Mwiinde Allan Mayaba, Simuunza Martin, Namangala Boniface, Chama-Chiliba Chitalu Miriam, Machila Noreen, Anderson Neil, Shaw Alexandra, Welburn Susan C
School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
School of Veterinary Medicine Department of Disease Control, University of Zambia, P.O Box 32379, Lusaka, Zambia.
Infect Dis Poverty. 2017 Oct 10;6(1):150. doi: 10.1186/s40249-017-0363-6.
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.
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.
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 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.
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.
由罗德西亚布氏锥虫引起的急性人类非洲锥虫病（rHAT）死亡率高，若不治疗则会致命。仅有少数研究探讨了rHAT对心理、社会和经济的影响。在本研究中，采用定性和定量相结合的研究方法，评估rHAT对赞比亚曼布韦、鲁丰萨、姆皮卡和查马地区的社会经济影响。
利用医院记录并与社区进行讨论，追踪2004年至2014年期间被诊断为rHAT的个体。使用结构化问卷对他们本人或其家人进行访谈，并与受影响社区进行焦点小组讨论。采用伤残调整生命年（DALYs）来调查疾病负担，分别计算有无贴现及年龄加权的情况。还调查了长期残疾对rHAT负担的影响。
本研究共识别出64例病例。大多数病例处于第二阶段，死亡率较高（12.5%）。未进行贴现或年龄加权时，DALYs总数为285。纳入长期残疾后，这一估计值增加了50%，达到462。残疾生存年数（YLD）占未贴现且未进行年龄加权的DALY总数的比例从6.4%增至37%。2013 - 2014年采用更积极的监测方法后，识别出的病例数大幅增加，表明报告不足的情况很严重。同样，女性比例大幅上升，表明被动监测可能尤其未能涵盖这一群体。每位患者因感染平均损失4.9个月的生产时间。健康后果包括疼痛、失忆和身体残疾。社会后果包括耻辱感、辍学、失去朋友和自尊。焦点小组讨论的结果揭示了社区成员中存在的误解，这可能归因于对rHAT缺乏了解。
rHAT对农村家庭和社区的社会经济影响巨大。需要改进监测并加强当地医疗服务，以实现早期准确诊断。对于有rHAT风险的社区，应优先进行疾病预防，并采取干预措施防止人畜共患病从家畜和野生动物传播。需要采取支持性措施减轻rHAT导致的残疾的长期影响。
