Sustainability
In the 1930s, colonial administrations conscious of the huge negative impact the disease had on the development of its territories, established large programmes to combat the spread and reduce the prevalence of sleeping sickness.
Over a 30 year period, specialized structures with dedicated and hardworking staff using systematic screening of populations managed to screen, treat and follow-up millions of individuals in Africa and almost stopped transmission of the disease in the early 1960s.
The rarity of cases led to a lack of interest in surveillance and the awareness of the risk of the disease to return waned. Gradually, the disease crept back and in the 1980s a number of flare-ups were observed in previously endemic areas, leading to a worrisome increase in the number of reported cases.
The greatest challenge to avoid a resurgence as experienced in the 1980s is to maintain sustainable control and surveillance. Sustainability can only be achieved through an integration of control and surveillance activities within a reinforced, existing health system.
The *current approach focuses on health systems and specialized teams. A specialized central structure at national level is necessary to ensure the monitoring, coordination and technical assistance needed. However the participation of the health system in the control is difficult with the existing tools. What is needed is a sensitive and specific test which would be cheap and easy to perform under field conditions. Also needed is a new drug, safe and easy to administer and able to cure both stages of the disease
* Report of a WHO Informal Consultation on sustainable control of human African trypanosomiasis, 1—3 May 2007, Geneva, Switzerland. Ref: WHO_CDS_NTD_IDM_2007.6.
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