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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. |
