03670nas a2200325   4500000000100000008004100001653001100042653002000053653002200073653003100095653002200126653003900148653003400187653000800221653001000229100001500239700001500254700001600269700002100285700001400306700001500320700001200335700001400347245017500361856011100536300000800647490000600655520266900661022001403330       2017                            d10aZambia10aTrypanosomiasis10aT. B. Rhodesiense10aSocial and economic burden10aSleeping sickness10aNeglected tropical diseases (NDTs)10aHuman African Trypanosomiasis10aHAT10aDALYs1 aMwiinde AM1 aSimuunza M1 aNamangala B1 aChama-Chiliba CM1 aMachila N1 aAnderson N1 aShaw AP1 aWelburn S00aEstimating the economic and social consequences for patients diagnosed with human African trypanosomiasis in Muchinga, Lusaka and Eastern Provinces of Zambia (2004-2014).  uhttps://idpjournal.biomedcentral.com/track/pdf/10.1186/s40249-017-0363-6?site=idpjournal.biomedcentral.com  a1500 v63 a<p><strong>BACKGROUND: </strong>Acute human African trypanosomiasis (rHAT) caused by Trypanosoma brucei rhodesiense is associated with high mortality and is fatal if left untreated. Only a few studies have examined the psychological, social and economic impacts of rHAT. In this study, mixed qualitative and quantitative research methods were used to evaluate the socio-economic impacts of rHAT in Mambwe, Rufunsa, Mpika and Chama Districts of Zambia.</p>

<p><strong>METHODS: </strong>Individuals diagnosed with rHAT from 2004 to 2014 were traced using hospital records and discussions with communities. Either they, or their families, were interviewed using a structured questionnaire and focus group discussions were conducted with affected communities. The burden of the disease was investigated using disability adjusted life years (DALYs), with and without discounting and age-weighting. The impact of long-term disabilities on the rHAT burden was also investigated.</p>

<p><strong>RESULTS: </strong>Sixty four cases were identified in the study. The majority were identified in second stage, and the mortality rate was high (12.5%). The total number of DALYs was 285 without discounting or age-weighting. When long-term disabilities were included this estimate increased by 50% to 462. The proportion of years lived with disability (YLD) increased from 6.4% to 37% of the undiscounted and un-age-weighted DALY total. When a more active surveillance method was applied in 2013-2014 the cases identified increased dramatically, suggesting a high level of under-reporting. Similarly, the proportion of females increased substantially, indicating that passive surveillance may be especially failing this group. An average of 4.9&nbsp;months of productive time was lost per patient as a consequence of infection. The health consequences included pain, amnesia and physical disability. The social consequences included stigma, dropping out of education, loss of friends and self-esteem. Results obtained from focus group discussions revealed misconceptions among community members which could be attributed to lack of knowledge about rHAT.</p>

<p><strong>CONCLUSIONS: </strong>The social and economic impact of rHAT on rural households and communities is substantial. Improved surveillance and strengthening of local medical services are needed for early and accurate diagnosis. Disease prevention should be prioritised in communities at risk of rHAT, and interventions put in place to prevent zoonotic disease spill over from domestic animals and wildlife. Supportive measures to mitigate the long-term effects of disability due to rHAT are needed.</p>
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