Experiences of the one-health approach by the Uganda Trypanosomiasis Control Council and its secretariat in the control of zoonotic sleeping sickness in Uganda

Waiswa, Charles; Azuba, Rose; Makeba, J.; Waiswa, I.C.; Wangoola, Robert Mandela

doi:10.1016/j.parepi.2020.e00185

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Over the last decade, confirmed cases of sleeping sickness have sharply declined thanks to Uganda’s Ministry of Health Trypanosomiasis Control Council (UTCC) and the efforts of international partners to engage other ministries and the community in the implementation of control strategies. The success of this strategy is largely attributed to the engagement of stakeholders and strategies including the use of insecticides to treat cattle as live bait for tsetse, therefore breaking the transmission of trypanosomes to both humans and animals [ 96 ]. This fine balance is at risk of disruption with the influx of refugees from South Sudan, because in that country the transmission of T. b. gambiense is still a problem [ 97 ].…”

Section: Surveillance and Disease Control Measures: Targets For Afric...mentioning

confidence: 99%

Current Treatments to Control African Trypanosomiasis and One Health Perspective

et al. 2022

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Human African Trypanosomiasis (HAT, sleeping sickness) and Animal African Trypanosomiasis (AAT) are neglected tropical diseases generally caused by the same etiological agent, Trypanosoma brucei. Despite important advances in the reduction or disappearance of HAT cases, AAT represents a risky reservoir of the infections. There is a strong need to control AAT, as is claimed by the European Commission in a recent document on the reservation of antimicrobials for human use. Control of AAT is considered part of the One Health approach established by the FAO program against African Trypanosomiasis. Under the umbrella of the One Health concepts, in this work, by analyzing the pharmacological properties of the therapeutic options against Trypanosoma brucei spp., we underline the need for clearer and more defined guidelines in the employment of drugs designed for HAT and AAT. Essential requirements are addressed to meet the challenge of drug use and drug resistance development. This approach shall avoid inter-species cross-resistance phenomena and retain drugs therapeutic activity.

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Section: Surveillance and Disease Control Measures: Targets For Afric...mentioning

confidence: 99%

Current Treatments to Control African Trypanosomiasis and One Health Perspective

et al. 2022

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“…Tsetse control activities are also carried out in a number of countries in which rhodesiense HAT is endemic, including Kenya [ 38 ], Malawi [ 39 ], United Republic of Tanzania [ 40 , 41 ], Uganda [ 42 ], Zambia [ 43 ] and Zimbabwe [ 44 ], where interventions against the tsetse vector are primarily driven by the need to control animal trypanosomiasis; interventions are normally implemented by veterinary services and livestock keepers. However, the benefits to One Health of tsetse control are well recognized both nationally and internationally [ 45 ], and they are explicitly pursued in many areas [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

The elimination of human African trypanosomiasis: Achievements in relation to WHO road map targets for 2020

et al. 2022

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Background In the 20th century, epidemics of human African trypanosomiasis (HAT) ravaged communities in a number of African countries. The latest surge in disease transmission was recorded in the late 1990s, with more than 35,000 cases reported annually in 1997 and 1998. In 2013, after more than a decade of sustained control efforts and steady progress, the World Health Assembly resolved to target the elimination of HAT as a public health problem by 2020. We report here on recent progress towards this goal. Methodology/principal findings With 992 and 663 cases reported in 2019 and 2020 respectively, the first global target was amply achieved (i.e. fewer than 2,000 HAT cases/year). Areas at moderate or higher risk of HAT, where more than 1 case/10,000 people/year are reported, shrunk to 120,000 km2 for the five-year period 2016–2020. This reduction of 83% from the 2000–2004 baseline (i.e. 709,000 km2) is slightly below the target (i.e. 90% reduction). As a result, the second global target for HAT elimination as a public health problem cannot be considered fully achieved yet. The number of health facilities able to diagnose and treat HAT expanded (+9.6% compared to a 2019 survey), thus reinforcing the capacity for passive detection and improving epidemiological knowledge of the disease. Active surveillance for gambiense HAT was sustained. In particular, 2.8 million people were actively screened in 2019 and 1.6 million in 2020, the decrease in 2020 being mainly caused by COVID-19-related restrictions. Togo and Côte d’Ivoire were the first countries to be validated for achieving elimination of HAT as a public health problem at the national level; applications from three additional countries are under review by the World Health Organization (WHO). Conclusions/significance The steady progress towards the elimination of HAT is a testament to the power of multi-stakeholder commitment and coordination. At the end of 2020, the World Health Assembly endorsed a new road map for 2021–2030 that set new bold targets for neglected tropical diseases. While rhodesiense HAT remains among the diseases targeted for elimination as a public health problem, gambiense HAT is targeted for elimination of transmission. The goal for gambiense HAT is expected to be particularly arduous, as it might be hindered by cryptic reservoirs and a number of other challenges (e.g. further integration of HAT surveillance and control into national health systems, availability of skilled health care workers, development of more effective and adapted tools, and funding for and coordination of elimination efforts).

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“…The reported overdosing with trypanocides and observation that farmers were using a topical veterinary pesticide to control ticks and tsetse on their animals was unexpected outside of the SOS districts. Although the current study area is not within the target area for SOS it appears that messages about the benefits of double dosing of trypanocides for T. brucei s.l., and application of topical veterinary pesticides for prevention of re-infection by trypanosomes and, treatment of tick-borne-diseases, may have spread beyond the SOS area ( Waiswa et al, 2020 ) and warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

Trypanocide usage in the cattle belt of southwestern Uganda

Kasozi,

MacLeod,

Sones

et al. 2023

Front. Microbiol.

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BackgroundSystematic infrastructure and regulatory weaknesses over many decades, in communities struggling with animal African trypanosomiasis (AAT) would be expected to create an environment that would promote drug misuse and risk development of drug resistance. Here, we explore rural community practices of livestock keepers, livestock extension officers and drug shop attendants to determine whether appropriate practice was being followed in administration of trypanocides and other drugs.MethodsA questionnaire-based survey was undertaken in southwestern Uganda in 2022 involving 451 farmers who kept cattle, sheep or goats and 79 “professionals” who were either livestock extension officers or drug shop attendants.ResultsRespondents reported using one or more type of trypanocidal drug on 80.1% of the 451 farms in the last 30 days. Diminazene aceturate was used on around three-quarters of farms, while isometamidium chloride was used on around one-fifth. Homidium bromide was used on less than 1% of farms. Cattle were significantly more likely to be treated with trypanocides than sheep or goats. On around two-thirds of farms, trypanocides were prepared and injected by farmers, with extension officers administering these drugs on most of the other third, especially on cattle farms. Almost all drugs were obtained from privately-owned drug shops. For treatment of AAT with trypanocides, prescription-only medicines were routinely used by farmers without professional supervision and in the absence of a definitive diagnosis. While a far greater proportion of professionals had a better education and had received training on the use of trypanocides than farmers, there was relatively little difference in their ability to use these drugs correctly. Farmers were more likely than professionals to use only DA to treat trypanosomiasis and were more likely to use antibiotics as well as trypanocidal drugs to treat the animal. Furthermore, they estimated, on average, that twice the recommended dose of either diminazene aceturate or isometamidium chloride was needed to treat a hypothetical 400 kg bovine. A minority of both farmers and professionals reported that they observed the recommended withdrawal times following injection of trypanocidal drugs and very few of either group knew the recommended withdrawal times for milk or meat. Only one in six farmers reported using the sanative pair (alternating use of diminazene aceturate and isometamidium chloride), to reduce the risk of drug resistant trypanosome strains emerging, while this approach was more widely used by professionals. Farmers reported using antibiotics more commonly than the professionals, especially in sheep and goats, raising concerns as to overuse and misuse of this critical class of drugs. In addition to using trypanocides, most farmers also reported using a topical veterinary pesticide for the control of ticks and tsetse. On average, farmers spent 12.2% of their income from livestock sales on trypanocides.ConclusionThis study highlights the complexity of issues involved in the fight against AAT using drug treatment. A multistakeholder campaign to increase awareness among farmers, drug shop attendants, and extension workers of the importance of adherence to recommended drug dosing, using the sanative pair and following recommended drug withdrawal guidance would promote best practice, reduce the risk of emergence of resistant strains of trypanosomes, and support enhanced food safety.

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Experiences of the one-health approach by the Uganda Trypanosomiasis Control Council and its secretariat in the control of zoonotic sleeping sickness in Uganda

Cited by 9 publications

References 29 publications

Current Treatments to Control African Trypanosomiasis and One Health Perspective

Current Treatments to Control African Trypanosomiasis and One Health Perspective

The elimination of human African trypanosomiasis: Achievements in relation to WHO road map targets for 2020

Trypanocide usage in the cattle belt of southwestern Uganda

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