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The major risk factors associated with acquisition of T. b. rhodesiense sleeping sickness in the Busoga focus, S.E. Uganda were investigated using a case-control study. 122 cases and 244 matched controls were used in the study. For each case two age-, sex- and resistance controls (1 matched nearest neighbour control and 1 village control) were selected. Patients and controls answered the same questionnaire which had been developed and field tested before the field study started. A logistic regression model for a 1:2 matched case control design was fit to the data. The following factors were found significant: cases spent more time outside their village of residence than controls and visited more SS high risk areas than controls, more cases than controls collected firewood in the forests. Generally, cases had less domestic animals grazing near the places of man-fly contact, especially near water and firewood collecting and bathing points, and near farms and gardens, than controls. Cases had more antecedents of sleeping sickness in the family. Generally cases had a less well developed information network than controls, and belonged economically to a less powerful group. Based on these results we may conclude that the risk to develop T.b. rhodesiense sleeping sickness depends upon a multitude of economical, cultural and human behaviour factors. These factors should be taken into account in the planning and monitoring of sleeping sickness control programmes.

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PIP: African Sleeping Sickness is endemic in 37 countries of sub-Saharan Africa. Recent estimates suggest that 50 million people are at risk of acquiring the disease and 25,000 new cases are recorded every year. African Sleeping Sickness is caused by protozoan organisms belonging to the genus Trypanosoma which are transmitted cyclically by tsetse flies. The trypanosomes are limited in the early stage to the blood stream from which they later move to the central nervous system. The disease is very hard to diagnose and treat. Clinical manifestations are highly variable and unspecific, and parasitological diagnosis is difficult because of the frequently low and fluctuating parasitemia. Most of the available serological tests can only detect the presence of antibodies to trypanosomes and therefore only indicate exposure to trypanosomes rather than active infection. Clinical, parasitological, and serological diagnosis are discussed. Treatment of the disease remains dependent upon the use of Suramin and Pentamidine for early stage cases and Mel B for late stage cases when the central nervous system changes occur. Through compassionate clinical trials, however, eflornithine, formerly known as DFMO, was recently found to be an effective therapeutic agent against gambiense sleeping sickness. The drug acts by irreversibly blocking the action of ornithine decarboxylase, which catalyzes an essential step in polyamine synthesis, and stops the growth of trypanosomes. A multicenter conventional clinical trial is being arranged before it is made commercially available.^ieng

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The performance of an enzyme-linked immunosorbent assay (antigen ELISA) for the detection, in serum or cerebrospinal fluid, of an invariant trypanosome antigen to diagnose Trypanosoma brucei rhodesiense sleeping sickness was evaluated in four clinical treatment centres. The test, which was carried out in polystyrene test-tubes, was positive in 88 (88.9%) of 99 parasitologically confirmed cases that were tested at the National Institute for Medical Research, Tabora, United Republic of Tanzania; 99 (94.3%) of 105 cases tested at the National Sleeping Sickness Control Programme, Jinja, Uganda; 86 (87.8%) of 98 cases tested at the Uganda Trypanosomiasis Research Organisation, Tororo, Uganda; and 59 (96.7%) of 61 cases tested at the Tropical Diseases Research Centre, Ndola, Zambia. The overall detection rate was 91.5%. There was no cross-reactivity with the agents of the common bacterial, viral, or parasitic diseases prevalent in the areas where the studies were conducted. The only false-positive result involved a blood donor from a trypanosomiasis endemic focus. The test was simple to perform, was read visually, and is therefore a potential tool for diagnosing human African trypanosomiasis.

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Sleeping Sickness epidemics have been occurring in Uganda since the beginning of the present century. These epidemics have been partially controlled in the past using the conventional methods of bush clearing, mass diagnostic surveys and treatment. Political and economic upheavals have greatly influenced the recurrence of these epidemics. This paper presents a review of the past and present situation and an outline of the control activities being undertaken in the country.

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Sleeping sickness epidemics have been noted to occur with some degree of periodicity and the question as to why this is so has been asked for quite a long time. These epidemics have been partially controlled in the past using the conventional methods of bush clearing, mass diagnostic surveys and treatment. Political, social and economic upheavals have been found to be very important factors in the recurrence of these epidemics. In addition, a number of facts and hypotheses have been advanced as possible causes of epidemic outbreaks of sleeping sickness. This paper presents a brief account of factual epidemic outbreaks of sleeping sickness in south eastern Uganda (Busoga) and then proceeds to discuss, in general terms, a number of hypotheses that have been incriminated to date, as possible causes that might lead to an epidemic outbreak of the disease.

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