Quantifying the Burden of Rhodesiense Sleeping Sickness in Urambo District, Tanzania

Abstract

BackgroundHuman African trypanosomiasis is a severely neglected vector-borne disease that is always fatal if untreated. In Tanzania it is highly focalised and of major socio-economic and public health importance in affected communities.ObjectivesThis study aimed to estimate the public health burden of rhodesiense HAT in terms of DALYs and financial costs in a highly disease endemic area of Tanzania using hospital records.Materials and MethodsData was obtained from 143 patients admitted in 2004 for treatment for HAT at Kaliua Health Centre, Urambo District. The direct medical and other indirect costs incurred by individual patients and by the health services were calculated. DALYs were estimated using methods recommended by the Global Burden of Disease Project as well as those used in previous rhodesiense HAT estimates assuming HAT under reporting of 45%, a figure specific for Tanzania.ResultsThe DALY estimate for HAT in Urambo District with and without age-weighting were 215.7 (95% CI: 155.3–287.5) and 281.6 (95% CI: 209.1–362.6) respectively. When 45% under-reporting was included, the results were 622.5 (95% CI: 155.3–1098.9) and 978.9 (95% CI: 201.1–1870.8) respectively. The costs of treating 143 patients in terms of admission costs, diagnosis, hospitalization and sleeping sickness drugs were estimated at US$ 15,514, of which patients themselves paid US$ 3,673 and the health services US$ 11,841. The burden in terms of indirect non-medical costs for the 143 patients was estimated at US$ 9,781.ConclusionsThis study shows that HAT imposes a considerable burden on affected rural communities in Tanzania and stresses the urgent need for location- and disease-specific burden estimates tailored to particular rural settings in countries like Tanzania where a considerable number of infectious diseases are prevalent and, due to their focal nature, are often concentrated in certain locations where they impose an especially high burden.

APOL1 Genotype, Kidney and Cardiovascular Disease, and Death in Older Adults

“…21 As a consequence, T. brucei infection poses a serious burden to individuals at or below child-bearing age in Africa. 22 …”

Assessment of the burden of human African trypanosomiasis by rapid participatory appraisal in three high-risk villages in Urambo District, Northwest Tanzania

“…For HAT in Urambo District the DALYs (age adjusted and accounting for 45% underreporting) were calculated to be 978.9 8 -a metric which says little about the lived experience of the disease in high risk-communities and among affected individuals. Qualitative approaches can allow for a more complete understanding of the impact of a disease in the community, and the complexities involved in controlling the disease and improving patient outcomes.…”

Trypanosome transmission dynamics in tsetse

“…Regretfully, a steep rise in disease incidence occurred during the following 40 years. Estimating the true burden of HAT is difficult, as the disease afflicts the poorest and most neglected populations that live in remote and rural settings located beyond the reach of health care systems [9]. In 2008, mortality associated with HAT ranked ninth out of 25 among human infectious and parasitic diseases in Africa [10].…”