Sleeping Sickness eliminated in Ghana; Can Public Health Official lay down their tools?


The World Health Organization’s (WHO) Director General, Dr Tedros Adhanom Ghebreyesus, in a tweet, congratulated the Ghanaian government, health workers and communities for working tirelessly towards elimination of the Trypanosoma brucei gambiense which causes Human African Trypnosomiasis (also known as Sleeping Sickness), as a disease of public health concern in the country.

Sleeping sickness occurs only in equatorial Africa where tsetse flies, the disease vectors, live. It is one of the 20 Neglected Tropical Diseases (NTDs). Contrary to its literal meaning, the disease does not just cause extreme sleepiness; infected people develop fever, chills, headache, swollen lymph nodes, sometimes a rash, drowsiness , problems with walking, and, if untreated, coma and death.

There has been a dramatic decrease (> 95%, with fewer than 1,000 cases in 2018) in the number of reported cases of African sleeping sickness over the past 20 years as a result of control efforts, and the disease being targeted for eradication by the World Health Organization. Togo became the first West African country to eliminate the disease in 2020.

What does the elimination of the disease mean to public health officials? Can they lay down their tools and catch their breaths? Let’s delve into the disease control process to better understand our stance.

By 2005, WHO had conceived an innovative strategy to combat NTDs as a group of diseases, based on a combination of five public health interventions:

(i) innovative and intensified disease management;

(ii) large scale preventive treatment;

(iii) integrated vector management;

(iv) veterinary public health; and

(v) access to water, sanitation and hygiene

The former two are medical interventions, aimed at curing, easing or preventing acute or chronic disease, while the latter three are cross-sectoral targeted at the root causes of NTDs, i.e. poor living conditions and close proximity with animals and vectors. In principle, NTDs can be prevented, controlled, and even eliminated by an appropriate combination of these interventions, as long as appropriate tools and commodities are available.

Public health interventions in dealing with infectious diseases start from control, run through to elimination of disease and infection, eradication, and then to extinction.

Control refers to reduction of the number of new infections(incidence), the number of people currently infected(prevalence), and the number of people who become sick(morbidity) or die(mortality) from a disease to a locally acceptable level as a result of deliberate efforts. Continued intervention measures are required to maintain the reductionat this stage.

Elimination of disease or infections refers to reduction to zero transmission of a disease in a specific geographic area or country, but not worldwide. Continued intervention measures to prevent re-establishment of transmission are required.

Eradication refers to permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts. At this stage, interventionalmeasures are no longer needed. Example: smallpox.

Extinction refers to the specific infectious agent no longer existing in nature or in the laboratory.

Elimination and eradication programmes are the ultimate goals of public health with no room for failures, but they carry with them an enormous responsibility.

This tremendous feat Ghana has achieved through dedication and teamwork should renew our strengths in combating the remaining NTDs while preventing re-establishment of the already eliminated ones.

Written by: Aishah Fadila Adamu.

Edited by: Gloria Golda Akwa

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