Abstract

BackgroundUpdated, accurate and comprehensive information on the distribution of human African trypanosomiasis (HAT), also known as sleeping sickness, is critically important to plan and monitor control activities. We describe input data, methodology, preliminary results and future prospects of the HAT Atlas initiative, which will allow major improvements in the understanding of the spatial distribution of the disease.MethodsUp-to-date as well as historical data collected by national sleeping sickness control programmes, non-governmental organizations and research institutes have been collated over many years by the HAT Control and Surveillance Programme of the World Health Organization. This body of information, unpublished for the most part, is now being screened, harmonized, and analysed by means of database management systems and geographical information systems (GIS). The number of new HAT cases and the number of people screened within a defined geographical entity were chosen as the key variables to map disease distribution in sub-Saharan Africa.ResultsAt the time of writing, over 600 epidemiological reports and files from seventeen countries were collated and included in the data repository. The reports contain information on approximately 20,000 HAT cases, associated to over 7,000 different geographical entities. The oldest epidemiological records considered so far date back to 1985, the most recent having been gathered in 2008. Data from Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea and Gabon from the year 2000 onwards were fully processed and the preliminary regional map of HAT distribution is presented.ConclusionThe use of GIS tools and geo-referenced, village-level epidemiological data allow the production of maps that substantially improve on the spatial quality of previous cartographic products of similar scope. The significant differences between our preliminary outputs and earlier maps of HAT transmission areas demonstrate the strong need for this systematic approach to mapping sleeping sickness and point to the inaccuracy of any calculation of population at risk based on previous maps of HAT transmission areas. The Atlas of HAT will lay the basis for novel, evidence-based methodologies to estimate the population at risk and the burden of disease, ultimately leading to more efficient targeting of interventions. Also, the Atlas will help streamline future field data collection in those parts of Africa that still require it.

Highlights

  • Updated, accurate and comprehensive information on the distribution of human African trypanosomiasis (HAT), known as sleeping sickness, is critically important to plan and monitor control activities

  • NonGovernmental Organizations (NGOs) and bilateral cooperation played a major role in the control of the HAT but the signing of a public-private partnership between World Health Organization (WHO) and sanofi-aventis in May 2001, renewed in October 2006, marked a turning point in sleeping sickness control

  • Discontinuation of civil strife in countries where HAT is endemic, most notably in Angola, Democratic Republic of the Congo (DRC), and Sudan, facilitated access to diagnosis and treatment to people living in the areas of highest endemicity

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Summary

Introduction

Accurate and comprehensive information on the distribution of human African trypanosomiasis (HAT), known as sleeping sickness, is critically important to plan and monitor control activities. NonGovernmental Organizations (NGOs) and bilateral cooperation played a major role in the control of the HAT but the signing of a public-private partnership between WHO and sanofi-aventis in May 2001, renewed in October 2006, marked a turning point in sleeping sickness control. This partnership contributed to WHO's efforts to fight the disease, making it possible to distribute drugs free-ofcharge. In spite of some persisting information gaps, e.g. in Liberia, Nigeria and Sierra Leone, the extensive information collected during the last years has substantially reduced the uncertainties that surrounded disease figures prior to 1997

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