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Sleeping Sickness in Southeastern Uganda: A SystemsApproach

Abstract

Sleeping sickness continues to be a significant public health burden in southeastern Uganda. Continued spread of the disease into new areas of Uganda highlights our inability to understand and predict the distribution of infection. Multiple factors influence the distribution of sleeping sickness, including climate, land cover, cattle movements, prevention and control activities, and social conflict. We draw on a systems approach to conceptualize and characterize the multiple interacting forces and processes that influence the spatial and temporal dynamics of sleeping sickness in Uganda. This synthesis reveals a complex system of interactions among human and biophysical systems, feedback, and scale dependence. We identify some common analytical modeling approaches relative to our system characterization and identify opportunities for sleeping sickness research and improved understanding of disease dynamics in Uganda.

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References

  1. Abaru DE (1985) Sleeping sickness in Busoga, Uganda, 1976-1983. Tropical Medicine and Parasitology 36:72–76

    PubMed  Google Scholar 

  2. Allsopp R, Baldry DAT, Rodrigues C (1972) The influence of game animals on the distribution and feeding habits of Glossina pallidipes in the Lambwe Valley. Bulletin of the World Health Organization 47:795–809

    PubMed  Google Scholar 

  3. Bourn D, Reid RS, Snow B, Wint W (2001) Environmental Change and the Autonomous Control of Tsetse and Trypanosomosis in Sub-Saharan Africa, Oxford: Environmental Research Group Oxford (ERGO) Ltd

    Google Scholar 

  4. Coleman PG, Welburn SC (2004) Are fitness costs associated with resistance to human serum in Trypanosoma brucei rhodesiense? Trends in Parasitology 20:311–315

    Article  PubMed  Google Scholar 

  5. Farming in Tsetse Conrolled Areas Project (2004) Farming in Tsetse Conrolled Areas Project. Available:http://www.deluga.cec.eu.int/en/newsletter/june04/farming.htm [accessed January 15, 2005]

  6. Fèvre EM (2001) More thoughts on the control of trypanosomes in cattle. Trends in Parasitology 17:412–413

    Article  PubMed  Google Scholar 

  7. Fèvre EM, Coleman PG, Odiit M, Magona JW, Welburn SC, Woolhouse MEJ (2001) The origins of a new Trypanosoma brucei rhodesiense sleeping sickness outbreak in eastern Uganda. Lancet 358:625–628

    Article  PubMed  Google Scholar 

  8. Fèvre EM, Coleman PG, Welburn SC, Maudlin I (2004) Reanalyzing the 1900-1920 sleeping sickness epidemic in Uganda. Emerging Infectious Diseases 10:567–573

    PubMed  Google Scholar 

  9. Ford J (1969) Control of the African trypanosomiases with special reference to land use. Bulletin of the World Health Organization 40:879–892

    PubMed  Google Scholar 

  10. Ford J (1971) The Role of the Trypanosomiases in African Ecology, Oxford: Clarendon Press

    Google Scholar 

  11. Ford J (1979) Ideas which have influenced attempts to solve the problems of African trypanosomiasis. Social Science and Medicine 13B:269–275

    Google Scholar 

  12. Ford J (1980) Early ideas about sleeping sickness and their influence on research and control. In: Sabben-Clare EE, Bradley DJ, Kirkwood K (editors), Health in Tropical Africa during the Colonial Period, Based on the Proceedings of a Symposium Held at New College, Oxford, 21-23 March 1977, Oxford: Clarendon Press, pp 30–34

    Google Scholar 

  13. Ford J, Katondo KM (1977) Maps of tsetse fly (Glossina) distribution in Africa 1973, according to sub-generic groups on scale of 1:5,000,000. Bulletin of Animal Health and Production in Africa 15:188–194

    Google Scholar 

  14. Gashumba JK, Mwambu PM (1981) Sleeping sickness epidemic in Busoga, Uganda. Tropical Doctor 11:175–178

    PubMed  Google Scholar 

  15. Gibson CC, Ostrom E, Ahn TK (2000) The concept of scale and the human dimensions of global change: a survey. Ecological Economics 32:217–239

    Article  Google Scholar 

  16. Hay SI, Packer MJ, Rogers DJ (1997) A review of the impact of remote sensing on the study and control of vector-borne disease. International Journal of Remote Sensing 18:2899–2930

    Article  Google Scholar 

  17. Hay SI, Randolph SE, Rogers DJ (editors) (2000) Remote Sensing and Geographical Information Systems in Epidemiology. Advances in Parasitology, Volume 47, New York: Academic Press

    Google Scholar 

  18. Hendrickx G, Napala A, Slingenbergh JH, DeDeken R, Vercruysse J, Rogers DJ (2000) The spatial pattern of trypanosomiasis prevalence predicted with the aid of satellite imagery. Parasitology 120:121–134

    Article  PubMed  Google Scholar 

  19. Hendy CRC, Makin MJ (1988) Land and development planning associated with trypanosomiasis control. International Scientific Council for Trypanosomiasis Research and Control (ISCTRC) 114:425–433

    Google Scholar 

  20. Hide G (1999) History of sleeping sickness in East Africa. Clinical Microbiology Reviews 12:112–125

    PubMed  Google Scholar 

  21. Hide G, Tait A, Maudlin I, Welburn SC (1996) The origins, dynamics and generation of Trypanosoma brucei rhodesiense epidemics in East Africa. Parasitology Today 12:50–55

    Article  PubMed  Google Scholar 

  22. Hursey BS, Slingenbergh J (1995) The tsetse fly and its effects on agriculture in sub-Saharan Africa. World Animal Review (84/85):67–73

    Google Scholar 

  23. Jahnke HE (1976) Tsetse Flies and Livestock Development in East Africa: A Study in Environmental Economies, Munich: Weltforum Verlag

    Google Scholar 

  24. Jordan AM (1979) Trypanosomiasis control and land use in Africa. Outlook on Agriculture 10:123–129

    Google Scholar 

  25. Jordan AM (1986) Trypanosomiasis Control and African Rural Development, London: Longman

    Google Scholar 

  26. Koerner T, de Raadt P, Maudlin I (1995) The Uganda sleeping sickness epidemic revisited: a case of mistaken identity? Parasitology Today 11:303–306

    Article  PubMed  Google Scholar 

  27. Koopman JS, Longini IM (1994) The ecological effects of individual exposures and nonlinear disease dynamics in populations. American Journal of Public Health 84:836–842

    PubMed  Google Scholar 

  28. Leak SGA (1999) Tsetse Biology and Ecology: Their Role in the Epidemiology and Control of Trypanosomosis, Wallingford, UK: CABI Publishing (in association with the International Livestock Research Institute, Nairobi, Kenya)

    Google Scholar 

  29. Lointier M, Truc P, Drapeau L, Nanga S, Tarek M (2001) Méthodologie de détermination de zones à risque de maladie du sommeil en Côte d’Ivoire par approche spatialisée [Methodology to determine risk zones for sleeping sickness in Cote d’Ivoire by the spatial approach]. Medecine Tropicale 61:390–396

    PubMed  Google Scholar 

  30. Lyons M (1991) African sleeping sickness: an historical review. International Journal of STD and AIDS 2(Suppl 1):20–25

    PubMed  Google Scholar 

  31. MacKichan IW (1944) Rhodesian sleeping sickness in Eastern Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 38:49

    Article  Google Scholar 

  32. Matovu FS (1982) Rhodesian sleeping sickness in south-eastern Uganda (the present problems). East African Medical Journal 59:390–393

    PubMed  Google Scholar 

  33. Mbulamberi DB (1989a) A review of human African trypanosomiasis (HAT) in Uganda. East African Medical Journal 66:743–747

    Google Scholar 

  34. Mbulamberi DB (1989b) Possible causes leading to an epidemic outbreak of sleeping sickness: facts and hypotheses. Annales de la Société Belge de Médecine Tropicale 69(Supp 1):173–179

    Google Scholar 

  35. Mbulamberi DB (1994) Recent advances in the diagnosis and treatment of sleeping sickness. Postgraduate Doctor (Africa) 16:16–19

    Google Scholar 

  36. McDermott JJ, Coleman PG (2001) Comparing apples and oranges—model-based assessment of different tsetse-transmitted trypanosomosis control strategies. International Journal for Parasitology 31:603–609

    Article  PubMed  Google Scholar 

  37. McDermott JJ, Kristjanson PM, Kruska RL, Reid RS, Robinson TP, Coleman PG, et al. (2001) Effects of climate, human population and socio-economic changes on tsetse-transmitted trypanosomiasis to 2050. In: Seed R, Black S (editors), World Class Parasites, Vol 1: The African Trypanosomes, Boston: Kluwer Academic, pp 25–38

    Google Scholar 

  38. Mills A, Pender J (1996) Environmental impact assessment of tsetse control historical quantification of land cover and land use. In: Power CH, Rosenberg LJ, Downey I (editors), Remote Sensing and GIS for Natural Resource Management (conference proceedings), Chatham, UK: Natural Resources Institute, pp 72–86

    Google Scholar 

  39. Musere J (1990) African Sleeping Sickness: Political Ecology, Colonialism and Control in Uganda, New York: Edwin Mellen

    Google Scholar 

  40. Odiit M (2003) Epidemiology of Trypanosoma brucei rhodesiense Sleeping Sickness in Eastern Uganda (PhD thesis), Edinburgh: University of Edinburgh

  41. Odiit M, Coleman PG, McDermott JJ, Fevre EM, Welburn SC, Woolhouse MEJ (2004a) Spatial and temporal risk factors for the early detection of Trypanosoma brucei rhodesiense sleeping sickness patients in Tororo and Busia districts, Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 98:569–576

    Article  Google Scholar 

  42. Odiit M, Shaw A, Welburn SC, Fevre EM, Coleman PG, McDermott JJ (2004b) Assessing the patterns of health-seeking behaviour and awareness among sleeping-sickness patients in eastern Uganda. Annals of Tropical Medicine and Parasitology 98:339–348

    Article  Google Scholar 

  43. Okiria R (1985) The prevalence of human trypanosomiasis in Uganda, 1970 to 1983. East African Medical Journal 62:813–816

    PubMed  Google Scholar 

  44. Okoth JO (1986) Peri-domestic breeding sites of Glossina fuscipes fuscipes Newst. in Busoga, Uganda and epidemiological implications for trypanosomiasis. Acta Tropica 43:283–286

    PubMed  Google Scholar 

  45. Olila D, McDermott JJ, Eisler MC, Mitema ES, Patzelt RJ, Clausen P-H, et al. (2002) Drug sensitivity of trypanosome populations from cattle in a peri-urban dairy production system in Uganda. Acta Tropica 84:19–30

    Article  PubMed  Google Scholar 

  46. Picozzi K, Tilley A, Fèvre EM, Coleman PG, Magona JW, Odiit M, et al. (2002) The diagnosis of trypanosome infections: applications of novel technology for reducing disease risk. African Journal of Biotechnology 1:39–45

    Google Scholar 

  47. Pisani E (2002) Chapter 7: Kenya and Uganda. In: McElrath K (editor), HIV and AIDS: A Global View, Westport, CT: Greenwood Press, pp 115–136

    Google Scholar 

  48. Platt AE (1996) Infecting Ourselves: How Environmental and Social Disruptions Trigger Disease, Washington, DC: Worldwatch Institute

    Google Scholar 

  49. Reid RS, Wilson CJ, Kruska RL, Mulatu WA (1997) Impacts of tsetse control and land-use on vegetative structure and tree species composition in south-western Ethiopia. Journal of Applied Ecology 34:731–747

    Google Scholar 

  50. Reid RS, Kruska RL, Deichmann U, Thornton PK, Leak SGA (2000) Human population growth and the extinction of the tsetse fly. Agriculture, Ecosystems, and Environment 77:227–236

    Google Scholar 

  51. Robinson TP, Rogers DJ, Williams B (1997) Mapping tsetse habitat suitability in the common fly belt of Southern Africa using multivariate analysis of climate and remotely sensed vegetation data. Medical and Veterinary Entomology 11:235–245

    PubMed  Google Scholar 

  52. Rogers DJ (1988) A general model for the African trypanosomiases. Parasitology 97:193–212

    PubMed  Google Scholar 

  53. Rogers DJ 1991) Satellite imagery, tsetse and trypanosomiasis in Africa. Preventive Veterinary Medicine 11:201–220

    Google Scholar 

  54. Rogers DJ (1995) Remote sensing and the changing distribution of tsetse flies in Africa. In: Harrington R, Stork NE (editors), Insects in a Changing Environment (17th Symposium of the Royal Entomological Society, Harpenden, UK, 7-10 September 1993), London: Academic Press, pp 177–193

    Google Scholar 

  55. Rogers DJ (2000) Satellites, space, time, and the African trypanosomiases. In: Hay SI, Randolph SE, Rogers DJ (editors), Baker JR, Muller R, Rollinson D (series editors), Advances in Parasitology, Vol 47, Special Edition: Remote Sensing and Geographical Information Systems in Epidemiology, San Diego: Academic Press, pp 129–171

    Google Scholar 

  56. Rogers DJ, Packer MJ (1993) Vector-borne diseases, models and global change. Lancet 342:1282–1284

    Article  PubMed  Google Scholar 

  57. Rogers DJ, Randolph SE (2003) Studying the global distribution of infectious diseases using GIS and RS. Nature Reviews Microbiology 1:231–236

    Article  PubMed  Google Scholar 

  58. Rogers DJ, Williams BG (1993) Monitoring trypanosomiasis in space and time. Parasitology 106(Suppl):S77–S92

    PubMed  Google Scholar 

  59. Rose G (1985) Sick individuals and sick populations. International Journal of Epidemiology 14:32–38

    PubMed  Google Scholar 

  60. Schwartz S, Susser E, Susser M (1999) A future for epidemiology? Annual Review of Public Health 20:15–33

    Article  PubMed  Google Scholar 

  61. Waiswa C, Olaho-Mukani W, Katunguka-Rwankishaya E (2003) Domestic animals as reservoirs for sleeping sickness in three endemic foci in south-eastern Uganda. Annals of Tropical Medicine and Parasitology 97:149–155

    Article  Google Scholar 

  62. Welburn SC, Odiit M (2002) Recent developments in human African trypanosomiasis. Current Opinion in Infectious Diseases 15:477–484

    PubMed  Google Scholar 

  63. Welburn SC, Fèvre EM, Coleman PG, Odiit M, Maudlin I (2001) Sleeping sickness: a tale of two diseases. Trends in Parasitology 17:19–24

    Article  PubMed  Google Scholar 

  64. Worboys M (1994) The comparative history of sleeping sickness in East and Central Africa, 1900-1914. History of Science 32:89–102

    PubMed  Google Scholar 

  65. World Health Organization (2001) Report on African Trypanosomiasis (Sleeping Sickness), Report of the Scientific Working Group Meeting on African Trypanosomiasis, Geneva: Special Programme for Research and Training in Tropical Diseases; 4-8 June 2001. Report No. TDR/SWG/01. Available:http://whqlibdoc.who.int/hq/2003/TDR_SWG_01.pdf [accessed December 21, 2004]

  66. Yu P, Habtemariam T, Oryang D, Obasa M, Nganwa D, Robnett V (1995) Integration of temporal and spatial models for examining the epidemiology of African trypanosomiasis. Preventive Veterinary Medicine 24:83–95

    Article  Google Scholar 

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Acknowledgments

This work was performed with the aid of a grant from the International Development Research Centre (IDRC), Ottawa, Canada. Information on the Centre is available on the Worldwide Web athttp://www.idrc.ca. Research was also supported by funding from the National Science and Engineering Research Council of Canada and the IDRC in Project 100106: “Links between Sleeping Sickness and Natural Resources Endowments and Use: What Can Communities Do?” Special thanks go to Dr. Mbulamberi, Ministry of Health, Uganda; Dr. Maiso, World Health Organization, Kampala; the late Dr. Thomas Gitau; and James Ford.

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Correspondence to Lea Berrang-Ford.

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Berrang-Ford, L., Waltner-Toews, D., Charron, D. et al. Sleeping Sickness in Southeastern Uganda: A SystemsApproach. EcoHealth 2, 183–194 (2005). https://doi.org/10.1007/s10393-005-6331-9

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Key words

  • sleeping sickness
  • trypanosomiasis
  • Uganda
  • tsetse
  • social conflict
  • systems approach