MSF highlights danger of sleeping sickness

The NGO Medecins sans frontieres-Holland (MSF-H) has expressed concern about the possibility of a re-emergence of sleeping sickness (trypanosomiasis) on an epidemic scale in the Republic of Congo. The danger was due to an almost complete collapse of the national prevention and control programme since 1996, during which not only active screening stopped but treatment and vector control (of the tsetse fly) were also interrupted, it said in its July situation report. In addition, there were three civil wars during the 1990s, and attendant excessive population movements in and out of traditional foci of the disease, including the Plateaux/Pool area and others bordering the DRC, it added. In November 2000, the MSF-H sleeping sickness programme was started - the NGO returned to Congo-Brazzaville in February last, having left the country in 1997 - and, as of May, was undertaking both passive and active screening, the latter through a mobile team based in Gambona. From April to July, 163 new cases were admitted for treatment in Gambona, with 146 later released cured. In addition, a mobile team continued screening activities in Plateaux area, along the River Congo, in Mpouya, Bodzeka and Makotipoko. Over 300 more patients were diagnosed during active screening (up to 31 July), of whom about 175 had finished treatment by 1 August, MSF-H reported. Among the issues to arise during the screening of the first eight villages was why perhaps three times as many patients had phase one of the illness, and whether or not that meant that phase-two patients were dying or going elsewhere (perhaps the DRC) for treatment, it said. During the remainder of August and September, the agency intends to undertake further screening in the Plateaux; additional decentralised treatment in Mpouya and Makotipoko; undertake exploratory missions to Ngabe and Bounze; assess the feasibility of vector control interventions; and develop proposals for a second phase of the sleeping sickness programme, it added. West African (Gambian) sleeping sickness is a serious disease that is fatal if not treated, though symptoms may not appear for months to years after the initial infection. Initial symptoms include swollen lymph nodes, swelling of face and hands, skin rash, fever, severe headaches, muscle and joint pain, and fatigue. Neurological damage occurs during the second stage, in which the victim can experience personality changes, slurred speech, changes in sleep patterns, progressive confusion, difficulty with walking, and seizures. Sleeping sickness has a profound impact on the health of a large portion of sub-Saharan Africa, with an estimated one third of the population of Africa living in tsetse fly-infested areas. The economic impact of sleeping sickness is also significant owing to the dramatic reduction in the labour force and resulting decrease in economic productivity - apart entirely from a reduction in cattle production of between 20 percent and 40 percent in areas where the disease is epidemic. (It is estimated that cattle-production losses alone amount to $2.7 billion each year.)