Vers la maîtrise de l’endémie sommeilleuse dans le foyer de Nola-Bilolo en Centrafrique

Abstract

Sleeping sickness is more prevalent in three historical regions of Central African Republic. Control measures were organized by the colonial authorities through health services to fight against this disease and other major diseases. Multivariate analysis and the government helped in controlling the disease in the focus of Nola-Bilolo, which was formerly hyperendemic. The authors report the results of the control measures that resulted in the extinction of the disease in this outbreak. This is a retrospective study from 1991 to 2008, and the data were collected from the National Program to fight against human African trypanosomiasis in Bangui and in the diagnostic and treatment center of Nola. It was highly endemic, with more than 300 cases recorded in the year 1991. The average number of cases was 200.8 per year between 1992 and 1998. Less than 50 cases per year were recorded from 2000 to 2006, and no cases have been detected since 2007. 69.35% of the patients were actively screened. 5,000 conical deltamethrin-impregnated traps (Gouteux and Lancien) had been used in 15 districts in the city of Nola and 46 surrounding villages by 20 trappers fully supported by the program. This is an example of regular active mass screening. Systematic treatment of detected cases and well-conducted vector control measures give hope to the affected populations to live peacefully in order to contribute to the development of their country.

Epidemiological, Clinical and Evolutionary Aspects of Human African Trypanosomiasis in Children in Nola

“…The Central African Republic (CAR) has three historical outbreaks of HAT, including Nola, located in the south-west of the country, in the Sangha-Mbaéré prefecture [4]. Numerous epidemiological surveys carried out in this outbreak have shown that it has remained very active, often with epidemic outbreaks [4] [5] [6].…”

“…The Central African Republic (CAR) has three historical outbreaks of HAT, including Nola, located in the south-west of the country, in the Sangha-Mbaéré prefecture [4]. Numerous epidemiological surveys carried out in this outbreak have shown that it has remained very active, often with epidemic outbreaks [4] [5] [6]. Historical data on human African trypanosomiasis in CAR show that in 1945, the country had the sad record of 25,000 trypanosomiasis cases out of the 50,000 in French Equatorial Africa [7].…”

“…) active outbreaks of HAT, including Nola, located in the south-west of the country, in the isolated and landlocked prefecture of Sangha-Mbaéré, where access is difficult[4] [5]. The combined efforts of the National HAT Control Program, set up in 1990, the WHO and non-governmental organizations led to the stabilization of the HAT epidemic in the Nola outbreak in 2000.…”

“…The intensification of regular surveillance (active and passive screening, followed by treatment to reduce the parasite reservoir), the creation of outpatient treatment centers (Nola commune, Bilolo commune) and vector control using Gouteux-Lancien conical traps impregnated with the insecticide deltamethrin, carried out in endemic villages, broke the chain of transmission and brought the HAT endemic under control in the Nola and Bilolo foci[23] [24][25]. All these actions, coupled with epidemiological surveillance, resulted in the Nola and Bilolo outbreaks becoming inactive between 2007 and 2011, with no reported cases of HAT[4]. The evolution of the HAT epidemic between 1991 and 2008 in the Nola and Bilolo outbreak is shown in Figure3.An epidemiological survey carried out in 2015 after the socio-militaro-political crisis that shook CAR in 2013 noted a possible re-emergence of the Nola and Bilolo outbreak with an HAT incidence rate of 1.12%[9].…”