Socio-Economic Causes and Effects of Human African Trypanosomiasis in the Democratic Republic of the Congo

1. Socio-Economic Causes and Effects of Human African Trypanosomiasis in the Democratic Republic of the Congo Jen Wilson And Silvia Escudero http://www.icp.ucl.ac.be/~opperd/parasites.iages/tryps6.gif

2. The Disease • Parasitic • Transmitted by Tsetse Fly • Infects humans and cattle • Kills over 50,000 people every year (Kabayo 2002) http://www.gla.ac.uk/ibls/II/parasitology/cureit.htm http://www.uen.org/utahlink/activities/view_activity.cgi?activity_id=3023

3. The Disease • Swelling occurs at site of bite. • Infection travels through blood stream. • Attacks central nervous system. • Results in swelling of brain. • Drowsiness during day; insomnia at night. • Death may occur in six months if no treatment is done (Smith 2006).

4. Endemicity Status Democratic Republic of the Congo http://pages.unibas.ch/diss/2004/DissB_6961.pdf

5. History • 17th – early 20th centuries: sleeping sickness and other vector-bourn diseases caused more human deaths than all other causes combined. • 1940’s-1960’s:vector control programs, modern drugs and insecticides led to the control of disease • Past 20 years:major epidemics and a resurgence of disease WHY? (Gubler 1998)

6. Resurgence of Sleeping Sickness in DRC http://www.cdc.gov/ncidod/eid/vol11no09/04-1020.htm#cit

7. Human Influences on Tsetse Fly • Population Growth / Urbanization • Exploitation of Land • Poor Health Policies • Climate Change

8. Population Growth/Urbanization • Population growth • Quick movement to urban areas • Movement is unplanned and uncontrolled • Inadequate housing, poor waste management, dirty water, densely packed people, etc. • Ideal conditions for tsetse fly http://www.kfw-entwicklungsbank.de/EN_Home/Topics/Good_Governance/index.jsp

9. Kinshasa • Study in 2005 in Kinshasa to determine where the greatest rate of infection was. • Results showed that peri-urban areas along rivers had high concentrations of tsetse flies (De Deken 2005). • People move to urban places and head to rivers for water where there is a high risk of infection. http://www.eolc-observatory.net/global_analysis/congokinshasa.htm

10. Land Use • Tsetse flies originally found in low lands • People are increasing land use and moving to the high lands (Eradicating Tsetse) • Farmers bring cattle with them • Cattle carry the disease and take it to tsetse-free areas. http://www.iaea.org/OurWork/ST/NA/NAAL/agri/ent/entTSETSEmain.php

11. Health Policies • 1960-70’s : threat for disease decreased • Health policy decisions decreased surveillance, prevention and control. • Lack of support from developed world. • DRC uses mass screening: study in 2004 showed that the effectiveness of testing is less than 50% (Robays 2004).

12. Climate Change • Not too much proof correlation. • Climate change mostly linked to human consumption. • Temperature and precipitation are most important factors determining whether the vector can survive. • A rise in temperature could conceivably increase the range of the vector. http://www.solcomhouse.com/globalwarming.htm

13. Effects of Disease • Depletion of Livestock • Loss of Capital • Urbanization and Economic Degradation

14. Livestock • Nagana: cattle variety of disease • Kills 3 million cows a year (Pearce 2002). • Decrease in meat production and other by products such as milk • Contributes to protein shortages in people • Farmers lose labor from the animals => poverty http://www.iaea.org/NewsCenter/Features/Tsetse/tsetse_gallery/pages/002.shtml

15. Where is the problem? http://www.genomics.liv.ac.uk/tryps/problem.html

16. Capital Loss • Meeting held in Ethiopia to discuss ways to fight sleeping sickness in 2004 • Experts reported that African countries lose 4.5 billion dollars every year due to the impact of disease on agriculture (Deutsche Press 2004). • Livestock owners administer 35 million dollars worth of doses of medication every year; each at about 1 dollar (Torr et al. 2005). • Loss of jobs

17. Urbanization/Economic Degradation • Fear of disease spreads and families move away from fertile lands. • Less people on fertile lands growing crops => economic degradation (Kabayo 2002). • Urbanization loops around and becomes a cause for increase in annual infections.

18. Connections Urbanization S S Number of people exposed Threat S S Number of people infected

19. Connections S Economy Productivity S S Workforce S S Vector control programs Animal Labor O Number of infected people O O S Number of tsetse flies Number of infected cows S

20. References “Cure It.” Institute of Biomedical Life Sciences. University of Glasgow. 7 April 2007 <http://www.gla.ac.uk/ibls/II/parasitology/cureit.htm>. De Deken, Redgi. “Trypanosomiasis in Kinshasa: Distribution of the Vector, Glossina fuscipes quanzensis, and Risk of Transmission in Peri-Urban Area.” Medical and Veterinary Entomology. 19.4 353-359 (2005). Blackwell Synergy. 6 April 2007. <http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2915.2005.00580>. “Democratic Republic of the Congo (Congo-Kinshasa).” The International Observatory on End of Life Care. 9 April 2007. <http://www.eolc-observatory.net/global_analysis/congokinshasa.htm>. “Eradicating Tsetse from the Southern Rift Valley of Ethiopia.” WREN Media. 6 April 2007. <http://tc.iaea.org/tcweb/publications/factsheets/ethiopia.pdf>. “Good Governance.” KfW Entwicklungsbank. 9 April 2007 <http://www.kfw-entwicklungsbank.de/EN_Home/Topics/Good_Governance/index.jsp>. Gubler, D.J. “Resurgent Vector-Borne Diseases as a Global Health Problem.” Emerging Infectious Diseases. Sept. 1998. 6 April 2007. <http://www.cdc.gov/ncidod/eid/vol4no3/gubler.htm>. Kabayo, J.P. (2002). Aiming to eliminate tsetse from Africa. TRENDS in Parasitology, 11, 473-475. Lutumba, Pascal. “Trypanosomiasis Control, Democratic Republic of Congo, 1993-2003.” Emerging Infectious Diseases. 11.9 (2005). Centers for Disease Control and Prevention. 9 April 2007. <http://www.cdc.gov/ncidod/eid/vol11no09/04-1020.htm#cit>. “Meeting Held in Ethiopia to Dscuss Ways to Fight Sleeping Sickness.” (2004). Deutsche Presse-Agentur. 7 March 2007. <http://web.lexis-nexis.com/universe/>. Opperdoes, Fred. “African Trypanosomiasis or Sleeping Sickness.” 19 Oct. 1997. 7 April 2007 <http://www.icp.ucl.ac.be/~opperd/parasites/tryps9.htm>. Pearce, F. (2002). An atomic-powered plan to end sleeping sickness. The Boston Globe,3. Retrieved March 7,2007, from Lexis-Nexis Academic database.

21. References Schmid, Caecilia. “10-Day Melarsoprol Treatment of Trypanosoma Brucei Gambiense Sleeping Sickness: From Efficacy to Effectiveness.” 21 Sept. 2004. 9 April 2007. <http://pages.unibas.ch/diss/2004/DissB_6961.pdf>. Smith, Scott. “Sleeping Sickness.” Medical Encyclopedia. 27 Nov. 2007. Medline Plus. 7 April 2007. <http://www.nlm.nih.gov/medlineplus/ency/article/001362.htm>. Robays, Jo. “The Effectiveness of Active Population Screening and Treatment for Sleeping Sickness Control in the Democratic Republic of Congo.” Tropical Medicine & International Health. 9.5 542-550. (2004). Blackwell Synergy. 6 April 2007. <http://www.blackwell-synergy.com/links/doi/10.1111%2Fj.1365-3156.2004.01240.x>. Torr, S.J., Hargrove, J.W., & Vale, G.A. (2005) Towards a rational policy for dealing with tsetse. TRENDS in Parasitology, 11, 537-541. “Tsetse Flies.” Entomology Unit. 2004. International Atomic Energy Agency. 9 April 2007. <http://www.iaea.org/OurWork/ST/NA/NAAL/agri/ent/entTSETSEmain.php>.

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