Limits...
Civil conflict and sleeping sickness in Africa in general and Uganda in particular.

Berrang Ford L - Confl Health (2007)

Bottom Line: Conflict and war have long been recognized as determinants of infectious disease risk.In Uganda, there is evidence of increasing spread and establishment of new foci in central districts.Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Medicine, University of Guelph, Canada. LeaBerrang@hotmail.com

ABSTRACT
Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives.

No MeSH data available.


Related in: MedlinePlus

Sleeping sickness epidemics and major political events in Uganda, 1905–2000. Cases from 1936 onwards include south-eastern Uganda only. Sources: Sleeping sickness data 1905–36 deaths [62], 1925–36 cases [62], 1937–58 cases [63], 1960–71 cases (Unpublished report, 1992, Mbulamberi, D. B. The sleeping sickness situation in Uganda: past and present. National Sleeping Sickness Control Program, Jinja, Uganda), 1972–75 cases [54], and 1976–2001 cases (Ministry of Health, Uganda); Political time-series [56, 64, 65].
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Figure 2: Sleeping sickness epidemics and major political events in Uganda, 1905–2000. Cases from 1936 onwards include south-eastern Uganda only. Sources: Sleeping sickness data 1905–36 deaths [62], 1925–36 cases [62], 1937–58 cases [63], 1960–71 cases (Unpublished report, 1992, Mbulamberi, D. B. The sleeping sickness situation in Uganda: past and present. National Sleeping Sickness Control Program, Jinja, Uganda), 1972–75 cases [54], and 1976–2001 cases (Ministry of Health, Uganda); Political time-series [56, 64, 65].

Mentions: Figure 2 shows a time-line of sleeping sickness incidence in south-eastern Uganda between 1900 and 2000. As seen in this figure, the epidemic of 1900–1920 coincides with establishment of colonial rule in Uganda, while the 1940–1946 epidemic coincides with World War II. There has been extensive discussion of the role of colonial governance in the 1900–1920 sleeping sickness outbreak [11,21,27,48-51]. The more recent T. b. rhodesiense epidemic in 1976–1990s coincided with political instability and civil war during and after the rule of Idi Amin [24]. Uganda's civil war influenced the transmission potential of sleeping sickness in a number of ways, including: breakdown of veterinary and public health services (↑1/r) [52-54]; collapse of vector control (↑m, ↑1/u); regrowth of bushy tsetse habitat in abandoned agricultural fields (↑m) [19,52]; increasing displacement of human and animal populations into marginal or swampy areas where they are more likely to be bitten by flies (↑α) [52]; In Uganda, internally displaced people (IDP) fled areas of intense conflict, particularly in the 'Luwero Triangle' region (Figure 1), an area in south-central Uganda where much of the conflict and violence was concentrated [55,56]. Refugees and IDPs returning home after the conflict faced increased risk due to the vegetation and new tsetse habitat that had grown during their absence (↑m, ↑α). These processes directly affected a number of parameters in the sleeping sickness transmission model (m, α, 1/u, 1/r), increasing the transmission potential of the disease (R0). The R0 value increased via these processes over several years (resulting in a time lag between the peak in civil conflict and the outbreak peak) before exceeding the threshold required for an outbreak.


Civil conflict and sleeping sickness in Africa in general and Uganda in particular.

Berrang Ford L - Confl Health (2007)

Sleeping sickness epidemics and major political events in Uganda, 1905–2000. Cases from 1936 onwards include south-eastern Uganda only. Sources: Sleeping sickness data 1905–36 deaths [62], 1925–36 cases [62], 1937–58 cases [63], 1960–71 cases (Unpublished report, 1992, Mbulamberi, D. B. The sleeping sickness situation in Uganda: past and present. National Sleeping Sickness Control Program, Jinja, Uganda), 1972–75 cases [54], and 1976–2001 cases (Ministry of Health, Uganda); Political time-series [56, 64, 65].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1851948&req=5

Figure 2: Sleeping sickness epidemics and major political events in Uganda, 1905–2000. Cases from 1936 onwards include south-eastern Uganda only. Sources: Sleeping sickness data 1905–36 deaths [62], 1925–36 cases [62], 1937–58 cases [63], 1960–71 cases (Unpublished report, 1992, Mbulamberi, D. B. The sleeping sickness situation in Uganda: past and present. National Sleeping Sickness Control Program, Jinja, Uganda), 1972–75 cases [54], and 1976–2001 cases (Ministry of Health, Uganda); Political time-series [56, 64, 65].
Mentions: Figure 2 shows a time-line of sleeping sickness incidence in south-eastern Uganda between 1900 and 2000. As seen in this figure, the epidemic of 1900–1920 coincides with establishment of colonial rule in Uganda, while the 1940–1946 epidemic coincides with World War II. There has been extensive discussion of the role of colonial governance in the 1900–1920 sleeping sickness outbreak [11,21,27,48-51]. The more recent T. b. rhodesiense epidemic in 1976–1990s coincided with political instability and civil war during and after the rule of Idi Amin [24]. Uganda's civil war influenced the transmission potential of sleeping sickness in a number of ways, including: breakdown of veterinary and public health services (↑1/r) [52-54]; collapse of vector control (↑m, ↑1/u); regrowth of bushy tsetse habitat in abandoned agricultural fields (↑m) [19,52]; increasing displacement of human and animal populations into marginal or swampy areas where they are more likely to be bitten by flies (↑α) [52]; In Uganda, internally displaced people (IDP) fled areas of intense conflict, particularly in the 'Luwero Triangle' region (Figure 1), an area in south-central Uganda where much of the conflict and violence was concentrated [55,56]. Refugees and IDPs returning home after the conflict faced increased risk due to the vegetation and new tsetse habitat that had grown during their absence (↑m, ↑α). These processes directly affected a number of parameters in the sleeping sickness transmission model (m, α, 1/u, 1/r), increasing the transmission potential of the disease (R0). The R0 value increased via these processes over several years (resulting in a time lag between the peak in civil conflict and the outbreak peak) before exceeding the threshold required for an outbreak.

Bottom Line: Conflict and war have long been recognized as determinants of infectious disease risk.In Uganda, there is evidence of increasing spread and establishment of new foci in central districts.Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Medicine, University of Guelph, Canada. LeaBerrang@hotmail.com

ABSTRACT
Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives.

No MeSH data available.


Related in: MedlinePlus