Factors influencing passive surveillance for T. b. rhodesiense human african trypanosomiasis in Uganda

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• 作者：Christine Acup^a ; Kevin Louis Bardosh^a ; Kim Picozzi^a ; Charles Waiswa^b ; ^c ; Susan Christina Welburn^a ; ^{sue.welburn@ed.ac.uk}
• 关键词：Human african trypanosomiasis ; HAT ; Sleeping sickness ; Tyrpanosoma brucei rhodesiense ; Trypanosoma brucei gambiense ; Health systems ; Diagnostic capacity ; Surveillance ; Uganda ; Under-reporting
• 刊名：Acta Tropica
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：165
• 期：Complete
• 页码：230-239
• 全文大小：1796 K
• 卷排序：165

文摘

The district health system is expected to provide passive surveillance for HAT in Uganda with HC-II and III facilities signposting suspected patients to HC-IV HAT treatment centres. Essential knowledge for signposting HAT cases, as regards the causative agent, clinical signs and the knowledge that HAT drugs are provided free of charge was lower amongst HC-II than HC-III staff. Most medical staff in HC-II and HC-III facilities has been made aware of HAT from radio broadcasts, newspapers and by word of mouth indicating a lack of formal training at this level. While the majority of respondents in HC-III (96%) had heard of HAT, 24% could not identify any signs or symptoms of HAT and 39% were not confident to make a diagnosis. Within HC-II 70% of respondents were aware of HAT but 24% did not know the clinical signs and 51% were not confident to make a diagnosis. Many respondents did not know whether HAT was endemic in their district. Within specialist rHAT specialist treatment centres for rHAT at HC-IV/hospital level staff were knowledgeable and confident in their ability to diagnose and manage cases. Between 2009–2012, 342 people were diagnosed with rHAT with over half (54%) identified in late stage disease where parasites had migrated to the central nervous system (CNS). Over this period an increasing proportion of cases were identified only at late stage, suggestive of a major delay in patient identification for referral and diagnosis that urgently needs to be addressed.