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Progressive control pathways (PCPs) are stepwise approaches for the reduction, elimination, and eradication of human and animal diseases. They provide systematic frameworks for planning and evaluating interventions. Here we outline a PCP for tsetse-transmitted animal trypanosomosis, the scourge of poor livestock keepers in tropical Africa. Initial PCP stages focus on the establishment of national coordination structures, engagement of stakeholders, development of technical capacities, data collection and management, and pilot field interventions. The intermediate stage aims at a sustainable and economically profitable reduction of disease burden, while higher stages target elimination. The mixed-record of success and failure in past efforts against African animal trypanosomosis (AAT) makes the development of this PCP a high priority.

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BackgroundAfrican animal trypanosomosis (AAT), or nagana, is widespread within the tsetse-infested belt of sub-Saharan Africa. Although a wealth of information on its occurrence and prevalence is available in the literature, synthesized and harmonized data at the regional and continental scales are lacking. To fill this gap the Food and Agriculture Organization of the United Nations (FAO) launched the Atlas of tsetse and AAT, jointly implemented with the International Atomic Energy Agency (IAEA) in the framework of the Programme Against African Trypanosomosis (PAAT).MethodsThe Atlas aims to build and regularly update a geospatial database of tsetse species occurrence and AAT at the continental level. The present paper focuses on the methodology to assemble a dynamic database of AAT, which hinges on herd-level prevalence data as estimated using various diagnostic techniques. A range of ancillary information items is also included (e.g. trypanosome species, survey period, species and breed of animals, husbandry system, etc.). Input data were initially identified through a literature review.ResultsPreliminary results are presented for Ethiopia, Kenya and Uganda in East Africa: 122 papers were identified and analyzed, which contained field data collected from January 1990 to December 2013. Information on AAT was extracted and recorded for 348 distinct geographic locations. The presented distribution maps exemplify the range of outputs that can be directly generated from the AAT database.ConclusionsActivities are ongoing to map the distribution of AAT in all affected countries and to develop the tsetse component of the Atlas. The presented methodology is also being transferred to partners in affected countries, with a view to developing capacity and strengthening data management, harmonization and sharing. In the future, geospatial modelling will enable predictions to be made within and beyond the range of AAT field observations. This variety of information layers will inform decisions on the most appropriate, site-specific strategies for intervention against AAT. Data on the occurrence of human-infective trypanosomes in non-human hosts will also provide valuable information for sleeping sickness control and elimination.

BackgroundTsetse fly-transmitted African animal trypanosomosis causes annual losses that run into billions of dollars. The disease is assumed to cause hunger and poverty in most sub-Saharan countries since it represents a serious impediment to sustainable livestock production. Both a cross-sectional and a longitudinal study were carried out from November to December 2007 to evaluate trypanosomosis risk and susceptibility of trypanosomes to trypanocidal drug treatment in village cattle populations in south-east Mali.MethodsEight purposively selected villages participated in the study. In each village, eight traps deployed along drainage lines over 24hour duration were used to catch tsetse. One hundred systematically selected cattle in the study villages were examined for trypanosomes. All trypanosome-positive cattle were randomly allocated into two treatment groups: a group treated with 0.5 mg/kg bw. isometamidium chloride (ISMM) and a group treated with 3.5 mg/kg bw. diminazene aceturate (DIM). The cattle were monitored for trypanosomes at day 14 and 28 post-treatment.ResultsOf the 796 cattle examined, 125 (15.7%) were trypanosome-positive. Village trypanosome prevalences ranged between 11% and 19%. There were no significant (p > 0.05) differences in the village trypanosome prevalences. Trypanosoma congolense was the dominant trypanosome species accounting for 73% (91/125) of the infections and T. vivax the remainder. Twenty (31.7%) of the 63 cattle on 0.5 mg/kg bw. ISMM treatment were still positive14 days post-treatment. Of the 43 aparasitaemic cattle monitored to day 28, 25.6% (11) became parasitaemic, resulting in a cumulative failure rate of 49.2% (31/63). Trypanosoma congolense accounted for 77.4% (24/31) of failed ISMM treatments. The 62 cattle treated with 3.5 mg/kg bw. DIM resulted in 30.6% (19/62) failed treatments. Although 42.2% (19/45) of T. congolense positive cattle did not respond to DIM treatment, all T. vivax positive cattle responded positively to DIM treatment.ConclusionsThe overreliance on trypanocides in the control of trypanosomosis will ultimately lead to multiple drug-resistant trypanosome populations as detected in villages in south-east Mali rendering the use of drugs doubtful. Effective alternative methods for trypanosomosis control ought to substitute chemotherapy to ensure sustainable cattle production in these villages. Since there is no single strategy for containing trypanocidal drug resistance, promotion of an integrated approach combining proven trypanosomosis control approaches in high trypanosomosis risk areas is most desirous. The best-bet strategy this study recommended for areas with multiple drug resistance included area-wide community tsetse control, control of co-infections to exploit self-cure against resistant trypanosome populations and the rational use of trypanocidal drugs which should be urgently promoted at all levels as a way of containing or reversing resistance.

Trypanocidal drugs are the most commonly purchased and used livestock input by resource-poor farmers in sub-Saharan Africa. The effective use of trypanocidal drugs by smallholder farmers is threatened by the development of widespread resistance. This is a particular concern for smallholder crop-livestock farmers in the cotton zone of West Africa. A recent project funded by the Germany Ministry for Economic Cooperation and Development (BMZ) confirmed significant resistance to trypanocidal drugs in villages with high trypanosomosis risk in Burkina Faso and Mali. Strategies for resistance prevention were investigated. Keeping trypanotolerant cattle was found to be an effective disease management strategy, but farmers' preference for trypano-susceptible breeds, for reasons unrelated to animal health, suggest that the intromission of zebu genotype will continue. Community vector control was found to be effective in managing trypanosomosis in the presence of resistance and the high-level participatory approach tested was found to be more sustainable than low-level approaches previously used in the region. This suggests that participatory vector control with appropriate external support is likely to be a viable option for implementing resistance 'clean-up'. Promoting rational drug use (RDU) emerged as a promising prevention strategy, with clear improvements in farmer knowledge, farmer practice and animal health outcomes. However, policy studies showed low understanding of the problem of resistance and the absence of an enabling environment for RDU. Engagement was initiated with actors involved in the problem of resistance and for its solution, including manufacturers, sellers and users of drugs, regulators and extension providers.

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