ordering
the new combination treatment
and kits through WHO.
 NECT cuts the cost of treatment
by half and significantly reduces
the burden on health workers.
africanhealingjourneys.com

Medecins Sans Frontiers; Switched off: sleeping sickness in conflict
http://www.msf.org.uk/two_doctors_20091030.news
CONCLUSION
 The campaign to eliminate the tsetse vector from the
African continent will face enormous hurdles due to
continued conflict.
 Progress to curb sleeping sickness is more likely to come
from;
a. Political stabilization in affected countries.
b. Local interventions
c. Development of administrative policy, capacity,
integration, and infrastructure to implement
localized control strategies
d. Prevention and control campaigns that address
conflict-related drivers of disease risk.
e. An understanding of areas where conflict may
contribute to increased disease risk
FURTHER READING
1. Berrang-Ford L, Waltner-Toews D, Charron D, Odiit M, McDermott J, Smit B: Sleeping
sickness in southeastern Uganda: a systems approach. EcoHealth 2005., 2:
2. Moore A, Richer M, Enrile M, Losio E, Roberts J, Levy D: Resurgence of sleeping
sickness in Tambura County, Sudan. American Journal of Tropical Medicine and
Hygiene 1999, 61:315-318.
3. Stanghellini A, Gampo S, Sicard JM: The role of environmental factors in the present
resurgence of human African trypanosomiasis [Role des facteurs
environnementaux dans la recrudescence actuelle de la trypanosomiase
humaine africain]. Bulletin de la Societe de Pathologie exotique 1994, 87:303-306.
4. Jordan AM: Trypanosomiasis control and land use in Africa. Outlook on Agriculture
1979, 10:123-129.
5. Mbulamberi DB: Recent advances in the diagnosis and treatment of
sleeping sickness. Postgraduate Doctor Africa 1994, 16:16-19.
6. Garfield RM and A. I. Neugat: Epidemiologic analysis of warfare: a historical review
Journal of the American Medical Association 1991, 266:688-692
REFERENCES
 Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in
general and Uganda in particular; Conflict and Health 2007, 1:6
doi:10.1186/1752-1505-1-6. Retrieved January 20,2010 from
http://doctorswithoutborders.org/news/allcontent.cfm
 Medecins Sans Frontiers(2009); Switched off: sleeping sickness
in conflict. Retrieved January 20, 2010 from
http://www.msf.org.uk/two_doctors_20091030.news
 IRINNEWS (2010). Africa: Detecting stealth sleeping sickness.
Retrieved January 20,2010 from
http://www.irinnews.org/PrintReport.aspx