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SUMMARY
Human African Trypanosomiasis (HAT) is a vector borne parasitic disease transmitted to
humans by bites of infected tse-tse flies. It is one of the neglected tropical diseases that pose
millions of people in sub-Saharan Africa at risk of contracting the disease and is earmarked
for elimination by the World Health Organization (WHO). In 2006, Nigeria was listed
amongst endemic countries with transmission occurring in a known endemic focus of Delta
State however, it had been difficult to assess whether transmission is occurring elsewhere in
the country due to the lack of active surveillance in other parts of the country. Reports of
nuisance and bites from tse-tse flies by residents of the grazing reserve and the dearth of
literature on the prevalence of HAT in the grazing reserve led to the survey to determine the
knowledge and prevalence of HAT among residents of Kachia grazing reserve.
A cross sectional descriptive study was conducted using a multi-stage sampling technique
with probability proportionate to size. Respondents were administered structured
questionnaire on socio demographic characteristics, knowledge and practices relating to
HAT prevention and predisposition to risk factors for HAT infection by trained interviewers
and then screened for HAT antibodies using card agglutination test for Trypanosomiasis
(CATT). Knowledge of HAT was scored into 5 domains and categorized as poor knowledge
(score 0-2) and good (score 3-5). Predisposition to risk of infection was defined as frequent
exposure to ≥two known risk factors for HAT. A case of HAT was defined as any
respondent that tested positive on CATT. Descriptive statistics, bivariate and logistic
regression were used to analyse the data and significance was set at 0.05.
The mean age of the 300 respondents that were sampled was 39±17years. One hundred and
sixty-nine (56.3%) were males. Only 36(12.0%) had adequate knowledge on HAT and
120(40.0%) would seek medical help in a hospital if affected. Respondents exposed to risk
factors were 229(76.3%). Common practices relating to HAT prevention among
respondents included clearing of overgrown bushes around houses 297(99%), use of xiv
insecticidal treated nets and the use of protective clothing when visiting the bush 123
(41.0%). Male respondents Odds Ratio (OR) 5.0 (CI 1.8, 13.6), age of 40years and above
OR 5.0 (CI 1.1, 24.4) and family history of HAT OR 8.7 (CI 2.4, 32.1) were factors
associated with having good knowledge of HAT and practice of HAT prevention measures.
None of the 300 respondents screened for HAT antibodies tested positive.
The respondents‟ knowledge about HAT was poor despite lots of preventive measures being
put in place to prevent exposure to the insect vector. Though infested by tse-tse flies, a zero
prevalence of HAT was recorded in the grazing reserve. There is need for concerted efforts
both at the national, state and local government levels to be put in place to control these
vectors.
Key Words: Human African Trypanosomiasis, Prevalence, Knowledge, Preventive
practices
xv
CHAPTER ONE- INTRODUCTION
1.1. Background
Human African Trypanosomiasis (HAT) also known as Sleeping sickness is a serious
scourge to the African continent including Nigeria. It is one of the most neglected tropical
diseases[1] targeted for elimination by the World Health Organization (WHO) and millions
of people in 36 countries in sub-Saharan Africa are at risk of contracting the disease.[2] The
occurrence of HAT is restricted to the distribution of its vector; the tse-tse fly, which is
exclusively found in sub-Saharan Africa between 14°N and 20°S.[1] More than 250 discrete
active sleeping sickness foci are recognized, most of which are in poor and remote rural
areas where health systems are often weak. However, the disease has also been reported in
peri-urban areas.[1]
The disease which was in epidemics in the 1920s was controlled by active surveillance, case
management and vector control measures through aerial spraying and by the mid 1960s, the
disease had almost disappeared. After this success, surveillance was relaxed, and the disease
reappeared in several areas.[2] In 1986, it was estimated that some 70 million people lived in
areas where disease transmission could take place with an upward trend of new cases.[2]
This re-emergence of HAT has been attributed to war, migration[3, 4] of carrier populations
f
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