Human African Trypanosomiasis

Home , Golungo Alto, Malanje, Ombessa, Soyo

Draft document under revision

Disease distribution and population at risk

World Health Organisation

Control of Neglected Tropical Diseases Innovative and Intensified Disease Management Human African Trypanosomiasis Surveillance and Control Programme

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006 ANGOLA AO

Estimated total population for mid 20061 15, 800,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf ■ Estimated population at risk for sleeping sickness2, 3 3,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

Sleeping sickness affected areas (update ongoing) Last case reported prior to 2000. Area updated Last case reported prior to 2000. Area not updated Last case reported after to 2000. Area updated Last case reported after to 2000. Area not updated

■ Capital: Luanda

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Soyo 11. Bengo 2. Noquia 12. Banga 3. M’banza-Kongo 13. Luinga 4. Béu 14. Golungo-Alto 5. Quimbele 15. Samba-Caju 6. Alto-zaza 16. Lukala 7. Bembe 17. Cambambe 8. Bungo 18. Malange 9. Uige 19. Cuando-Cubango 10. Luanda

Present situation4 4 Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in seven provinces in the north Angola reported cases 1995-2005 and the 10 years tendency curve east, namely Bengo, Kuanza-Norte, Kuanza-Sud, Luanda, Malanje, Uige and Zaire. The Instituto de Combate e 9000 Controlo das Tripanossomiases (ICCT) is leading and 8000 coordinating all control activities in collaboration with 7000 MSF, Caritas, Instituto Portugues de Medicina Preventiva, 6000 Fundanga and projects of the Belgian and French bilateral

5000 co-operation. The ICCT receives an important financial support from 4000

New Cases New the Angolan Government and has managed to establish 3000 13 mobile teams. This, however, remains insufficient in 2000 the light of the geographical extent and population size 1000 of the endemic areas. Staff presently involved in control 0 operations is well trained and highly dedicated.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

BENIN BJ

Estimated total population for mid 20061 8,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 3,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Porto Novo

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Atacora 2. Donga

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Benin cases 1995-2005 and 10 years tendency curve Cases were sporadically diagnosed in the Département of Atakora and Donga. The SSNCP, funded by the 90 Government under the national health regular budget, is 80 able to perform control activities in the endemic areas. The 70 last case finding survey was performed in May 2004 during 60 which no case was detected. 50

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

BOTSWANA BW

Estimated total population for mid 20061 1,800,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 Undetermined (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Gaborone

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Ngamiland 2. Chobe

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

In the past, transmission took place in the Okawongo Delta. However, trypanosomiasis cases have not been reported from that area for decades and it is believed that transmission no longer occurs. A large tsetse fly control programme has been implemented for many years in this area. The country has excellent health structures but no specific HAT surveillance system, for which there is apparently no need.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME

BURKINA FASO BF

Estimated total population for mid 20061 XXXXXXX 1 Population Reference Bureau – 2006 population data sheet.pdf http://www.prb.org/pdf06/06World DataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 3,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Ouagadougou

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Ouahigouya 9. Koudougou 2. Ouagadougou 10. Sissili 3. Zorgho 11. Pô-Zabré 4. Manga 12. Boulougou 5. Tapoa 13. Bobo-Dioulasso 6. Kenedougou 14. Banfora 7. Kossi 15. Diébougou 8. Dedougou 16. Poni

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update.Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Burkina Faso cases 1995-2005 It is uncertain if transmission is presently occurring in the south and 10 years tendency curve and south east where all recent cases have been identified among returning migrants workers from Côte d’Ivoire. Interruption of 16 local of transmission is supported by the fact that last survey in 14 the area, carried out in February 2005, did not diagnose any

12 autochthonous case. The SSNCP is integrated in the Division of Disease Control and has no logistic means to implement control 10 operations on its own but borrows equipment and field staff from 8 others projects to perform field surveys. 6

2 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

BURUNDI BI

Estimated total population for mid 20061 7,800,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 5,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Bujumbura

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Bweru-north

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

Transmission previously occurred in north-east Burundi. Constant monitoring during 1979–1980 did not disclose any new trypanosomiasis cases. There is no specific structure for HAT surveillance in the country.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Updated November 2006

CAMEROON CM

Estimated total population for mid 20061 16,380,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 1,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ ■ Capital: Yaounde

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Mamfé 6. Yokadouma 2. Fontem-Sanchou 7. Wouri 3. Bafia-Bokito-Ombessa 8. Bipindi 4. Akonolinga-Ayos 9. Campo 5. Doumé

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in the Région du Sud which Cameroon reported cases 1990-2005 and the 10 years exponential tendency curve includes Bipindi and Campo foci, in the Région du Sud- Ouest, Fontem and Manfé foci and in the Région de 60 l’Est, the Doumé focus. The Sleeping Sickness National Control Programme (SSNCP) is integrated in the 50 Division of Disease Control of the Ministry of Health. It

40 is under-equipped and under-staffed having to borrow the equipment and the personnel from other projects to 30 perform any control activities. The Organisation de

New cases New Coordination pour la lutte contre les Endémies en 20 Afrique Centrale (OCEAC) provides some assistance to

10 implement active surveillance. No active case finding took place in 2005. 0

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

CENTRAL AFRICAN REPUBLIC CF

Estimated total population for mid 20061 4,300,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 100,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Bangui

Common names of sleeping sikness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Nana-Bakassa (Ouham) 6. Djema (Haut-Mbomou) 2. Batangafo (Ouham) 7. Zemio (Haut-Mbomou) 3. Bossangoa (Ouham) 8. Obo (Haut-Mbomou) 4. Bouca (Ouham) 9. Bambuti (Haut-Mbomou) 5. Nola (Shanga-Mbaere)

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Central African Republic reported cases 1995-2005 Transmission is occurring in 4 prefectures (Haut-Mbomou, Lobaye, and 10 years tendency curve Ouham and Shanga-Mbaere). MSF-Spain has implemented all control

1200 activities in Haut Mbomou since 2001. The SSNCP staff are well trained and properly equipped, it implements disease control 1000 operations in Lobaye, Ouham and Shanga-Mbaere prefectures. A French bilateral cooperation programme provides support to the 800 SSNCP.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

CHAD TD

Estimated total population for mid 20061 10,000,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 50,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: N’Djamena

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. N’Damena 6. Tapol 2. Massenya 7. Gore 3. Bouno 8. Doba-Bodo 4. Tchoa 9. Moissala 5. Sahr

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Chad reported cases 1995-2005 and 10 years tendency curve Transmission is occurring in 1 province (Logone Oriental) where the Bodo focus is situated. The SSNCP is well 800 equipped and trained, but staff members are ageing; staff

700 renewal should be seriously considered to ensure continued surveillance and control. 600 500

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

CONGO CG

Estimated total population for mid 20061 3,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 500,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Brazzaville

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Impfondo 8. Louboma 2. Ouesso 9. Nkayi 3. Makoua 10. Madingou 4. Owando 11. Kinkala 5. Mossaka 12. Brazzaville 6. Djarabala 13. Ngabe 7. Sibiti 14. Pointe Noire

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Republic of Congo reported cases 1990-2005 Transmission is occurring mostly along the Congo river in and the 10 years exponential tendency curve 4 regions (Bouenza, Cuvette, Plateau and Pool). MSF-Holland is carrying out control activities in coordination 1200 with the SSNCP in all major foci. The SSNCP staff are well trained and equipped. A French bilateral cooperation 1000 programme is supporting SSNCP activities, which focuses on

800 areas where MSF-Holland is absent.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

CONGO, Democratic Republic CD

Estimated total population for mid 20061 62,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 10,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Kinshasa

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Doruma 18. Bolobo 2. Ubangui-Loko 19. Bandundu 3. Gemena-Takaya 20. Kasongo-Lunda 4. Gemena-Bwamanda 21. Inzia 5. Bomongo-Bamboma 22. Bagata 6. Mbandaka-Lokolela 23. Idiofa 7. Kwamouth 24. Fadundu 8. Mushie 25. Cilomba 9. Seke-Banza 26. Ganda-Jika 10. Songolo 27. Masuika 11. Luozi 28. Mweka 12. Djuma 29. Tchofa-Lubao 13. Boma 30. Kasongo-Kindu 14. Kimpese 31. Kibomo 15. Kwilu-Ngongo 32. Bunkeya 16. Inkisi 33. Kongolo 17. Kutu 34. Kabambare

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in 10 provinces (Bandundu, Bas- CONGO DEMOCRATIC REPUBLIC reported cases 1990-2005 and the 10 years exponential tendency curve Congo, Equateur Nord, Equateur Sud, Kasaï Occidental, Kasaï Oriental, Kinshasa, Maniema, Nord-Katanga and 30000 Orientale). Important support from a Belgian bilateral cooperation project allows the sleeping sickness national 25000 control programme (SSNCP) to maintain 46 mobile teams. 20000 The staff are well trained and effective. France and Denmark also provide bilateral support for HAT control activities. In 15000 addition, Memisa, Fometro and MSF-Belgium are implementing control projects that are coordinated by the 10000 SSNCP.

5000 (see also map of the Democratic Republic of Congo by Health Zones affected by sleeping sickness). 0

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

COTE D’IVOIRE CI

Estimated total population for mid 20061 19,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 4,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Yamoussoukro

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Man 6. Bouafle (Marahoué) 2. Danane 7. Abengourou 3. Issia (Marahoué) 8. Gagnoa 4. Daloa (Marahoué) 9. San Pedro-Sassandra 5. Sinfra-Bonon (Marahoué) 10. Aboissso

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in 1 region (Marahoué), which Cote d'Ivoire reported cases 1995-2005 and 10 years tendency curve includes the active foci of Bonon and Sinfra and, further south, the Oumé focus. The SSNCP, an administrative structure 350 with no logistics to perform surveys, is technically assisted by 2 national structures (the Projet de recherches 300 cliniques sur la trypanosomiase based in Daloa and the 250 Institut Pierre Richet based in Bouaké).

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Updated November 2006

EQUATORIAL GUINEA EG

Estimated population for mid 20061 500,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 300,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Malabo

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Luba 3. Mbini 2. Campo 4. Cogo

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Equatorial Guinea reported cases 1997-2005 Transmission is occurring in the “Litoral Province” and the 10 years tendency curve which includes the Cogo, Campo and Mbini foci. The Sleeping Sickness National Control Programme 80 (SSNCP) is well equipped and well trained. The Spanish 70 bilateral co-operation has been providing financial

60 support since 1985 for surveillance.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

ETHIOPIA ET

Estimated total population for mid 20061 74,800,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 100,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Addis-Abeba

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Gambella

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Hunan African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

The last cases were reported in the late 1970s and early 1980s from the Gambella Region in the western part of the country. No new cases have been reported since then. There is no dedicated surveillance structure in the country.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

GABON GA

Estimated total population for mid 20061 1,400,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 400,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Libreville

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Cocobeach 6. Sud Como 2. Noya 7. Lambaréné 3. Nord versant-Mondah (Estuaire) 8. Port-Gentil 4. Nord versant-Como (Estuaire) 9. Lebama 5. Kango

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in 1 province (Estuaire). Gabon reported cases 1995-2005 and 10 years tendency curve The SSNCP is well equipped and the staff well trained.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

GAMBIA GM

Estimated total population for mid 20061 1,500,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 100,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Banjul

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Estuary-Gambia River Historical note: The sleeping-sickness trypanosome was discovered in 1901 by Forde in a European ship's captain who had navigated the river Gambia for several years. Forde does not seem to have examined the parasite in detail. Later, the same case was studied by Dutton, and following on his reports on the parasite and the disease, an expedition was sent from Liverpool and London to carry the investigation further.

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

No cases have been identified or reported for several decades throughout the country. There are no dedicated structures for surveillance.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

GHANA GH

Estimated total population for mid 20061 8,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 3,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Accra

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Binaga-Zongoïre 8. Bumbuna 2. Alfai 9. Kpembe South 3. Gogosapeliga 10. Mampong 4. Samene 11. Yeji 5. Sakogu 12. Kumasi 6. West Wa 13. Offinso 7. Mid Volta

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

The last case was reported in 2000 from Takoradi (western Ghana reported cases 1995-2005 and 10 years tendency curve region). An active case-finding survey was subsequently performed in December 2005 in this area but no cases were 1.2 detected. Control activities are the responsibility of the Disease Control Unit of the Ghanaian Health Service, which 1 works in collaboration with, and with the technical support of the West African Centre for International Parasite 0.8 Control based in the Noguchi Memorial Institute for

0.6 Medical Research.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

GUINEA GN

Estimated total population for mid 20061 9,800,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 2,500,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing))

■ Capital: Conakry

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Labe 5. Dubreka 2. Kankan 6. Mamou 3. Mandiana 7. Kissidougou 4. Boffa 8. Nzerekore

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in Basse Guinée, which includes Guinea reported cases 1990-2005 and the 10 years exponential tendency curve the foci of Boffa, Dubreka and Forecariah, and in Guinée Forestière, where the Nzerekore area is the main focus. The 140 SSNCP lacks equipment and human resources.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006 GUINEA BISSAU GW

Estimated total population for mid 20061 1,400,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 300,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Bissau

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Cacheu-Saõ Domingo 4. Bolama 2. Gabù 5. Bijagos (1 & 2) 3. Biombo

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

The last case was reported in 1989 from the Archipelago de Bijagos. In the past, endemic areas included the Cacheu, Gabú and São Domingos regions. Surveillance ceased in the 1990s. There are no dedicated structures for surveillance.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

KENYA KE

Estimated total population for mid 20061 34,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 700,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

Sleeping sickness affected areas update ongoing) Last case reported prior to 2000. Area updated Last case reported prior to 2000. Area not updated Last case reported after to 2000. Area updated Last case reported after to 2000. Area not updated

■ Capital: Nairobi

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Central Nyanza (Alupe) 2. Central Nyanza (Lambwe valle)

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Endemic areas are located in 3 districts of Central Nyanza Kenya reported cases 1995-2005 and 10 years tendency curve (Bungoma, Busia and Teso) close to the Ugandan border. Despite a solid passive case detection system managed by the 25 Trypanosomiasis Research Centre, no cases were detected between 2002 and 2004. However, 1 case was diagnosed in Busia (Alupe 20 treatment center) in January 2006.

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

LIBERIA LR

Estimated total population for mid 20061 3,400,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 200,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Monrovia

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Lofa 3. Nimba 2. Bong 4. Montrovia

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO; Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

Cases were sporadically identified in the Bong Mines Region in the late 1960s and early 1970s. There are no structures dedicated to surveillance and surveys are therefore not performed.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

MALAWI MW

Estimated total population for mid 20061 12,800,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 1,200,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Lilongwe

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Vwaza 3. Nkhota-kota 2. Kasungu 4. Makanjila

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update.Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Transmission is occurring in Nkhotakota and Rumphi Malawi reported cases 1995-2005 and 10 years tendency curve districts, where cases are regularly identified. The SSNCP is managed by the Disease Control Unit within the Department of 80 Preventive Health Services in the Ministry of

70 Health and Population. In addition to a programme manager at the central level, there are district coordinators at district level. 60 Programme implementation is the responsibility 50 of community health workers. Those involved in HAT surveillance and control underwent in-service training in 40 2004, which was organized under the auspices of a team of 30 international experts. 20 10

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9 9 9 9 9 0 0 0 0 0 0 -10 9 9 9 9 9 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 2

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

MALI ML

Estimated total population for mid 20061 13,900,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 2,500,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Bamako

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Kenieba 9. Kangaba 2. Kati 10. Ouéléssébougou 3. Kolokani 11. Bougouni 4. Banamba 12. Kolondieba 5. Baroueli 13. Kadiolo 6. Segou 14. Sikasso 7. Kalikoro 15. Koutiala 8. Baguineda 16. Yorosso

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update.Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

The last case was reported was from the Kenieba area in 2002. An Mali reported cases 1995-2005 and 10 years tendency curve active case-finding survey was carried out in December 2005 in that area; no cases were identified. In-service training was provided 20 during this last survey. The SSNCP is poorly staffed and under- 18 equipped. 16 14 12 10 8 6 4 2 0

5 6 7 8 9 0 1 2 3 4 5 9 9 9 9 9 0 0 0 0 0 0

9 9 9 9 9 0 0 0 0 0 0

1 1 1 1 1 2 2 2 2 2 2

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

MOZAMBIQUE MZ

Estimated total population for mid 20061 19,900,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 700,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Maputo

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Zumbo (Niassa province) 4. Majune 2. Casula (Tete province) 5. Cabo Delgado 3. Metangula

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

The last cases were identified in 2002 and 2004 from Niassa Mozambique reported cases 1995-2005 and 10 years tendency curve and Tete provinces respectively. Control is vested in primary health structures under the responsibility of the National Institute of Health 3 within the Ministry of Health.

5 6 7 8 9 0 1 2 3 4 5 9 9 9 9 9 0 0 0 0 0 0

9 9 9 9 9 0 0 0 0 0 0

1 1 1 1 1 2 2 2 2 2 2

-1

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

NAMIBIA NA

Estimated total population for mid 20061 2,100,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 undetermined (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Windhoek

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Caprivi

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

Sporadic cases have been reported from the Caprivi Strip along the far eastern border of Cuando Cubango Province in Angola. However, transmission in that area is no longer believed to take place since no cases have been reported for several decades. There is no specific structure for HAT surveillance.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

NIGER NE

Estimated total population for mid 20061 14,400,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 500,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Niamey

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

No case has been reported in several decades. There are no structures dedicated to HAT surveillance in the country.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

NIGERIA NG

Estimated total population for mid 20061 134,500,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 13,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Abuja

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Abraka 3. Gboko 2. Benue

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Nigeria reported cases 1995-2005 Transmission is occurring in 1 state (Delta), where cases and 10 years tendency curve are regularly reported from the Abraka focus. However, it is difficult to assess whether transmission takes place elsewhere in the 35 country given the lack of active surveillance. 30 All patients in whom the disease is diagnosed are treated in the Eku Baptist Medical Centre. There is no dedicated structure or established 25 surveillance system. The National Institute for Trypanosomiasis 20 Research has the expertise to 15 perform research and could carry out field work but has not been vested with the responsibility nor financed to 10 implement nationwide surveillance. 5 0

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-10

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

RWANDA RW

Estimated total population for mid 20061 9,100,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 9,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Kigali

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Mikongo-Akagera

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African trypanosomiasis Surveillance and Control Programme.

NO GRAPH

Cases were sporadically reported from the Mutara region and the Akagera national park. Neither dedicated structure nor trained staff exist in the country.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

SENEGAL SN

Estimated total population for mid 20061 11,900,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 Undetermined (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Dakar

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Petite Côte 2. Casamance

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

Cases were sporadically reported from the Casamance Region in the 1970s and 1980s, but no cases have been reported since then. There is no dedicated structure for surveillance.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

SIERRA LEONE SL

Estimated total population for mid 20061 5,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 400,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Freetown

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Sherbro

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

No case has been reported for several decades. National health authorities believe the country is free of transmission despite the closeness of active foci in neighbouring Guinea. There is no dedicated structure for surveillance.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

SUDAN SD

Estimated total population for mid 20061 41,200,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 5,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing))

■ Capital: Khartoum

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Tambura 7. Yei 2. Ezo 8. Kajo-Keji 3. Li-Rangu 9. Juba 4. Ibba 10. Torit-Magwi 5. Maridi-Mundri 11. Akobo-Bashala 6. Yambio

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Sudan reported cases 1995-2005 Transmission is occurring in the Equatoria Region (including Ezo, and 10 years tendency curve Juba, Kajo-Keji, Magwi, Maridi, Mundri, Tambura, Torit, Yambio and Yei counties). Control activities are mainly led by MSF- 4500 France, -Switzerland and -Spain, Malteser and Merlin. The SSNCP 4000 and the Tropical Medicine Research Institute have independently 3500 carried out control activities in the Juba area. 3000 2500

2000

1500

1000

500

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1 1 1 1 1 2 2 2 2 2 2

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

SWAZILAND SZ

Estimated total population for mid 20061 1,100,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 Undetermined (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Mbabane

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

While tsetse flies and animal trypanosomoses still exist in the country, no human cases have been reported for several decades. There is no dedicated HAT surveillance structure in the country.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

TANZANIA, United Republic of TZ

Estimated total population for mid 20061 37,900,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 1,500,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing))

■ Capital: Dar es Salam

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Kagera-Ngara 11. Tabora 2. Kagera-Binaramoulo 12. Tabora-south 3. Musoma 13. Rukwa-Mpanda 4. Kibondo 14. Nkasi 5. Arusha-Mbulu 15. Mbeya 6. Arusha 16. Ifakara 7. Arusha-Babati 17. Tunduru 8. Arusha-Kondoa 18. Lindi-Liwale 9. Kigoma 19. Lindi-Nachingwea 10. Tabora-Nzega

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Tanzania reported cases 1995-2005 Transmission is occurring in 3 regions: Kigoma, (Kibondo and Kasulu districts), Tabora (Kigoma, Sikonge and 600 Urambo districts) and Rukwa (Mpanda district). Cases are regularly identified in local health structures. There is no 500 dedicated structure at national level, but 1 person (based within the Ministry of Health) acts as a focal point for HAT 400 and is in charge of monitoring the disease. Some control activities are implemented by the National Institute for 300 Medical Research from its Tabora station.

200

100

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WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

TOGO TG

Estimated total population for mid 20061 6,300,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 700,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Lomé

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Tone 2. Oti

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme

NO GRAPH

The last cases were reported in 1995 from the Savanes Region. Since then, several active case-finding surveys have been carried out in endemic and neighbouring areas; the last one took place in November 2004. No cases were detected during those surveys. HAT control is vested in the National Institute of Hygiene.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006 UGANDA UG

Estimated total population for mid 20061 27,700,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 2,000,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Kampala

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information) 1. Arua 4. Mukono 2. Moyo 5. Busoga 3. Adjumani

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Uganda T.b.g reported cases 1995-2005 and 10 years tendency curve T.b. gambiense (T.b.g.) Transmission is occurring in the north-western part of the country, affecting 4 1800 1600 districts (Adjumani, Arua, Moyo and Yumbe). HAT control activities are 1400 decentralized and managed by district health authorities. It is believed that an 1200 overlap of T.b. gambiense and T.b. rhodesiense could occur, which would 1000 considerably complicate control issues because of the epidemiological 800 600 differences between the 2 forms of the 400 disease. 200 0

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9 9 9 9 9 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 2

T.b. rhodesiense (T.b.r.) Uganda T.b.r. reported cases 1995-2005 and 10 years tendency curve Foci of T.b. rhodesiense are located in the south-east, affecting 10 districts (Busia, Busiri, Iganga, Jinja, Kamule, Kamuli, Mayuge, Mukono, Soroti and 600 Tororo) that are separated from the T.b.gambiense foci by Apac, Kaberamaido, 500 Lira and Masindi districts. However, the transmission area of T.b. rhodesiense 400 has been regularly extending northwards, and sporadic cases were identified in 300 2004 in Lira and Kaberamaido. This surprising epidemiological pattern has

200 been associated with cattle movements that took place during the civil strife.

100 More recently, in 2005, during a round table in Addis Ababa (Ethiopia), a multisectoral approach for surveillance and control involving humans and 0

5 6 7 8 9 0 1 2 3 4 5 animals as well as the disease vector was proposed to prevent the 2 forms of 9 9 9 9 9 0 0 0 0 0 0

9 9 9 9 9 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 2 HAT from overlapping. Should this overlap exist, it would substantially complicate surveillance and control operations.

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

ZAMBIA ZM

Estimated total population for mid 20061 11,900,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 500,000 (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Lusaka

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Kampesa 4. Mpikao 2. Nyiamba North-West 5. Luangwa river valley 3. Kanona East 6. Chipata North

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update. Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

Cases are sporadically reported from 2 districts (Mpika Zambia reported cases 1995-2005 and 10 years tendency curve and Petakua) in the Luangwa fly belt. There is no dedicated structure for surveillance or control. Diagnosis and, eventually, treatment 40 relies exclusively on district hospitals. 35 30 25 20 15 10 5 0

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1 1 1 1 1 2 2 2 2 2 2 -10

WORLD HEALTH ORGANIZATION – HUMAN AFRICAN TRYPANOSOMIASIS SURVEILLANCE AND CONTROL PROGRAMME Last update November 2006

ZIMBABWE ZW

Estimated total population for mid 20061 13,100,000 1 Population Reference Bureau – 2006 population data sheet http://www.prb.org/pdf06/06WorldDataSheet.pdf

Estimated population at risk for sleeping sickness2, 3 undetermined (2 From WHO TRS 881, 1998) XXXXX (3 update ongoing)

■ Capital: Harare

Common names of sleeping sickness affected areas (WHO HAT Surveillance and Control Programme data set) (Click on the name of each area to access epidemiological information)

1. Kariba-Makuti 3. Nyamapanda 2. Zambezi escarpment

Present situation4 4Human African Trypanosomiasis (sleeping sickness): epidemiological update.Weekly Epidemiological Record, 2006 Feb; 81(8):71-80. WHO, Human African Trypanosomiasis Surveillance and Control Programme.

NO GRAPH

South Africa and Great Britain sporadically report cases, generally tourists visiting the Kariba lake region. However, no surveillance system exists for the local population and no dedicated surveys are being implemented by national health authorities.