Historical Review of Human African Trypanosomiasis and Specific Need for Surveillance Strengthening in Abraka Delta State, Nigeria

Abstract

Human African trypanosomiasis (HAT) or sleeping sickness is a major public health problem, with epidemics occurring during the early  part of the 20th century. Control activities of case-finding, treatment, and vector eradication across northern Nigeria with national and  international support drastically reduced the prevalence from 14% between 1931 and 1940 to below 1% by 1980. With these successes,  the Nigerian Institute for Trypanosomiasis Research (NITR) became underfunded and stopped regular active surveys. In 1985, a new HAT- endemic Abraka focus in Delta State emerged, and the Institute strengthened its surveillance there and in Benue State. In 1988, all  outstations were closed, except for the Sleeping Sickness Reference Diagnostic Centre, Gboko, and Benue State. To date, only the Abraka  focus has reported HAT case (s) to the WHO in 2012 and 2013. From 2014 to 2017, the Foundation for Innovative New Diagnostics (FIND),  in collaboration with NITR and Ministries of Health, introduced intensive passive surveillance in 51 health centres in Delta State aimed at accelerating the control of HAT using rapid diagnostic tools (RDTs), LEDfluorescent microscopy, and molecular methods of LAMPprovided  free of charge by FIND. The results indicated 157 sero-positives out of 10,093 patients with HAT suspicion index screened but failed to  confirm any HAT case by microscopy or molecular analysis. Of interest was the case of HAT exported to the United Kingdom from the  Abraka area in 2017, suggesting continuing transmission. To achieve the 2030 HAT global elimination goal, surveillance programmes with sufficient diagnostic capacities must be implemented in Abraka, Delta State, Nigeria. This is not only important, but will also help in  generating additional data and information useful in validating the future status of HAT in Abraka, Delta State Nigeria.