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Msc: CONTROL of INFECTIOUS DISEASES PROJECT REPORT MSc: CONTROL OF INFECTIOUS DISEASES PROJECT REPORT TITLE STRATEGIES FOR CONTROLLING MALARIA AND HUMAN AFRICAN TRYPANOSOMIASIS IN ANGOLA SUPERVISOR: PROFESSOR MICHAEL MILES CANDIDATE: 49 11 83 WORD COUNT: 9976 Submitted in part fulfilment of the requirements for the degree of MSc on Control of Infectious Diseases 1 of 73 ACKNOWLEDGEMENTS I would like to express my gratitude to almighty God for the ability to undertake a Masters Degree course on Control of Infectious Diseases, at the London School of Hygiene and Tropical Medicine. I would like to thank Professor Michael Miles, very much for giving me the opportunity to do this project and for sending me to the field, supervising this project and for all his support and guidance throughout the project. I would like also to thank Professor Schofield, Dr. Matthew Yeo from LSHTM for support and advice on the project, all lecturers, and seminar leaders and fellow students from LSHTM for encouragement and support. I am very grateful to the Ministry of Health in Angola Dr. Jose Van-dunem, Dr. Nilton Saraivo, D.r Filomena Forte, Professor Josenando Theophile, Dr. Kiasekoka Miguel, Dr. Vatunga, Dr. Amadeus, Dr. Morgado, Dr. Adao Castelo Antonio, Dr. Eduardo, Dra Marilia, Dr. Jose Samuel, Dra Maria Rita, Dr. Zinalda, Dr. Rafael, Dr. Nicolau Mfinda, Mr. Felix and health personnel of the national control programme of malaria in Angola and Instituto de Combate e Controlo de Trepanosomiases, Hospital Jorgina Machel, Clinica de Bom Deus, Hospital Geral de Benguela, Centro de Internamento e Investigacao de Doencas de Sono, director provincial de saude no Kuanza Sul for hosting me in fieldwork and encouraging me and assisting me to do interviews with health personnel and patients. Many thanks to my wife Dr. Lando Vita and my two sons Ebenezer Vita and Emmanuel Vita thanks to my father Filipe Luvumbo and Rosita Lubondo and my sister Tete, Nsimba, Lufua, and my uncle Dr. Domingos Vita for support. Thanks to Apostle Simao Lutumba and Mama Sofia for providing me a place to stay during the fieldwork in Angola. Many thanks to members of Southampton and London International Evangelical Church, for spiritual support in prayer. Thanks to all people who supported me directly or indirectly to do the course and this project. 2 of 73 ABBREVIATION ACT Artemisinin Combination Therapy ASDI Swedish Agency for International Development CATT Card Agglutination Test for Trypanosomiasis DNPM Direccao National Do Programa da Malaria DR Doctor DRC Democratic Republic of Congo EPCM Estratégico Plano de controle de malaria GDP Gross Domestic Product GFM Global Fund malaria HAT Human African trypanosomiasis IPTp Intermittent preventative therapy for pregnant IPTi Intermittent preventative therapy for infant IEC Information education communication IRS Indoor residual spraying ICCT Instituto de Combate e Controle de Tripanossomíase LAV Luta Anti Vetorial LLIN Long Lasting Insecticide Treated Net LSHTM London School of Hygiene and Tropical Medicine MDGs Millennium Development Goals MMCM Manual de Manejo de Casos de Malaria MCT Missão de Combate a Tripanossomíase MPLA Movimento Popular para libertação de Angola NCPM National Control Programme for Malaria NCP National Control Programme PNCM Programa Nacional de controle de Malaria PMI President‟s Malaria Initiative RBM Roll Back Malaria RCB Republic of Congo Brazzaville 3 of 73 SP Sulfadoxine-Pyrimethamine UNITA União Nacional para Independência Total de Angola UNICEF United Nations International Children Emergency Fund WHO World Health Organization 4 of 73 ABSTRACT This study is concerned with the strategy for controlling malaria and human African trypanosomiasis in Angola. Malaria results in the premature death of children under five years old and pregnant women in Angola. Malaria is classified as one of the major killing diseases in Angola with higher prevalence and incidence in the provinces of Luanda and Huambo. War in Angola was one of the principal factors that influenced the higher prevalence and incidence of malaria and human African trypanosomiasis. Morbidity and mortality of malaria and trypanosomiasis in Angola affected the economy of the country in decreasing the gross product domestic (GDP). Methods: Qualitative and quantitative method of systematic review to gather data for this project was used. Interviews and questionnaires with Angolan public health personnel and patients at the National Direction of Malaria and Instituto de Combate e Controle de Tripanosomiase, hospitals and visits to some endemic foci in Angola. Results: Malaria infects any one and both genders in Angola. The disease is distributed to all provinces. Prevalence and incidence of malaria is higher in the province of Huambo and Luanda. Auto medication and lack of completing therapy are problems associated with treatment. African trypanosomiasis is classified as a neglected disease. People were dying with disease without notification. Active men, women and children under three years old are more vulnerable to disease. Conclusion: Malaria and human African trypanosomiasis causes serious problems to public health. Active control of malaria and human African tripanosomiasis in Angola will help to decrease morbidity and mortality rate. Identifying people who are affected and treating them, controlling vectors by using LLIN, IRS, pulverization and capture of tsetse are effective strategies for controlling malaria and human African trypanosomiasis in Angola. 5 of 73 Contents ACKNOWLEDGEMENTS ...................................................................................................... 2 ABBREVIATION ...................................................................................................................... 3 ABSTRACT .............................................................................................................................. 5 List of Tables ............................................................................................................................ 8 List of Figures .......................................................................................................................... 9 1.0. INTRODUCTION ........................................................................................................ 10 1.1 MALARIA IN ANGOLA .......................................................................................... 11 1.2 INCUBATION PERIOD OF MALARIA ................................................................ 11 1.3 TRANSMISSION .................................................................................................... 11 1.4 CLINICAL PRESENTATION OF MALARIA ....................................................... 12 1.5 DIAGNOSIS OF MALARIA ................................................................................... 12 1.6 TREATMENT OF MALARIA ................................................................................. 12 1.7 STRATEGIES FOR CONTROLLING MALARIA IN ANGOLA ........................ 12 1.8 HUMAN AFRICAN TRYPANOSOMIASIS .......................................................... 15 1.9 CLINICAL MANIFESTATION ............................................................................... 16 1.10 DIAGNOSIS OF HUMAN AFRICAN TRYPANOSOMIASIS ........................ 16 1.11 TREATMENT ....................................................................................................... 16 1.12 CONTROL OF HUMAN AFRICAN TRIPANOSOMIASIS IN ANGOLA ..... 17 1.13 HISTORY OF TRYPANOSOMIASIS IN ANGOLA ........................................ 17 1.14 EPIDEMIOLOGICAL DATA............................................................................... 19 1.15 GENERAL DESCRIPTION OF ANGOLA ....................................................... 21 1.16 HISTORICAL PERSPECTIVE .......................................................................... 21 2.0. OVERAL AIM OF PROJECT:................................................................................... 22 2.1. SPECIFIC OBJECTIVES OF PROJECT ............................................................. 23 3.0. METHODS: ................................................................................................................. 24 3.1 INTRODUCTION .................................................................................................... 24 3.2 LITERATURE SEARCHES ................................................................................... 24 3.3 INCLUSION CRITERIA ......................................................................................... 25 3.4 EXCLUSION CRITERIA ........................................................................................ 25 3.5 INTERVIEWS AND QUESTIONNAIRES ........................................................... 25 3.6 VISIT TO ENDEMIC FOCI .................................................................................... 26 3.7 DATA ANALYSIS ................................................................................................... 26 3.8 ETHICAL CONSIDERATIONS ............................................................................. 26 4.0 RESULTS, OF LITERATURE REVIEWED IN ANGOLA ..................................... 27 4.2 MALARIA, RESULTS OF LITERATURE REVIEWED IN ANGOLA ............... 27 4.3 PREVALENCE AND INCIDENCE OF MALARIA IN ANGOLA ....................... 28 4.4 TREATMENT OF MALARIA IN ANGOLA .......................................................... 29 4.5 CONTROL OF MALARIA IN ANGOLA ............................................................... 30 4.6 HUMAN AFRICAN
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