Sleeping sickness still thrives in poor communities

It did not occur to John Ocung that he was suffering from sleeping sickness because tests from the clinics he visited always concluded that he had malaria. Even though he was on medication, it did not relieve his pain.

Then, he developed severe headache, a visual blackout and paralysis in his left leg. His wife, who was worried that he would not survive, suggested they turn to prayers. Ocung resisted. Eventually, he ended up at Lwala Hospital in Otuboi Sub-county, Kaberamaido District.

“I did not know I had sleeping sickness because I was always diagnosed with malaria. Their treatment never healed me,” Ocung narrates from his hospital bed at Lwala, where he has spent a week receiving treatment after doctors confirmed he was suffering from sleeping sickness.

“I suffered severe headache, I could not see clearly and always felt my leg was paralysed. I could not sleep at night and could do so mostly during the day, between 8am and 2pm,” Ocung recalls.

He adds: “I wish I had come to the hospital earlier. I now feel better with the medication I am receiving. My leg is improving and I can now get some sleep. However, I still get headache, a cold, and pass urine frequently.”
Ocung, 55, a father of eight, is optimistic that he will be cured of the disease soon.

Late-stage disease
Charles Elamu, the Kaberamaido District vector control officer says in Ocung’s case, the disease was already at an advanced stage. It had therefore affected his central nervous system.

During this stage, patients develop visual problems, they feel sleepy most of the time and their speech becomes incoherent.

Like Ocung, Moses Eryengu initially relied on malaria drugs which he got from his drug shop in Soroti Town to treat his illness. Little did he know, at the time, that it was sleeping sickness that was keeping him ill most of the time.

“I was weak and could not even stand up. I was admitted to hospital. Tests confirmed I had sleeping sickness and not malaria. I felt relieved because at least I now knew what it was. I even thought I had been bewitched because of the on-and-off fever and body weakness,” he says.

He adds that if he had remained in Soroti treating malaria and typhoid, he would have succumbed to sleeping sickness.

In Eryengu’s case though, when the first tests were carried out, it showed that his disease was in the early stages. Subsequently, he started treatment and after successful completion of the dose, further tests showed he had been cured.

He was discharged from hospital in January. “My only problem now is that I spit a lot, even at night. When I move long distances I become dizzy and it becomes difficuly for me to walk in the sun,” he says.

“This illness has set me back in my business and the education of my children and siblings because I have no income to pay for their fees,” he says, adding: “I am confident I will re-organise myself when I fully recover.” Lwala Hospital is the only treatment centre for sleeping sickness in Lango sub-region.

Those with symptoms have to go through two painful lumbar punctures where fluids are sucked from their cerebral spinal code and taken for analysis in the laboratory. The second puncture is usually carried out if one has not cured from the first dose of medication.

When infection happens
In Kaberamaido District, the number of sleeping sickness cases is usually high between December and January, and drops from February to April.

Eryengu has an appeal for government: “They should carry out an aerial spray all over our sub region to kill the tsetse flies. Otherwise the traps set against the flies are short-lived and people vandalise them or use them as clothes.”

According to the World Health Organisation (WHO), sleeping sickness also known as Human African Trypanosomiasis (HAT) is a vector-borne parasitic disease, which is caused by infection with protozoan parasites belonging to the genus trypanosoma. It is transmitted to humans by tsetse fly (glossina genus) bites, which acquire their infection from human beings or from animals that harbour the parasites that cause the disease.

Symptoms of the disease include fever, swollen lymph glands, aching muscles and joints, headaches and irritability. When left untreated, the disease attacks the central nervous system and can cause death.

According to WHO, sleeping sickness occurs only in 36 sub-Saharan Africa countries where there is a high prevalence of tsetse flies.

The population most exposed to tsetse fly and affected by sleeping sickness live in remote areas with limited access to adequate health services, which complicates the surveillance and therefore the diagnosis and treatment of cases.

In addition, displacement of populations, war and poverty are common factors that facilitate transmission, as poor people with no access to health services cannot be diagnosed early enough and put on treatment.

Control efforts
However, WHO says continuous prevention control efforts over the years have reduced the number of new cases. In 2009, there were 9,878 new cases of the disease reported in Uganda. This was also the first time in 50 years that less than 10,000 cases were reported.
And in 2012, this figure dropped further to 7,216 cases.
“Sleeping sickness is prevalent in about 40 districts, with 10 million more people at risk. Because of concerted control efforts, we have been reporting just a third of cases in the past five years ago,” says Dr Charles Wamboga, the programme manager in-charge of sleeping sickness control at the Ministry of Health.

The ministry notes that Uganda is affected by mainly two types of the diseases-trypanosoma brucei gambiense and trypanosoma brucei rhodesiense.

Trypanosoma brucei gambiense predominantly occurs in the West Nile region, which is bordered by the Democratic Republic of Congo and South Sudan- countries also known to have a high prevalence of the disease. Human beings are the main reservoir for this form of sleeping sickness.

On the other hand, Trypanosoma brucei rhodesiense was originally limited to the South Eastern region of the country. Recently, however, this type of sleeping sickness has been reported in some parts of Northern Uganda such as Alebtong District.
Cattle are the main reservoir for this acute form of sleeping sickness.

Medication
According to the Ministry of Health, case detection, is mainly through passive and active screening (on a limited scale). All diagnosed cases are treated with drugs such as suramin and pentamidine for early stages of the disease, and melarsoprol and nifurtimox/eflornithine combination therapy for late stage cases.

The Health ministry management centres have been established in several districts across the country to treat cases of the disease.

With support from the Pan African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC), advocacy and social mobilisation have also been revitalised, with most of the support for the programme funded by WHO.

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