Detecting sleeping sickness: a comparison between the efficacy of mobile teams and community health workers

The solution to the problem of human African trypanosomiasis (HAT) first of all requires improved case detection. Effective tests have been available for a number of years but the results of medical surveys are still mediocre , mainly because the populations are poorly mobilized. Those few mobile tea ms still visiting villages obtain very low presentation rates. In spite of major information campaigns among villagers, in Cote d'lvoire the Institut Pierre Richet (IPR) and Trypanosomiasis Clinical Research Project (PRCT) te ams examined only 42% (9311) of the 22 300 inhabitants of a disease focus d uring a conventional ten-day survey. In the same focus, community health wo rkers specially trained in sleeping sickness and in the collection of blood samples on filter-paper examined 73% of the population (15000 individuals) in less than two months. Implementation of a sleeping sickness control strategy is restricted to two types of intervention: either conventional mobile teams which are on hand, competent and rapidly operational but which fail to carry out exhaustive c ase detection, or integration of case detection into primary health care by entrusting surveillance to the community health workers. This approach req uires a minimum of training but ensures that sentinels are permanently pres ent in the village communities. By using the community health workers rathe r than mobile teams it should be possible to achieve comprehensive monitori ng. In operational terms, the cost of surveillance per person is US$ 0.55 for t he mobile teams as against US$ 0.10 for the community health workers. Integration of HAT case detection into primary health care is therefore an effective and economical solution, provided the community health workers ar e properly supervised and above all motivated.