By Sharon Atieno
Guinea has eliminated the human African trypanosomiasis (HAT) or sleeping sickness as a public health problem.
It has managed to control the gambiense form of the disease to below the World Health Organization (WHO)’s threshold of one case per 10 000 inhabitants in all endemic areas.
With symptoms ranging from fever, headaches, joint pain and, in advanced stages, neurological symptoms like confusion, disrupted sleep patterns and behavioural changes, sleeping sickness is a vector-borne parasitic disease caused by infected tsetse flies.
There are two forms of the disease: one caused by Trypanosoma brucei gambiense, found in 24 countries in West and Central Africa and which accounts for more than 92% of cases; and another caused by Trypanosoma brucei rhodesiense, found in 13 countries in East and Southern Africa accounting for the remaining cases.
“The elimination of sleeping sickness is the result of many years of effort by the Guinean government, its partners and communities in the overall context of the national policy to combat all neglected tropical diseases,” said Dr Oumar Diouhé BAH, Guinea’s Minister of Health and Public Hygiene.
Since the resurgence of sleeping sickness along Guinea’s coast in the 1990s, the country has worked with different stakeholders to control the disease.
Guinea’s Ministry of Health and Public Hygiene established the National Programme for the Control of HAT in 2002, with support from the World Health Organization (WHO) and the Institut de Recherche pour le Développement (IRD), and later from partners such as the Drugs for Neglected Diseases initiative and the Institut Pasteur de Guinée. The programme began with mass medical screenings to diagnose and treat cases effectively, marking a crucial step in controlling the disease.
The programme introduced vector control interventions in 2012 aiming to interrupt contact between people and tsetse flies. Initially implemented in the Boffa-East area, this strategy expanded nationwide by 2016, with nearly 15 000 impregnated mini-screens (with insecticides to attract and kill the tsetse flies) deployed annually.
However, from 2013 to 2015, the Ebola epidemic caused a suspension of medical activities, leading to a resurgence in HAT cases. In 2020, the COVID-19 pandemic posed further disruptions, but the programme adapted by implementing door-to-door HAT screening to maintain control efforts.
The success of these efforts is due to collaboration with local communities, ensuring that interventions were culturally acceptable and widely supported. Advances in diagnostic techniques, treatment delivery, and consistent financial and technical backing from partners also bolstered the programme’s impact.
“In Guinea, we have been fortunate enough to be able to set up an integrated programme in which all activities are carried out in a coordinated fashion, including diagnosis, treatment, vector control, awareness-raising campaigns, and community involvement. Research has always been a pillar of this programme and an essential prerequisite for any disease control activity. The goal is now ambitious: zero human cases of sleeping sickness by 2030,” said Dr Mamadou Camara, Coordinator of the National HAT Control Programme of the National Neglected Tropical Diseases Control Programme (PNLMTN-PCC).
“The elimination of human African trypanosomiasis by Guinea is a significant public health achievement. Vulnerable families and communities can now live free of the threat posed by this potentially fatal disease,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “I congratulate the government, health workers, partners and communities for this crucial milestone. “
“This Guinean success is a crucial step towards the elimination of this disease, which has devastated our communities in the past. Our collective efforts must now focus on maintaining this elimination, as the disease can re-emerge if we lower our guard.
“We are developing a new treatment called acoziborole which should help us to treat patients in the most remote areas, and which will play a key role in maintaining this elimination,” said Dr Mariame Camara, principal investigator of the clinical trials conducted by DNDi in Guinea to develop acoziborole.
Besides Guinea, seven other countries have been validated by WHO for eliminating the gambiense form of HAT: Togo (2020), Benin (2021), Côte d’Ivoire (2021), Uganda (2022), Equatorial Guinea (2022), Ghana (2023) and Chad (2024). The rhodesiense form of the disease has been eliminated as a public health problem in one country, Rwanda, as validated by WHO in 2022.