The pathway to sustainable elimination of Human African Trypanosomiasis in Democratic Republic of Congo
Human African Trypanosomiasis (HAT) is a vector-borne parasitic disease caused by two subspecies of Trypanosoma brucei (T. b.) pathogenic to humans ; T. b. rhodesiense, in the Eastern and Southern Africa and T. b. gambiense in Central and Western Africa. It is limited to sub-Saharan Africa, between latitudes 14N and 29S, within the limits of the geographical distribution of the tsetse fly of Glossina genus, that transmits the disease. About 97-98% of all cases are due to T. b. gambiense that causes the chronic form of the disease (gambiense HAT), concerned by this research thesis, while T. b. rhodesiense causes the acute form of the disease. Due to steady decreasing in cases number along the last two decades, Gambiense HAT (gHAT) has been targeted for elimination as public health problem (PHP) by 2020 and now it is targeted for elimination of transmission (EoT) by 2030. The Democratic Republic of the Congo (DRC) remains the most affected country; now that the evolution of the disease seems inexorable towards the elimination of gHAT in the country, considering the fact that this disease trend observed at the national level, is certainly not the same at the subnational level, we aim to evaluate the disease trend from the national level to the subnational level as well as the quality and coverage of gHAT control activities between 2000 and 2016. Regarding the objective to eliminate HAT, based on lessons learned from past successes and failures and from research, challenges have been identified for sustained elimination of gHAT. These challenges include diagnostic and therapeutic tools and strategies suitable for Primary Health Care (PHC) system and health facilities in remote areas where gHAT is most prevalent, maintaining the technical capacity and interest among health care workers, and raising public awareness, ensuring sufficient coverage of control activities, addressing the question of the animal and asymptomatic reservoir, implementing effective monitoring of gHAT elimination and cost-effective surveillance system to assure a sustainable elimination and diagnose promptly any risk of reemergence of disease. Our scientific work is mainly oriented towards improving diagnostic tools and detection/treatment strategies to address the issue of integrating gHAT control into PHC system, improving coverage of activities, and analyze current results toward gHAT elimination in DRC. The sharp decline in number of gHAT cases in DRC is aligned with the gHAT elimination objective. However trend of this disease is very variable from one region to another.
Antwerp : University of Antwerp, Faculty of Medicine and Health Sciences , 2023
xxx, 272 p.
Supervisor: Lutumba, Pascal [Supervisor]
Supervisor: Van geertruyden, Jean-Pierre [Supervisor]
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The publisher created published version Available from 27.09.2024
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Creation 28.09.2023
Last edited 29.09.2023
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