T3 ONE HEALTH MALAWI Research Papers Trypanosomiasis

T3 ONE HEALTH MALAWI Research Papers Trypanosomiasis

Trypanosomiasis

2021

• TITLE - Trypanosomiasis cases cluster analysis for localization of interventions in endemic Malawi sites
• AUTHOR - Musaya, Janelisa
• JOURNAL - Kamuzu University of Health Sciences Data Repository
• ABSTRACT - We are proposing to conduct the following study types (1) Desk analysis of patient archived samples leading to geospatial maps (2) Cross-sectional surveys of tsetse densities and HAT in mapped cluster sites. In Malawi, trypanosomiasis is a latent threat due to interaction between humans and wild animals. Human cases usually occur as a result of tsetse fly bites in animal reserves where the vectors are found. For the past five years, Rumphi and Nkhotakota districts have experiencing outbreaks which demonstrates that the risk in this environment is growing. It was noted however in our recent work in these districts that the infected individuals present very late at the hospitals. Late presentation means case management with very toxic drugs, and which also requires hospitalization. It is not yet understood why a lot of people prefer to report late at the hospital. But of most importance is to influence people to recognize signs and symptoms early enough for them to seek medical care. We propose to use the already existing medical records of the trypanosomiasis cases admitted at the district hospitals to trace where they came from in order for us to understand factors that are affecting transmission in those areas. Once the areas are identified we would want to engage with the people in those area and train them on how to use Targets (tsetse control measure) to reduce the area density of tsetse flies. Tsetse flies are vectors of transmission for trypanosomiasis. Our major hypothesize therefore is that mapping human cases will show area clusters of infections which can be easily targeted for interventions. The main aim is to trace geospatially where trypanosomiasis cases are coming from in order to find ways of introducing area specific control interventions in Rumphi and Nkhotakota districts. The study is divided into two interacting work packages: Work package one (WP1) is to use case report forms from the hospital archives, to identify villages where trypanosomiasisi casescome from in order to understand factors influencing transmission. Work package two (WP2) is to train communities in WP1 above on how to identify Tsetse high density areas and how they can control transmission by using tsetse targets (insecticide treated cloths). We hope to pinpoint exactly where the interventions should be targeted and inform them what interventions will work in those areas. With current Centre for Disease Control efforts of using Tsetse targets to reduce transmission we want to empower communities to be able to make and deploy targets on their own as a control strategy. The results will be shared with the local communities, the district executive committee and the ministry of health for policy decision making.
  

2020

• TITLE - Monitoring the elimination of human African trypanosomiasis at continental and country level: Update to 2018
• AUTHOR - Jose R. Franco, Giuliano Cecchi, Gerardo Priotto, Massimo Paone, Abdoulaye Diarra, Lise Grout, Pere P. Simarro, Weining Zhao, Daniel Argaw
• JOURNAL - PLoS Neglected Tropical Diseases
• ABSTRACT - In 2012 human African trypanosomiasis (HAT), also known as sleeping sickness, was targeted for elimination as a public health problem, set to be achieved by 2020. The World Health Organization (WHO) provides here the 2018 update on the progress made toward that objective. Global indicators are reviewed, in particular the number of reported cases and the areas at risk. Recently developed indicators for the validation of HAT elimination at the national level are also presented. With 977 cases reported in 2018, down from 2,164 in 2016, the main global indicator of elimination is already well within the 2020 target (i.e. 2,000 cases). Areas at moderate or higher risk (i.e. ‚â• 1 case/10,000 people/year) are also steadily shrinking (less than 200,000 km2 in the period 2014‚Äì2018), thus nearing the 2020 target [i.e. 90% reduction (638,000 km2) from the 2000‚Äì2004 baseline (709,000 km2)]. Health facilities providing diagnosis and treatment of gambiense HAT continued to increase (+7% since the previous survey), with a better coverage of at-risk populations. By contrast, rhodesiense HAT health facilities decreased in number (-10.5%) and coverage. At the national level, eight countries meet the requirements to request validation of gambiense HAT elimination as a public health problem (i.e. Benin, Burkina Faso, Cameroon, C√¥te d‚ÄôIvoire, Ghana, Mali, Rwanda, and Togo), while for other endemic countries more efforts are needed in surveillance, control, or both. The 2020 goal of HAT elimination as a public health problem is within grasp, and eligible countries are encouraged to request validation of their elimination status. Beyond 2020, the HAT community must gear up for the elimination of gambiense HAT transmission (2030 goal), by preparing for both the expected challenges (e.g. funding, coordination, integration of HAT control into regular health systems, development of more adapted tools, cryptic trypanosome reservoirs, etc.) and the unexpected ones.
• ISSUE - 5
• VOLUME - 14
• DOI - 10.1371/journal.pntd.0008261

2020

• TITLE - Molecular identification of trypanosomes in cattle in Malawi using PCR methods and nanopore sequencing: epidemiological implications for the control of human and animal trypanosomiases
• AUTHOR - Megasari Marsela, Kyoko Hayashida, Ryo Nakao, Elisha Chatanga, Alex Kiarie Gaithuma, Kawai Naoko, Janelisa Musaya, Chihiro Sugimoto, Junya Yamagishi
• JOURNAL - Parasite
• ABSTRACT - This study aimed to identify trypanosomes infecting cattle in Malawi in order to understand the importance of cattle in the transmission dynamics of Human African Trypanosomiasis (HAT) and Animal African Trypanosomosis (AAT). A total of 446 DNA samples from cattle blood from three regions of Malawi were screened for African trypanosomes by ITS1 PCR. The obtained amplicons were sequenced using a portable next-generation sequencer, MinION, for validation. Comparison of the results from ITS1 PCR and MinION sequencing showed that combining the two methods provided more accurate species identification than ITS1 PCR alone. Further PCR screening targeting the serum resistance-associated (SRA) gene was conducted to detect Trypanosoma brucei rhodesiense. Trypanosoma congolense was the most prevalent Trypanosoma sp., which was found in Nkhotakota (10.8%; 20 of 185), followed by Kasungu (2.5%; 5 of 199). Of note, the prevalence of T. b. rhodesiense detected by SRA PCR was high in Kasungu and Nkhotakota showing 9.5% (19 of 199) and 2.7% (5 of 185), respectively. We report the presence of animal African trypanosomes and T. b. rhodesiense from cattle at the human‚Äìlivestock‚Äìwildlife interface for the first time in Malawi. Our results confirmed that animal trypanosomes are important causes of anemia in cattle and that cattle are potential reservoirs for human African trypanosomiasis in Malawi.
• VOLUME - 27
• DOI - 10.1051/parasite/2020043

2020

• TITLE- Improved Access to Diagnostics for Rhodesian Sleeping Sickness around a Conservation Area in Malawi Results in Earlier Detection of Cases and Reduced Mortality
• AUTHOR - Marshal Lemerani, Fredrick Jumah, Paul Bessell, Sylvain Biéler, Joseph Mathu Ndung’u
• JOURNAL - Journal of Epidemiology and Global Health
• ABSTRACT - Trypanosoma brucei rhodesiense Human African Trypanosomiasis (rHAT) is a zoonotic disease transmitted by tsetse flies from wild and domestic animals. It presents as an acute disease and advances rapidly into a neurological form that can only be treated with melarsoprol, which is associated with a high fatality rate. Bringing diagnostic services for rHAT closer to at-risk populations would increase chances of detecting cases in early stages of disease when treatment is safer and more effective. In Malawi, most of the rHAT cases occur around Vwaza Marsh Wildlife Reserve. Until 2013, diagnosis of rHAT in the region was only available at the Rumphi District Hospital that is more than 60 km away from the reserve. In 2013, Malawi’s Ministry of Health initiated a project to enhance the detection of rHAT in five health facilities around Vwaza Marsh by upgrading laboratories and training technicians. We report here a retrospective study that was carried out to evaluate the impact of improving access to diagnostic services on the disease stage at diagnosis and on mortality. Between August 2014 and July 2017, 2014 patients suspected of having the disease were tested by microscopy, including 1267 who were tested in the new facilities. This resulted in the identification of 78 new rHAT cases, of which six died. Compared with previous years, data obtained during this period indicate that access to diagnostic services closer to where people at the greatest risk of infection live promotes identification of cases in earlier stages of infection, and improves treatment outcomes.
• ISSUE - 4
• VOLUME - 10
• DOI - 10.2991/jegh.k.200321.001

2019

• TITLE - Genetic diversity and population structure of Glossina morsitans morsitans in the active foci of human African trypanosomiasis in Zambia and Malawi
• AUTHOR - Yukiko Nakamura, Junya Yamagishi, Kyoko Hayashida, Naoki Osada, Elisha Chatanga, Cornelius Mweempwa, Kalinga Chilongo, John Chisi, Janelisa Musaya, Noboru Inoue, Boniface Namangala, Chihiro Sugimoto
• JOURNAL - PLoS Neglected Tropical Diseases
• ABSTRACT - The tsetse fly, Glossina morsitans morsitans, is a significant problem in Zambia and Malawi. It is the vector for the human infective parasite Trypanosoma brucei rhodesiense, which causes human African trypanosomiasis, and various Trypanosoma species, which cause African animal trypanosomiasis. Understanding the genetic diversity and population structure of G. m. morsitans is the basis of elucidating the connectivity of the tsetse fly populations, information that is essential in implementing successful tsetse fly control activities. This study conducted a population genetic study using partial mitochondrial cytochrome oxidase gene 1 (CO1) and 10 microsatellite loci to investigate the genetic diversity and population structure of G. m. morsitans captured in the major HAT foci in Zambia and Malawi. We have included 108 and 99 G. m. morsitans samples for CO1 and microsatellite analyses respectively. Our results suggest the presence of two different genetic clusters of G. m. morsitans, existing East and West of the escarpment of the Great Rift Valley. We have also revealed genetic similarity between the G. m. morsitans in Kasungu National Park and those in the Luangwa river basin in Zambia, indicating that this population should also be included in this historical tsetse belt. Although further investigation is necessary to illustrate the whole picture in East and Southern Africa, this study has extended our knowledge of the population structure of G. m. morsitans in Southern Africa.
• ISSUE - 7
• VOLUME - 13
• DOI - 10.1371/journal.pntd.0007568

2021

• TITLE - A one health investigation of pathogenic trypanosomes of cattle in Malawi
• AUTHOR - Elizabeth T. Chimera, Geoffrey T. Fosgate, Eric M.C. Etter, Alain Boulang, Ilse Vorster, Luis Neves
• JOURNAL - Preventive Veterinary Medicine
• ABSTRACT - Parasitic protozoan trypanosomes of the genus Trypanosoma cause infections in both man and livestock in Africa. Understanding the current spatial distribution of trypanosomes, herd-level factors associated with Trypanosoma brucei infection as well as local knowledge of African trypanosomosis is key to its prevention and control. A cross-sectional study was performed that sampled 53 livestock farmers and 444 cattle throughout Malawi. Cattle were screened for trypanosomes using serology and molecular techniques. Questionnaires were administered to livestock herders and incidence of hospital diagnosed human trypanosome infections was estimated from reports submitted to the Department of Health Unit. The apparent prevalence of trypanosome species based on molecular detection was low for Trypanosoma brucei (2%; 95 % CI: 1‚Äì4 %) and Trypanosoma congolense (3%; 95 % CI: 2‚Äì5 %) but higher for Trypanosoma theileri (26 %; 95 % CI: 22‚Äì30 %). The central region of the country was identified as being at a higher risk of T.brucei infection. One of the sampled cattle was confirmed as being infected with Trypanosoma brucei rhodesiense. Human trypanosome cases were more frequently reported in the northern region with an estimated incidence of 5.9 cases per 100,000 people in Rumphi District. The control of zoonotic diseases that impact poor livestock herders requires a One Health approach due to the close contact between humans and their animals and the reliance on animal production for a sustainable livelihood.
• VOLUME - 188
• DOI - 10.1016/j.prevetmed.2020.105255

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