conflict and health; civil conflict and sleeping sickness in africa

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 CONTENTSIntroduction Disease DefinitionMode of TransmissionDisease SymptomTreatmentGeographical

DistributionCase In Point; South-

Eastern Uganda

Hurdles to Intervention and Prevention

Solutions Breakthrough TreatmentConclusion Further ReadingReferences

Sustained political instability 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.

The association between 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

IINTRODUCTION

Conflict and war are recognized as determinants of infectious disease risk.

Sleeping sickness re-emerged in sub-Saharan Africa since the 1970’s.

It has coincided with extensive civil conflict in affected regions.


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refugees.org

INTRODUCTION

Factors that increase the incidence of outbreaks during outbreaks include;

decreased hygiene dietary deficiencies decline of health services travel insecurity reduced access of

humanitarian support reduced veterinary and

zoonoses control internal displacement of

populations into marginal areas.


refugees.org

refugees.org

INTRODUCTION

DISEASE DEFINITIONA protozoan

parasitic disease.It affects humans,

livestock and a large number of sylvatic species in much of sub-Saharan Africa


goryfiles.blogspot.com baggas.com

infosdelaplanete.org flickr.com

MODE OF TRANSMISSIONTransmitted by the

tsetse fly vector trypanosomiasis.

There are two sub-species of human-infectious trypanosomes;T.b. gambienseT.b. rhodesiense


T.b.gambiensegrahamazon.com

T.b. rhodesiensegrahamazon.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.


biochem.arizona.edu

Stage two symptoms include;

confusion reduced

coordinationdisturbed sleep

cycle with bouts of fatigue

manic periods,daytime slumber and night-time insomnia.

Medecins Sans Frontiers; Switched off: sleeping sickness in conflict http://www.msf.org.uk/two_doctors_20091030.news

dfid-ahp.org.uksleepzine.com

doctorswithoutborders.org

research4development

DISEASE SYMPTOMS

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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.

Ford, L.B., (2007). Civil conflict and sleeping sickness in Africa in general and Uganda in particular;

miyazaki-med.ac.jp

answers.com medilinkz.org

medilinkz.org

TREATMENTSleeping 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.


Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6 Africa: Detecting stealth sleeping sickness;

http://www.irinnews.org/PrintReport.aspx

msf.ie

world-countries.net

msf.org

pubs.acs.org

GEOGRAPHICAL DISTRIBUTION First identified and characterized in

Africa in the last part of the 19th century.

Widespread and severe epidemics of the 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


medilinkz.org

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


wildgooseministries.org

HURDLES TO INTERVENTION AND PREVENTIONTransmission 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.


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.

SOLUTIONSEfforts 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 TREATMENTNECT (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

CONCLUSIONThe 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 interventionsc. 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 READING1. 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

REFERENCESFord, 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

conflict and health; civil conflict and sleeping sickness in africa

Documents

health civil conflict

particular conflict

ongoing civil conflict

extensive civil conflict

sleeping sickness

conflictrelated casualties

disease symptomsstage

disease parasite