title: Sleeping sickness in Uganda: revisiting current and historical distributions.
abstract: BACKGROUND
  Sleeping sickness is a parasitic, vector-borne disease, carried by the tsetse fly and prevalent in sub-Saharan Africa. The disease continues to pose a public health burden in Uganda, which experienced a widespread outbreak in 1900-1920, and a more recent outbreak in 1976-1989. The disease continues to spread to uninfected districts.
  
  
  OBJECTIVE
  This paper compares the spatial distributions of sleeping in Uganda for the 1900-1920 outbreak period with current disease foci, and discusses information gaps and implications arising for future research, prevention and control.
  
  
  METHODS
  Population census records for 1911 and sleeping sickness records from Medical and Sanitary Reports of the Ugandan Protectorate for 1905-1936 were extracted from the Uganda Archives. Current sleeping sickness distribution data were provided by the Ministry of Health, Uganda. These were used to develop sleeping sickness distribution maps for comparison between the early 1900s and the early 2000s.
  
  
  RESULTS
  The distribution of sleeping sickness from 1905-1920 shows notable differences compared to the current distribution of disease. In particular, archival cases were recorded in south-west and central Uganda, areas currently free of disease. The disease focus has moved from lakeshore Buganda (1905-1920) to the Busoga and south-east districts.
  
  
  CONCLUSIONS
  Archival sleeping sickness distributions indicate the potential for a much wider area of disease risk than indicated by current disease foci. This is compounded by an absence of tsetse distribution data, continued political instability in north-central Uganda, continued spread of disease into new districts, and evidence of the role of livestock movements in spreading the parasite. These results support concerns as to the potential mergence of the two disease foci in the south-east and north-west of the country.
authors.affiliation: Department of Population Medicine, University of Guelph, Canada. LeaBerrang@hotmail.com
authors.forename: Lea
authors.initials: L
authors.lastname: Berrang-Ford
authors.forename: Martin
authors.initials: M
authors.lastname: Odiit
authors.forename: Faustin
authors.initials: F
authors.lastname: Maiso
authors.forename: David
authors.initials: D
authors.lastname: Waltner-Toews
authors.forename: John
authors.initials: J
authors.lastname: McDermott
mesh_terms: D000818:Animals; D019352:Censuses; D003710:Demography; D004196:Disease Outbreaks; D004199:Disease Vectors; D049673:History, 20th Century; D006801:Humans; D008499:Medical Records; D014347:Trypanosoma brucei gambiense; D014353:Trypanosomiasis, African / Q000453:epidemiology* / Q000266:history*; D014370:Tsetse Flies; D014454:Uganda / Q000453:epidemiology