Estimating the burden of rhodesiense sleeping sickness during an outbreak in Serere, eastern Uganda

BACKGROUND: Zoonotic sleeping sickness, or HAT (Human African Trypanosomiasis), caused by infection with Trypanosoma brucei rhodesiense, is an under-reported and neglected tropical disease. Previous assessments of the disease burden expressed as Disability-Adjusted Life Years (DALYs) for this infection have not distinguished T.b. rhodesiense from infection with the related, but clinically distinct Trypanosoma brucei gambiense form. T.b. rhodesiense occurs focally, and it is important to assess the burden at the scale at which resource-allocation decisions are made. METHODS: The burden of T.b. rhodesiense was estimated during an outbreak of HAT in Serere, Uganda. We identified the unique characteristics affecting the burden of rhodesiense HAT such as age, severity, level of under-reporting and duration of hospitalisation, and use field data and empirical estimates of these to model the burden imposed by this and other important diseases in this study population. While we modelled DALYs using standard methods, we also modelled uncertainty of our parameter estimates through a simulation approach. We distinguish between early and late stage HAT morbidity, and used disability weightings appropriate for the T.b. rhodesiense form of HAT. We also use a model of under-reporting of HAT to estimate the contribution of un-reported mortality to the overall disease burden in this community, and estimate the cost-effectiveness of hospital-based HAT control. RESULTS: Under-reporting accounts for 93% of the DALY estimate of rhodesiense HAT. The ratio of reported malaria cases to reported HAT cases in the same health unit was 133:1, however, the ratio of DALYs was 3:1. The age productive function curve had a close correspondence with the HAT case distribution, and HAT cases occupied more patient admission time in Serere during 1999 than all other infectious diseases other than malaria. The DALY estimate for HAT in Serere shows that the burden is much greater than might be expected from its relative incidence. Hospital based control in this setting appears to be highly cost-effective, highlighting the value of increasing coverage of therapy and reducing under-reporting. CONCLUSION: We show the utility of calculating DALYs for neglected diseases at the local decision making level, and emphasise the importance of improved reporting systems for acquiring a better understanding of the burden of neglected zoonotic diseases

Contribution of Nutrient Diversity and Food Perceptions to Food and Nutrition Security Among Smallholder Farming Households in Western Kenya: A Case Study

Background:Sub-Saharan Africa is the only region in the world where hunger is prevalent in over one-third of the population, with smallholder farming households, producers of over 80% of Africa’s food, facing both calorie and micronutrient deficiencies. With agricultural systems serving as the main source of all nutrients, little is known about the extent to which agricultural diversity in different seasons can meet macro- and micronutrient needs in rural Africa.Objective:Linkages between nutrient diversity and food species were investigated.Methods:A case study was conducted in Western Kenya to assess the seasonal nutrient diversity, seasonal nutrient accessibility levels, and food perceptions in 30 smallholder farms, 7 markets, and among 97 focus group discussion participants, respectively. All present food plant and animal species were inventoried and assigned to 1 of the 7 major Food and Agriculture Organization–defined food groups. Based on 2 macronutrients and 5 micronutrients, dendrogram-based nutrient functional diversity metrics were calculated.Results:On-farm and market food species offered all 7 macro- and micronutrients under investigation, regardless of seasonal variation in species numbers. Although there were varying seasonal nutrient accessibility levels in markets, farms were especially effective in readily availing 4 of the 7 nutrients. However, the main food shortage months coincided only with maize shortage, but a diversity of local foods, deemed to be of low cultural and culinary preferences, were available.Conclusions:Nutrition education on the importance of a diversity of local foods in meeting dietary needs, thus stimulating the demand side, can contribute to achieving year-round household food security