Tackling Sleeping Sickness in the Central African Republic

In November 2011, MSF staff in the Central African Republic held a sleeping sickness screening near Maitikoulou, in the northwest region of the country. Sleeping sickness, or human African trypanosomiasis (HAT), is a neglected infectious disease that is often fatal, affecting humans and animals in tropical areas of Africa.

People wait in line to be tested for sleeping sickness as an MSF staffer explains the symptoms of the disease and how the test will be carried out.

CAR 2011 © Carmen Barra/MSF

The MSF team collects blood samples by finger prick.

CAR 2011 © Carmen Barra/MSF

After the blood is collected, it is tested to determine whether the person is carrying the sleeping sickness parasite.

CAR 2011 © Carmen Barra/MSF

If the patient tests positive and the medical staff confirm ‘stage one’ of sleeping sickness, they perform a lumbar puncture to find out whether the disease has entered ‘stage two’. This is determined by the number of white blood cells and/or the presence of parasites in the cerebrospinal fluid.

CAR 2011 © Carmen Barra/MSF

The first stage of HAT is known as the haemolymphatic phase, and symptoms are fever, headaches, join pain, and itching. Invasion of the circulatory and lymphatic system by the parasites is associated with severe swelling of the lymph nodes. If untreated, the disease can cause anemia and endocrine, cardiac, or kidney dysfunctions.

CAR 2011 © Carmen Barra/MSF

The second stage, called the neurological phase, occurs when the parasite invades the central nervous system by passing through the blood-brain barrier. The symptoms include confusion, disruption of sleep, daytime slumber, and nighttime insomnia. Without treatment, the disease is fatal, and causes progressive mental deterioration leading to coma and death. Damage caused in the neurological phase is irreversible.

The proper type of treatment depends on the stage of the disease. Drugs used during the first stage are of lower toxicity and easier to administer. The earlier sleeping sickness is identified, the better the prospect of a cure.

The success of treatment in the second stage of sleeping sickness depends on a drug that can cross the blood-brain barrier to reach the parasite. Such drugs are toxic and complicated to administer.

The steep drop in the prevalence of sleeping sickness in this part of the country shows positive progress. But screenings for sleeping sickness require major a investment in human and material resources. In Africa, such resources are often scarce, particularly in remote areas where the disease is most often found. As a result, many infected individuals could die before they are diagnosed and treated.

Tackling Sleeping Sickness in the Central African Republic

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Tackling Sleeping Sickness in the Central African Republic

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