Sleeping sickness re-emerges in Uganda
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《英国医生杂志》
Millions of Ugandans are at risk of contracting sleeping sickness (trypanosomiasis), after its re-emergence in areas where numbers of cases had been brought down to very low levels. The disease is also spreading to new areas.
National control programmes had been sacrificed in favour of programmes for new emerging public health problems such as HIV and AIDS, said Bob Mbulamberi, an expert on trypanosomiasis and assistant commissioner for health services in charge of control of vector borne diseases in the ministry of health. He said that over the past 12 years the disease had been given only marginal recognition by the government and the international community as a health problem and as a priority for research.
As a result the number of outbreaks in southeastern districts of Uganda where the disease has traditionally been endemic has increased. Drugs have been scarce, and resistance to drugs has increased, he added.
Dr Mbulamberi said that two strains of the disease were responsible for the rise. The chronic strain, caused by the protozoon Trypanosoma brucei gambiense, was in the West Nile region and was spreading to the north and northeastern parts of the country, while the acute strain, T brucei rhodesiense, was in the southeastern part of the country and was also spreading.
According to latest statistics from the health ministry, 70% of the country is infested with tsetse flies, with the most important species being Glosinna fuscipes fuscipes, which covers two thirds of the tsetse belt in the country.
Political upheaval in the country has also helped the spread of the disease. For example, in the West Nile region the 1978-9 liberation war to dislodge the former dictator Idi Amin uprooted whole populations and caused the people to flee to southern Sudan, where many contracted trypanosomiasis. When they were repatriated to Uganda in 1983-4 they brought the chronic strain of the disease with them. And the continuing 17 year old war in northern Uganda is further helping the spread of the chronic strain southwards.
Other problems are a lack of active community participation and involvement in control of the disease and a lack of targeted information about the importance and control of the disease.
The government抯 1999 programme to restock livestock in northeastern Uganda with unscreened animals from the southeastern region helped export the disease to the northeastern region after the end of the 1987-9 rebel war in the region.
"We are going to be in serious trouble if the two strains overlap. If you have a mixture of strains diagnosis becomes an extremely complex situation, as you get a new population of parasites which are more resistant to drugs," Dr Mbulamberi said.
He also said the scarcity of the drugs needed to treat the disease, such as suramin, pentamidine, and melarsoprol, was adding to the problems. European drug companies such as Bayer and Aventis, which once produced the drugs, had stopped production because the drugs made no profit, he said.
But he added that the World Health Organization and Médecins Sans Frontières have continued to help Uganda by procuring the drugs from Aventis and Bayer on a special order.(Kampala Benjamin Ochan)
National control programmes had been sacrificed in favour of programmes for new emerging public health problems such as HIV and AIDS, said Bob Mbulamberi, an expert on trypanosomiasis and assistant commissioner for health services in charge of control of vector borne diseases in the ministry of health. He said that over the past 12 years the disease had been given only marginal recognition by the government and the international community as a health problem and as a priority for research.
As a result the number of outbreaks in southeastern districts of Uganda where the disease has traditionally been endemic has increased. Drugs have been scarce, and resistance to drugs has increased, he added.
Dr Mbulamberi said that two strains of the disease were responsible for the rise. The chronic strain, caused by the protozoon Trypanosoma brucei gambiense, was in the West Nile region and was spreading to the north and northeastern parts of the country, while the acute strain, T brucei rhodesiense, was in the southeastern part of the country and was also spreading.
According to latest statistics from the health ministry, 70% of the country is infested with tsetse flies, with the most important species being Glosinna fuscipes fuscipes, which covers two thirds of the tsetse belt in the country.
Political upheaval in the country has also helped the spread of the disease. For example, in the West Nile region the 1978-9 liberation war to dislodge the former dictator Idi Amin uprooted whole populations and caused the people to flee to southern Sudan, where many contracted trypanosomiasis. When they were repatriated to Uganda in 1983-4 they brought the chronic strain of the disease with them. And the continuing 17 year old war in northern Uganda is further helping the spread of the chronic strain southwards.
Other problems are a lack of active community participation and involvement in control of the disease and a lack of targeted information about the importance and control of the disease.
The government抯 1999 programme to restock livestock in northeastern Uganda with unscreened animals from the southeastern region helped export the disease to the northeastern region after the end of the 1987-9 rebel war in the region.
"We are going to be in serious trouble if the two strains overlap. If you have a mixture of strains diagnosis becomes an extremely complex situation, as you get a new population of parasites which are more resistant to drugs," Dr Mbulamberi said.
He also said the scarcity of the drugs needed to treat the disease, such as suramin, pentamidine, and melarsoprol, was adding to the problems. European drug companies such as Bayer and Aventis, which once produced the drugs, had stopped production because the drugs made no profit, he said.
But he added that the World Health Organization and Médecins Sans Frontières have continued to help Uganda by procuring the drugs from Aventis and Bayer on a special order.(Kampala Benjamin Ochan)