title: Challenges of controlling sleeping sickness in areas of violent conflict: experience in the Democratic Republic of Congo.
abstract: BACKGROUND
  Human African trypanosomiasis (HAT), or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC), which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT.
  
  
  CONCLUSIONS
  In 2007, Médecins Sans Frontières (MSF) began screening for HAT in the Haut-Uélé and Bas-Uélé districts of Orientale Province in northeastern DRC, an area of high prevalence affected by armed conflict. Through early 2009, HAT prevalence rate of 3.4% was found, reaching 10% in some villages. More than 46,000 patients were screened and 1,570 treated for HAT during this time. In March 2009, two treatment centres were forced to close due to insecurity, disrupting patient treatment, follow-up, and transmission-control efforts. One project was reopened in December 2009 when the security situation improved, and another in late 2010 based on concerns that population displacement might reactivate historic foci. In all of 2010, 770 patients were treated at these sites, despite a limited geographical range of action for the mobile teams.
  
  
  CONCLUSIONS
  In conflict settings where HAT is prevalent, targeted medical interventions are needed to provide care to the patients caught in these areas. Strategies of integrating care into existing health systems may be unfeasible since such infrastructure is often absent in resource-poor contexts. HAT care in conflict areas must balance logistical and medical capacity with security considerations, and community networks and international-response coordination should be maintained. Research and development for less complicated, field-adapted tools for diagnosis and treatment, and international support for funding and program implementation, are urgently needed to facilitate HAT control in these remote and insecure areas.
authors: Médecins Sans Frontières, Rue de Lausanne 78, 1211 Geneva, Switzerland. jacquitong@yahoo.co.uk.
authors: Jacqueline
authors: J
authors: Tong
authors: Olaf
authors: O
authors: Valverde
authors: Claude
authors: C
authors: Mahoudeau
authors: Oliver
authors: O
authors: Yun
authors: François
authors: F
authors: Chappuis
references: PLoS Negl Trop Dis. 2008;2(12):e303
references: 19104656
references: Lancet. 2009 Jul 4;374(9683):56-64
references: 19559476
references: J Infect Dis. 2010 Feb 1;201(3):453-63
references: 20047500
references: Confl Health. 2007 Mar 29;1:6
references: 17411421
references: Int J Health Geogr. 2010 Nov 01;9:57
references: 21040555
references: PLoS Negl Trop Dis. 2010 May 25;4(5):e720
references: 20520803
references: PLoS Med. 2008 Feb;5(2):e55
references: 18303943
references: Emerg Infect Dis. 2010 Feb;16(2):354-6
references: 20113585
references: PLoS Negl Trop Dis. 2011 Feb 22;5(2):e1007
references: 21364972
references: Lancet. 2004 Nov 13-19;364(9447):1801-13
references: 15541455
references: Disasters. 2003 Jun;27(2):141-53
references: 12825437
references: Soc Sci Med. 2011 Feb;72(3):398-407
references: 20619948
references: Wkly Epidemiol Rec. 2006 Feb 24;81(8):71-80
references: 16673459
references: MMWR Morb Mortal Wkly Rep. 2003 May 23;52(20):469-71
references: 12807080
references: Lancet. 2006 Jan 7;367(9504):44-51
references: 16399152
references: Parasit Vectors. 2008 Feb 12;1(1):3
references: 18275594
references: PLoS Negl Trop Dis. 2010 Dec 21;4(12):e923
references: 21200426
references: Parasitology. 2009 Dec;136(14):1943-9
references: 19691861