Insights into the Control and Management of Human and Bovine African Trypanosomiasis in Zambia between 2009 and 2019—A Review
2. Materials and Methods
- Work is done to evaluate and identify African trypanosomiasis control programmes that are cost effective and sustainable in the regions where they are applied.
- Data on biological characteristics of tsetse and seasonal differences in African trypanosomiasis infection risk be considered when developing tsetse and trypanosomiasis control programmes in Zambia.
- More robust field diagnostic procedures for African trypanosomiasis be developed that consider the environmental, capacity and infrastructure constraints of working in countries like Zambia.
- Line Ministries consider sharing resources in order to improve diagnosis and treatment of African trypanosomiasis and other zoonotic diseases.
- A One Health approach be considered for the control of African trypanosomiasis in humans, livestock, wildlife and tsetse flies.
Conflicts of Interest
|PCV||Packed Cell Volume|
|HAT||Human African Trypanosomiasis|
|PCR||Polymerase Chain Reaction;|
|LAMP||Loop Mediated Isothermal Amplification;|
|WBC||White Blood Cell;|
|GMA||Game Management Area;|
|CAT||Canine Animal Trypanosomiasis;|
|SRA||human Serum Resistance Associated;|
|RIME||Repetitive Insertion Mobile Element;|
|CON2-LAMP||specific primer targeting the 18Rrna gene of T. congolense; RHC, Rural Health Centre;|
|FAO||Food and Agriculture Organization RTTCP, Regional Tsetse and Trypanosomiasis Control Programme;|
|SAS/SAT||Sequential Aerial Spraying;|
|ITT||Insecticide Treated Targets and Traps;|
|PATTEC||Pan African Tsetse and Trypanosomiasis Eradication Campaign;|
|AAT||Animal African Trypanosomiasis;|
|ITC||Insecticide Treated Cattle|
|Author Year||Study Aim||Study Design||Sample and Participation||Study Findings||Needs Domain|
|(Simukoko et al., 2011|
|To assess the monthly risk of bovine trypanosomiasis in cattle kept in tsetse-infested eastern plateau of Zambia.||Longitudinal study of bovine trypanosomiasis incidence in cattle||Eighty-five herds of cattle that grazed together were selected for a 19-month follow-up study||-The risk of trypanosome infection varied significantly between months with the higher risk recorded between December and February.|
-PCVs of infected and un-infected cattle did not differ significantly
-Trypanosoma congolense and T. vivax were detected in 92.3% and 4.5% of the infected cattle, respectively. Mixed infections were detected in 3.2% of positive samples.
-Overall, 155 infections were detected using PCR while microscopy detected 85 infections.
|(Mwanakasale and Songolo, 2011)|
|-To identify districts in Zambia that were still reporting cases of Human African Trypanosomiasis (HAT).|
-To compare the occurrence of HAT cases before and after year 2000.
|-Cross sectional survey of districts located close to national parks.|
-Literature review of occurrence of HAT in Zambia in the 1960s to 1990s.
|-Conducted in nine provinces of Zambia except for Lusaka district.|
-Used google search, PubMed and world health organisation HINARI access to obtain data on HAT occurrence. Only articles with data on HAT distribution, epidemics, treatments and control of HAT before 2000 were reviewed.
|-Chama, Mpika and Chipata districts were still reporting HAT cases. Seven districts that used to report HAT no longer had cases after January 2000.|
-All surveyed districts had no existing tsetse control programs.
-In all surveyed health institutions, giemsa stain thick smear microscopy was the routine diagnostic method to detect HAT. Only Chilonga mission hospital used microhaematocrit centrifuge method to detect HAT.
-Six of the surveyed hospitals had stocks of suramin but none had melarsoprol.
-Findings from literature survey show a significant difference in HAT reporting foci from 1960s to 1990s and 2000 to 2007 with some old foci disappearing whilst new ones emerged or re-emerged
|(Anderson et al., 2011)|
|To characterise the nature of the reservoir community for trypanosomiasis in the absence of influence from domesticated hosts||A cross-sectional survey of trypanosome prevalence in wildlife hosts.|
Conducted in the Luangwa valley from 2005 to 2007
|A total of 418 wild animals were examined for the presence of trypanosomes||-Overall prevalence in all species was 13.9% with infection likely to be detected in waterbuck, lion, kudu and bushbuck, respectively.|
-Bushbuck indicated to be important hosts for T. brucei s.l with bushbuck, greater Kudu, and Lion to be important hosts for T. congolense while T. vivax was frequently detected in waterbuck.
-T. b. rhodesiense were first identified in African buffalo and T. brucei s.l in leopard
-First use multispecies PCR for the diagnosis of samples collected from free ranging wildlife which offers improved diagnostic specificity and sensitivity compared to traditional techniques.
-Results indicated the ability of trypanosomes to survive in a wide variety of wildlife hosts.
|(Namangala et al., 2012)|
|To evaluate the performance of repetitive insertion mobile element (RIME)– loop mediated isothermal amplification (LAMP) and human serum resistance associated (SRA)–LAMP against microscopy in HAT diagnosis||Case study||Four male patients from Luangwa and Zambezi river basins||-Both RIME-LAMP and SRA-LAMP were able to detect T. b. rhodesiense in patients’ blood and in cerebrospinal fluid (CSF).|
-LAMP results correlated with microscopy results but they do not confirm the standard staging criteria using microscopy and white blood cell (WBC) in CSF.
|(Namangala et al., 2013)|
|To evaluate the performance of LAMP against microscopy to detect CAT in exotic dogs||Cross sectional survey of trypanosomiasis in exotic dogs||Six exotic dogs naturally infected with trypanosomes from Zambia’s South Luangwa National Park and Chiawa GMA.||-Results indicated first report of canine animal trypanosomiasis (CAT) in Zambia|
-All cases initially diagnosed by microscopy and later confirmed by LAMP, showing good correlation between the two methods.
-Three dogs reported infection with T. congolense according to CON2-LAMP
-All SRA-LAMP positive cases were also RIME-LAMP positive indicating similar sensitivity.
|(Mwanakasale et al., 2013)|
|To assess current health delivery system in the management of HAT.||Cross sectional survey of health institutions using structured questionnaires||Nine health institutions from Mpika district of Zambia were involved in the study||-The general knowledge on HAT of health staff from surveyed health institutions was unsatisfactory for proper management of the disease|
-Study revealed gross understaffing of essential staff to clinically diagnose and manage HAT-No staff from the surveyed institutions had received specific training on HAT diagnosis and treatment.
-There was only one treatment centre (Chilonga mission hospital) from the surveyed health institutions
-Erratic supply of trypanocides at the only treatment centre in the district
-Only 2 of the surveyed institutions has functional laboratories with qualified personnel. Both institutions used less-sensitive methods to diagnose HAT
-Distances between rural health centres (RHCs) and treatment centres and non-availability of transport to ferry suspected HAT patients.
|(Lisulo et al., 2014)|
|To evaluate the performance of LAMP in determining trypanosome prevalence in indigenous dogs.||Cross sectional survey of Canine African Trypanosomiasis||A total of 237 indigenous dogs from 47 villages within five chiefdoms of Mambwe district of Zambia||-Fourteen cases of trypanosomes were detected using microscopy.|
-LAMP detected an additional 6 cases indicating higher sensitivity and specificity than microscopy.
-Adult dogs were more likely to acquire CAT as they are involved in hunting.
-CAT was significantly related to corneal opacity
-Dogs are potential links for trypanosome exchange between livestock and humans.
|(Nyimba et al., 2015)|
|To determine the prevalence and species distribution of caprine trypanosomiasis||Cross-sectional cluster survey of AAT in goats||Overall, 422 goats from Kalomo and Sinazongwe districts of Southern province of Zambia||-One goat was found infected on microscopy while 100 goats reported positive for AAT on LAMP. |
-Infection rate for Sinazongwe district was 22.4% while that for Kalomo district was 24.7%
-Trypanosoma brucei, T. vivax and T. congolense were detected in 82.0%, 31.0% and 23.0% of the infected goats, respectively. Mixed infections were detected in 33.0% of positive samples.
-Study results indicate the re-emergence of AAT in study areas were aerial spraying was once conducted by the government.
|(Laohasinnarong et al., 2015)|
|To examine the presence of different trypanosome species in cattle, goats and tsetse using a combination of microscopy, PCR and LAMP||Cross sectional survey of trypanosomes in cattle, goats and tsetse flies.||In total, 243 cattle, 36 goats and 546 tsetse flies were examined for the presence of trypanosomes. Study conducted from Petauke, Chama and Isoka districts of Zambia.||-Microscopy exhibited relatively low sensitivity than PCR and LAMP|
-There was poor agreement among test methods. For instance, failure of PCR and LAMP to detect microscopically positive samples.
-KIN PCR was found to be sensitive for detecting T. congolense
-TviCatL-PCR and PFL-LAMP were better for detecting T. Vivax and T. b. rhodesiense, respectively.
-The presence of T. b. rhodesiense in tsetse samples indicates its ability to take blood meal from multiple hosts (wildlife, humans and domestic animals), facilitating the circulation of the parasite in the ecosystem.
-Infection in cattle and goats was highest with T. congolense and least with T. vivax
|(Mulenga et al., 2015)|
|To investigate health personnel’s and health centre’s capacity to diagnose Human African trypanosomiasis||Cross sectional survey using structured questionnaires.||A sample of 101 health personnel drawn from 12 and nine health centres from Chama and Mambwe districts, respectively||-Staffing levels from both districts were extremely low with most health centres manned by one trained staff|
-Staff had basic knowledge to identify HAT with staff from Chama districts more likely to identify a case compared to their Mambwe counterparts.
-Only Chama district had functional laboratories. Most health centres surveyed reported frequent use of rapid test kits for diagnosing mainly malaria parasites thus reducing diagnosis of other blood parasites that can be detected by microscopy including HAT.
|(Mbewe et al., 2015b)|
|To examine how socio- economic and environmental factors are associated with adherence to the recommended guidelines on trypanocide use||Cross sectional survey using a structured questionnaire.||Farmers interviewed from five veterinary camps from Itezhi tezhi district of central province of Zambia||-Of the interviewed farmers, 25.6% adhered to FAO guidelines on trypanocide use; (i) reducing the number of treatments on|
whole herd up to a maximum of four times in a year by integrating drug usage with other control measures and (ii) avoiding exposure of the whole parasite population to the drug by limiting treatments to individual sick animals.
-None of the socio-economic factors (age, education, cattle herd size, competence in trypanocide use and access to extension on trypanocide use) were associated with a farmer’s adherence to FAO guidelines.
-Low adherence to recommended FAO guidelines on trypanocide use was associated with the location of crush pen, whether in GMA or not, as an environmental factor. Farmers in GMAs were less likely to adhere to FAO guidelines than those in non-GMA.
|(Mbewe et al., 2015a)|
|-To investigate the prevalence of animal trypanosomiasis in anaemic cattle||Cross sectional survey of AAT in cattle||A total of 564 Anaemic cattle from Itezhi tezhi district of Zambia||-Out of 564 cattle screened, 58 (10.3 %) had anaemia. PCR-RFLP results showed that 17 (29.3 %) anaemic cattle were positive for pathogenic trypanosomes compared to 1 (1.7 %) on parasitological examination using thick smears. |
-Infections were caused by Trypanosoma congolense and Trypanosoma vivax.
|(Grant et al., 2015)|
|-To examine the narratives on African trypanosomiasis in Zambian policy.|
-To explore relationships between human, animal and environmental sectors
|Case study of key informant interviews||Twenty participants from international organisations, research organisations and local activists.||-Environmentalists believed tsetse stop farmers encroaching protected areas thus keeping areas natural and wild.|
-Increased poverty because tsetse keeps farmers away from productive areas.
-The Zambian government has other diseases of priority other than African trypanosomiasis and does not have funds to keep areas tsetse free.
-Major focus of African trypanosomiasis control is emphasised on cattle and not humans.
-The need to undertake tsetse control using the best methods have been identified but with no financial resources to support the plan.
-Tsetse-infested forests that have been cleared for cotton growing have disrupted tsetse habitats due to chemicals used.
-Current conservation strategies have sustained the preservation of tsetse flies and African trypanosomiasis.
|(Mweempwa et al., 2015)|
|To establish the impact of habitat fragmentation on the physiological and demographic parameters of tsetse flies in order to enhance the understanding of the relationship between fragmentation and AAT risk||Longitudinal study of tsetse age, abundance and trypanosome infection in areas of varying degrees of habitat fragmentation in eastern Zambia.||-A set of 3200 Glossina morsitans morsitans were caught using black screen fly rounds.|
-Overall, 577 female tsetse flies were dissected for ovarian age estimation.
-A sentinel herd of 40 cattle was established at each of the four sites of Katete and Mambwe districts.
|-Results indicated a significant increase in tsetse age as fragmentation increased.|
-Tsetse density was lower in most fragmented areas whilst the proportion of female flies increased significantly as fragmentation reduced.
-AAT incidence in cattle was determined using buffy coat method. Infection rate in both cattle and tsetse flies was higher in highly fragmented areas.
|(Meyer et al., 2016)|
|A literature review of past and on-going tsetse and African trypanosomiasis programmes||Systematic literature review of tsetse and African trypanosomiasis programmes between 1980 and 2015||Five African countries including Zambia.|
68 documents plus 12 structured questionnaires reviewed.
|-Twenty-three major Tsetse and Trypanosomiasis control programmes recorded from the five countries. Three control programmes conducted in Zambia during the stated period include the following:|
- Insecticide treated targets and traps (ITT) + trypanocidal drugs (TRY) in western province under government services for tsetse elimination (1987–1989).
- Sequential aerial spraying (SAS) + ITT in eastern province under Regional Tsetse and Trypanosomiasis Control Programme (RTTCP) for tsetse control (1989–1994)
-SAS + ITT in Kwando Zambezi belt under Pan African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC) for tsetse elimination (2008 onwards)
|(Alderton et al., 2016)|
|To develop an agent-based model (ABM) for investigating Trypanosoma brucei rhodesiense||-Mixed methods||-ABM comprised of human/animal trypanosomiasis and tsetse ecological survey data obtained along the 75km transect in the Luangwa valley of Zambia.|
-Ethnicity, age and gender data were also incorporated.
|-ABM produced output that could not be readily generated by other techniques. On average there were 1.99 (S.E. 0.245) human infections and 1.83 (S.E. 0.183) cattle infections per 6-month period. |
-The model output identified that the approximate incidence rate (per 1000 person-years) was lower amongst cattle owning households (0.079, S.E. 0.017), than those without cattle (0.134, S.E. 0.017).
- Immigrant tribes (e.g., Bemba I.R. = 0.353, S.E.0.155) and school-age children (e.g., 5–10-year-old I.R. = 0.239, S.E. 0.041) were the most at-risk for acquiring infection.
|(Holt et al., 2016)|
|To assess AAT vulnerability in cattle owing communities||Cross sectional survey of cattle owners using questionnaire interviews.||210 households from Lundazi and Mambwe districts of Zambia||-AAT was constant with seasonal pattern, some trypano-tolerant breeds and communal grazing, small/moderate herd size with crops and mixing farming as primary income source, losses to draft reported, slightly higher mortalities and moderate costs diagnosing and treating, less likely to report treatment failure, low/good knowledge of control and tsetse traps/targets reported.|
-moderate AAT challenge, some concerns with resistance reported and most likely to keep pigs while some keep sheep and goats.
|(Meyer et al., 2018)|
|To propose a framework for conducting a cost benefit analysis of possible AAT control analysis||A literature review of AAT of cattle production, herd management, impact of AAT on productivity, incidence and mortality||Two districts from Cameroon and Zambia (Mambwe district)||-For Zambia, the 10-year impact of tsetse elimination on the net value of cattle production was calculated as benefit–cost ratios using a discount rate of 5% and indicated the following:-2.3 (1.8–2.7) Targets, insecticide treated cattle (ITC) barrier|
-2.0 (1.6–2.4) Targets, barrier traps
-2.8 (2.3–3.3) Aerial spraying, ITC barrier
-2.5 (2.0–2.9) Aerial spraying, barrier trap
-The use of SAT as elimination method for Mambwe district yielded a higher benefit–cost ratio than the use of targets.
-The model estimated the total discounted control costs at 3.8 million USD and benefits at 10.5 million USD for Mambwe district if SAT was used as tsetse elimination method
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Mulenga, G.M.; Henning, L.; Chilongo, K.; Mubamba, C.; Namangala, B.; Gummow, B. Insights into the Control and Management of Human and Bovine African Trypanosomiasis in Zambia between 2009 and 2019—A Review. Trop. Med. Infect. Dis. 2020, 5, 115. https://doi.org/10.3390/tropicalmed5030115
Mulenga GM, Henning L, Chilongo K, Mubamba C, Namangala B, Gummow B. Insights into the Control and Management of Human and Bovine African Trypanosomiasis in Zambia between 2009 and 2019—A Review. Tropical Medicine and Infectious Disease. 2020; 5(3):115. https://doi.org/10.3390/tropicalmed5030115Chicago/Turabian Style
Mulenga, Gloria M., Lars Henning, Kalinga Chilongo, Chrisborn Mubamba, Boniface Namangala, and Bruce Gummow. 2020. "Insights into the Control and Management of Human and Bovine African Trypanosomiasis in Zambia between 2009 and 2019—A Review" Tropical Medicine and Infectious Disease 5, no. 3: 115. https://doi.org/10.3390/tropicalmed5030115