Sleeping sickness (Human African Trypanosomiasis, HAT) is caused by Trypanosoma brucei, a protozoan parasite transmitted by the bite of the tsetse fly. The disease is found over vast areas of sub-Saharan Africa, and exists in two clinical forms: a more acute and a more chronic form. After an onset with fever and general malaise the disease is characterised by endocrine and neurological disturbances which ultimately lead to death without appropriate treatment. A 1st stage with parasites in the blood & lymph system leads to a 2nd stage with infection of the brain.
The treatment of the 2nd stage depends on the arsenic drug “Melarsoprol”, for refractory cases eflornithine is being used. Therapy with both drugs is lengthy (10 to 30 days) and complicated, and severe adverse events as well as relapses occur quite frequently. The patients have to be hospitalised for treatment and are usually accompanied by relatives for the complete time of treatment.
Epidemiological situation. By the 1960’s, the disease had been brought under control, but since 1985 the situation has deteriorated and the disease has reappeared, with major outbreaks in countries which have not maintained surveillance activities, due mostly to lack of funds or war-situations. By the year 2000, the numbers in Africa reached the level of the 1930s, however, a further increase did not take place, and today the numbers show a trend to decrease again. Today 4 countries show epidemic situations and harbour the majority of the cases: Angola, DR Congo, South Sudan and Uganda. The prevalence of HAT is estimated at 300’000 to 400’000 patients with a mortality of approximately 50’000/year.
Founding of EANETT. At the time of the “East African Community” (1967-1977) a network for research and control of sleeping sickness between Kenya, Uganda and Tanzania existed and contributed substantially to the prevention and control of trypanosomiasis. The collapse of this ‘East African Community’ in the late 70s terminated this co-operation. Under the pressure of a growing flaring up of sleeping sickness, Uganda, Kenya and Tanzania began to co-ordinate its sleeping sickness activities especially along their borders. The STI had bilateral research collaborations with the three above mentioned countries and with Sudan. On request of the national institutes for HAT control of the 4 countries, the STI submitted to SDC the project for an Eastern Africa Network for Trypanosomiasis (EANETT) which was founded in November 1999. SDC core funding started in 2001 and was granted for 6 years (phase I and phase II).
Activities during phase I and II, effects and impact.
The goal of EANETT is to strengthen collaboration in research, training, prevention and control of Human African Trypanosomiasis to reduce mortality, morbidity and the risk of infection and thus contribute to reduce poverty.
The objectives for the past 6 years were:
· To establish a functional network for sleeping sickness research, control
· To assess the prevalence of sleeping sickness and the risk of overlap of the two disease forms
· To study the distribution and nature of drug resistant trypanosomes
· To carry out training activities for national capacity building and individual career development
· To extend the network to neighbouring countries in East Africa
· To build up an information network and transfer research results to the end users
In the first year management structures were established (Board of Management, secretariat) and information and communication was improved. Collaborative research was initiated in 3 areas of high priority: 1) surveillance of HAT and its vectors using GIS, 2) treatment failures with melarsoprol (drug resistance), and 3) the risk of spread and overlap of the two disease forms in Uganda and Tanzania. Technology transfer was done through 4 workshops for young scientists/students and individual training as required. Capacity building supported 2 MSc and 6 PhD programmes (finished or still in progress). Each year an Annual Conference for auto-evaluation and planning was held. The last conference took place in 2005 in Mombasa attended by 45 participants from 10 countries with 29 oral presentations. In 2004 the conference was held in Khartoum with 50 participants giving 27 presentations. In 2005 Malawi became a new member country.
Collaboration could be established with WHO (support of surveillance and training), the TDR programme of WHO and with MSF France (field work in South Sudan), the EU FITCA programme, the Drugs for Neglected Diseases initiative (DNDi) and also with the University Innsbruck, Austria; Johns Hopkins University, USA; Obihiro University, Hokkaido, Japan. Co-opted members were incorporated to complement the available expertise in the network. Co-opted members are S. Aksoy, Yale University, USA; P. Büscher, Institute of Tropical Medicine, Antwerp; A. Tami, Tropical Institute, Amsterdam.
Could the objectives be reached?
EANETT as a functional regional network has an excellent reputation in Africa and beyond. Links were established with international organizations (WHO, TDR, DNDi, FIND) but also with research groups in Europe and the US. Links also exist to the Gates Foundation through the diamidine drug development consortium (University of North Carolina and STI). In this context EANETT would be an ideal platform for clinical trials.
The expansion of the network was done very carefully, Malawi was incorporated as a new member country and links to Zambia were also established.
The research related objectives could only partially be reached. They were very ambitious and the lack of full funding for the research projects was slowing down progress. Assessing the prevalence of the disease is a continuous process which never comes to an end. The elucidation of the nature of melarsoprol resistance turned out to be more complex than expected. In training and capacity building many activities were initiated and successfully brought to an end. Workshops, annual conferences, individual training and MSc and PhD programmes were the highlight of the EANETT activities. Transfer of research results was achieved through our Annual Conference and other international conferences e.g. the biennial conference of the International Scientific Council for Trypanosomiasis Research and Control, but also through the link to WHO and their HAT sentinel activities.
