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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. CONFLICT AND HEALTH. CIVIL CONFLICT AND SLEEPING SICKNESS IN AFRICA. TABLE OF CONTENTS.

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CONFLICT AND HEALTH; Civil conflict and sleeping sickness in Africa

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  1. 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

  2. CONFLICT AND HEALTH CIVIL CONFLICT AND SLEEPING SICKNESS IN AFRICA

  3. TABLE OF CONTENTS • Introduction • Disease Definition • Mode of Transmission • Disease Symptom • Treatment • Geographical Distribution • Case In Point; South-Eastern Uganda • Hurdles to Intervention and Prevention • Solutions • Breakthrough Treatment • Conclusion • Further Reading • References

  4. IINTRODUCTION • 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). Civilconflict and sleeping sickness in Africa in general and Uganda in particular; Conflict and Health 2007, 1:6 doi:10.1186/1752-1505-1-6

  5. INTRODUCTION • 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. • 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 refugees.org news.bbc.co.uk alphabetics.info

  6. 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. • 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 refugees.org refugees.org

  7. DISEASE DEFINITION • A protozoan parasitic disease. • It affects humans, livestock and a large number of sylvatic species in much of sub-Saharan Africa • 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 infosdelaplanete.org flickr.com goryfiles.blogspot.com baggas.com

  8. MODE OF TRANSMISSION • Transmitted by the tsetse fly vector trypanosomiasis. • There are two sub-species of human-infectious 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.gambiense • grahamazon.com T.b. rhodesiense grahamazon.com

  9. 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

  10. DISEASE SYMPTOMS • Stage two symptoms include; • confusion • reduced coordination • disturbed 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 sleepzine.com dfid-ahp.org.uk doctorswithoutborders.org research4development

  11. 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 medilinkz.org answers.com medilinkz.org

  12. 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 TREATMENT world-countries.net pubs.acs.org msf.org msf.ie

  13. 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 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 GEOGRAPHICAL DISTRIBUTION medilinkz.org medilinkz.org

  14. 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:10.1186/1752-1505-1-6 wildgooseministries.org

  15. 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:10.1186/1752-1505-1-6 • 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.

  16. 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 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 SOLUTIONS

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

  18. 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 • 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

  19. 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

  20. 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

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