CURRENT SITUATION OF AFRICAN TRYPANOSOMIASIS

African trypanosomiasis (sleeping sickness) is fatal, if untreated, an d occurs in 36 African countries, south of the Sahara, where some 50 m illion people are at risk of acquiring infection. In the absence of ad equate control measures epidemics occur, which are costly and difficul t to control. The history of sleeping sickness has been characterized by waves of epidemics, resurgences and outbreaks. Nevertheless, sleepi ng sickness has been brought practically under control in the early 19 50s, in West and Central Africa, through systematic surveillance of th e population at risk and in East Africa, mainly by vector control. Fol lowing the attainment of independence from colonial rule in subsequent years, failure by national health authorities to give due attention t o sleeping sickness control, due to civil and political unrest, lack o f adequate resources and competing national health priorities, has res ulted in epidemics and the recrudescence of many old foci and the appe arance of new ones. Thus, sleeping sickness is currently a major conce rn among many countries, particularly in East and Central Africa. Duri ng the past decade, progress has been achieved through research in the development of new tools for diagnosis, which are simple to use by na tional health personnel and for vector control, which can be used at t he community level. Eflornithine, a new drug, has been registered for the treatment of gambiense sleeping sickness, and although it is expen sive, it is relatively safe and provides an alternative therapy to the existing treatment, which may cause severe adverse effects. These too ls have raised hopes for improved control, but their integration into health care systems, which could improve surveillance of the populatio n at risk, has been slow. In view of the worsening economic situation of endemic countries, and the focus of attention and resources on the AIDS pandemic, prospects of any significant improvement in the sleepin g sickness situation would largely depend on the successful mobilizati on of external resources.