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BackgroundHuman African trypanosomiasis (HAT), or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC), which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT.DiscussionIn 2007, Médecins Sans Frontières (MSF) began screening for HAT in the Haut-Uélé and Bas-Uélé districts of Orientale Province in northeastern DRC, an area of high prevalence affected by armed conflict. Through early 2009, HAT prevalence rate of 3.4% was found, reaching 10% in some villages. More than 46,000 patients were screened and 1,570 treated for HAT during this time. In March 2009, two treatment centres were forced to close due to insecurity, disrupting patient treatment, follow-up, and transmission-control efforts. One project was reopened in December 2009 when the security situation improved, and another in late 2010 based on concerns that population displacement might reactivate historic foci. In all of 2010, 770 patients were treated at these sites, despite a limited geographical range of action for the mobile teams.SummaryIn conflict settings where HAT is prevalent, targeted medical interventions are needed to provide care to the patients caught in these areas. Strategies of integrating care into existing health systems may be unfeasible since such infrastructure is often absent in resource-poor contexts. HAT care in conflict areas must balance logistical and medical capacity with security considerations, and community networks and international-response coordination should be maintained. Research and development for less complicated, field-adapted tools for diagnosis and treatment, and international support for funding and program implementation, are urgently needed to facilitate HAT control in these remote and insecure areas.

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BACKGROUND The prevalence of diabetes in the US is very high. and Chinese patients with diabetes are estimated to comprise 50% of the total cases. Rates of diabetes continue to rise amongst Chinese and Chinese American patients; however, research regarding effective diabetes interventions for this minority group is sparse. OBJECTIVE A systematic review was conducted to shine a light on a study design and interventions for future studies investigating efficacy of a family-based intervention to improve diabetes care in Chinese Americans. METHODS The systematic review was conducted from the summer of 2019 to the spring of 2023. PubMed, CINAHL, ScienceDirect, ProQuest, Google Scholar, Scopus and the Cochrane Central Register of Controlled Trials were the databases used for the search. Key search terms utilized were “diabetes type 2,” “Chinese patients,” “minority patients,” “interventions for diabetes,” “diabetes and family,” “culturally responsive interventions for diabetic patients,” “family education for diabetes,” and “diabetes in China.” RESULTS The initial search retrieved 2,335 articles. Ten articles met the selection criteria to examine efficacy of family-based interventions for Chinese American patients. The review showed that providing multiple sessions of education and counseling for both patients and family members is promising in improving diabetes care. Recruitment of 20-60 dyads of a patient and a family member can help to assess family dynamics in the process of diabetes care, such as food shopping and preparation, and of diabetes management to further evaluate efficacy of an intervention. Glycated hemoglobin (HbA1c) was the primary outcome used most often. Other secondary outcomes included knowledge and efficacy in diabetes management and self-care activities related to diabetes care. CONCLUSIONS A family-based intervention is essential for optimizing diabetes care for Chinese Americans. Thus, recruitment of a dyad of a patient and a family is important to investigate efficacy of a family-based intervention in improving diabetes care in this population. Strategies for improving recruitment and retention of dyads were identified. In addition, technology can be used to promote the delivery of interventions to patients, which in turn increases efficacy. Implications: This review can help researchers investigate the efficacy of family-based interventions in promoting diabetes management by designing culturally appropriate study protocols and interventions. CLINICALTRIAL This is a review paper thus a trial registration is not required.