Trypanosomiasis places a considerable burden on both human and animal health
across much of sub-Saharan Africa. Appreciation of the neglected burden of
trypanosomiasis led to a European Union funded programme called Farming in
Tsetse Controlled Areas (FITCA); within Uganda this programme put in place
measures to attempt the control of both animal and human trypanosomiasis.
This thesis begins by examining the history of trypanosomiasis control in Uganda
over the past century before exploring a contemporary control treatment programme
implemented in four districts of Uganda by FITCA in 2002. The impact of this
programme was monitored over the course of a year by the determination of
trypanosome prevalence in cattle using molecular diagnostic techniques (PCR) at a
number of sites in the treated districts of Uganda. In addition, incidence of sleeping
sickness in the human population before and after the intervention programme were
monitored by recording and analysing sleeping sickness cases reported to district
health centres. A spatial analytical framework was used to investigate disease
clustering on a year-by-year basis with reference to FITCA intervention sites.
Prior to the implementation of the control programme, the prevalence of
trypanosome infection in cattle across the study area was 16%; post-intervention,
trypanosome infection levels had fallen to 9%. In particular, post-intervention levels
of T. brucei s.l. dropped in all districts and overall the proportion of these infections
that were attributed to human infective T. b. rhodesiense reduced from 33% to less
than 10%. Analysis indicates that the cost per percentage decrease in the prevalence
of cattle trypanosomiasis achieved by the programme was US$2,193. Statistical and
spatial analysis observed no impact of the FITCA intervention on either the
incidence or distribution of reported sleeping sickness cases, although different
patterns were observed in epidemic and endemic areas.
Trypanosomiasis remains a neglected disease making it imperative that any resources
donated for its control are used wisely by employing optimal control strategies to
obtain maximum results at minimal cost. The efficacy of the FITCA Uganda
programme is discussed with reference to how the programme may be improved, and
whether cattle treatment represents the best long-term strategy for trypanosomiasis
control in Uganda.