Sleeping sickness is controlled by case detection and treatment but this often only reaches less than 75% of the population. Vector control is capable of completely interrupting HAT transmission but is not used because of expense. We conducted a full scale field trial of a refined vector control tec...hnology. From preliminary trials we determined the number of insecticidal tiny targets required to control tsetse populations by more than 90%. We then carried out a full scale, 500 km2 field trial covering two HAT foci in Northern Uganda (overall target density 5.7/km2). In 12 months tsetse populations declined by more than 90%. A mathematical model suggested that a 72% reduction in tsetse population is required to stop transmission in those settings. The Ugandan census suggests population density in the HAT foci is approximately 500 per km2. The estimated cost for a single round of active case detection (excluding treatment), covering 80% of the population, is US$433,333 (WHO figures). One year of vector control organised within country, which can completely stop HAT transmission, would cost US$42,700. The case for adding this new method of vector control to case detection and treatment is strong. We outline how such a component could be organised.
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Human African Trypanosomiasis, also known as sleeping sickness is a devastating parasitic disease. It is a neglected tropical disease affecting communities in Africa. In this video we take a look at the disease, how it presents and and ways to control it.
At the forefront of DNDi’s efforts to develop new treatments is the need to understand the realities and treatment needs of patients and health care staff in the field. The ultimate goal for human African trypanosomiasis (HAT) is a truly simplified
treatment which can be orally administered, impl...emented at the primary health care level, and effective against both stages of the disease.
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Psychiatry and Pediatrics
Chapter I.4
Guidelines on obstructive sleep apnea in India.
DNDi is now striving to make fexinidazole available to the majority of people who have T.b. gambiense sleeping sickness. We are supporting a three-year access and pharmacovigilance study that began in 2020 and have so far carried out in-country training of relevant staff in 250 hospitals and... health centres in T.b. gambiense-endemic countries; and updated national treatment and pharmacovigilance guidelines in Angola, Central African Republic, the Democratic Republic of Congo, Equatorial Guinea, Guinea, and Chad.
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A wide spectrum of disease severity has been described for Human African Trypanosomiasis (HAT) due to
Trypanosoma brucei rhodesiense (T.b. rhodesiense), ranging from chronic disease patterns in southern countries of East Africa to an increase in virulence towards the north. However, only limited d...ata on the clinical presentation of T.b. rhodesiense HAT is available. From 2006-2009 we conducted the first clinical trial program (I MPAMEL III) in T.b. rhodesiense endemic areas of
Tanzania and Uganda in accordance with international standards (ICH-GCP). The primary and secondary outcome measures were safety and efficacy of an abridged melarsoprol schedule for treatment of second stage disease. Based on diagnostic findings and clinical examinations at baseline we describe the clinical presentation of T.b. rhodesiense HAT in second stage patients from two distinct geographical settings in East Africa.
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This was a Phase 3, multi-center, randomized, open-label, parallel-group, active control study where 273 male and female patients with first stage Trypanosoma brucei gambiense HAT were treated at six sites: one trypanosomiasis reference center in Angola, one hospital in South Sudan, and four hospita...ls in the Democratic Republic of the Congo between August 2005 and September 2009 to support the registration of pafuramidine for treatment of first stage HAT in collaboration with the United States Food and Drug Administration. Patients were treated with either 100 mg of pafuramidine orally twice a day for 10 days or 4 mg/kg pentamidine intramuscularly once daily for 7 days to assess the efficacy and safety of pafuramidine versus pentamidine. Pregnant and lactating women as well as adolescents were included.
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BMJ Global Health2020;5:e002914. doi:10.1136/bmjgh-2020-002914
The evidence produced in mathematical models plays a key role in shaping policy decisions in pandemics. A key question is therefore how well pandemic models relate to their implementation contexts. Drawing on the cases of Ebola and in...fluenza, we map how sociological and anthropological research contributes in the modelling of pandemics to consider lessons for COVID-19. We show how models detach from their implementation contexts through their connections with global narratives of pandemic response, and how sociological and anthropological research can help to locate models differently. This potentiates multiple models of pandemic response attuned to their emerging situations in an iterative and adaptive science. We propose a more open approach to the modelling of pandemics which envisages the model as an intervention of deliberation in situations of evolving uncertainty. This challenges the ‘business-as-usual’ of evidence-based approaches in global health by accentuating all science, within and beyond pandemics, as ‘emergent’ and ‘adaptive’.
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During the first year of the Covid-19 pandemic, the world’s economy slowed. Yet, the global annual average particulate pollution (PM2.5) was largely unchanged from 2019 levels. At the same time, growing evidence shows air pollution—even when experienced at very low levels—hurts human health. T...his recently led the World Health Organization (WHO) to revise its guideline for what it considers a safe level of exposure of particulate pollution, bringing most of the world—97.3 percent of the global population—into the unsafe zone. The AQLI finds that particulate air pollution takes 2.2 years off global average life expectancy, or a combined 17 billion life-years, relative to a world that met the WHO guideline. This impact on life expectancy is comparable to that of smoking, more than three times that of alcohol use and unsafe water, six times that of HIV/AIDS, and 89 times that of conflict and terrorism.
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India is the world’s second most polluted country. Air pollution shortens average Indian life expectancy by 5 years,
relative to what it would be if the World Health Organization (WHO) guideline fine particulate pollution (PM2.5) of 5 μg/m3 was met. Some areas of India fare much worse than avera...ge, with air pollution shortening lives by almost 10
years in the National Capital Territory of Delhi, the most polluted city in the world.
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Virtually all (99.9 percent) of Southeast Asia’s 656.1 million people live in areas where particulate pollution exceeds the World Health Organization (WHO) guideline of 5 μg/m³. Despite the lockdowns of the pandemic, pollution continued to rise in much of Southeast Asia in 2020. This pollution c...uts short the life expectancy of the average Southeast Asian person by 1.5 years, relative to what it would be if the WHO guideline was met. That’s a total of 959.8 million person-years lost to pollution in the eleven countries that make up this region. Some countries in the region experience greater impacts from pollution.
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In Central and West Africa, regions together comprising 27 countries and 605 million people, the average person is exposed to particulate pollution levels that are more than 4 times the World Health Organization’s (WHO) guideline of 5 μg/m³1. If these particulate pollution levels persist, averag...e life expectancy in the regions would be 1.6 years lower, and a total of 971 million person-years would be lost, relative to if air quality met the WHO guideline. The Democratic Republic of the Congo, Rwanda and Burundi, are the top three most polluted countries in the region.
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Bangladesh is the world’s most polluted country. Air pollution shortens the average Bangladeshi’s life expectancy by 6.9 years, relative to what it would be if the World Health Organization (WHO) guideline of 5 μg/m³ was met. Some areas of Bangladesh fare much worse than average, with air poll...ution shortening lives by nearly 9 years in Dhaka, the country’s most polluted city.
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Pakistan is the world’s fourth most polluted country. Air pollution shortens the average Pakistani’s life expectancy by 3.8 years, relative to what it would be if the World Health Organization (WHO) guideline of 5 μg/m3 was met.1 Some areas of Pakistan fare much worse than average, with air pol...lution shortening lives by almost 7 years in the country’s most polluted regions, like Lahore and Peshawar.
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Nepal is the world’s third most polluted country. Air pollution shortens average Nepalese life expectancy by 4.1 years, relative to what it would be if the World Health Organization (WHO) guideline of 5 μg/m3 was met.1 The highest concentrations of air pollution are observed in Nepal’s southwes...tern districts, which share their borders with the highly-polluted Indo-Gangetic Plain of India. Here, residents stand to lose nearly 7 years of life expectancy.
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Air pollution’s impact on life expectancy in Nigeria is greater than that of HIV/AIDS and almost on par with malaria and unsafe water and sanitation, shortening the average Nigerian’s life expectancy by 1.8 years, relative to what it would be if the World Health Organization (WHO) guideline of 5... μg/m3 was met.1 Some areas of Nigeria fare much worse than average, with air pollution shortening lives by almost 4 years on average in parts of Taraba state in Northeastern Nigeria.
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