Trypanosomiasis cases cluster analysis for localization of interventions in endemic Malawi sites

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Kamuzu University of Health Sciences
Study type We are proposing to conduct the following study types  Desk analysis of patient archived samples leading to geospatial maps  Cross-sectional surveys of tsetse densities and HAT in mapped cluster sites Problem In Malawi, trypanosomiasis is a latent threat due to interaction between humans and wild animals. Human cases usually occur as a result of tsetse fly bites in animal reserves where the vectors are found. For the past five years, Rumphi and Nkhotakota districts have experiencing outbreaks which demonstrates that the risk in this environment is growing. It was noted however in our recent work in these districts that the infected individuals present very late at the hospitals. Late presentation means case management with very toxic drugs, and which also requires hospitalization. It is not yet understood why a lot of people prefer to report late at the hospital. But of most importance is to influence people to recognize signs and symptoms early enough for them to seek medical care. We propose to use the already existing medical records of the trypanosomiasis cases admitted at the district hospitals to trace where they came from in order for us to understand factors that are affecting transmission in those areas. Once the areas are identified we would want to engage with the people in those area and train them on how to use Targets (tsetse control measure) to reduce the area density of tsetse flies. Tsetse flies are vectors of transmission for trypanosomiasis. Our major hypothesize therefore is that mapping human cases will show area clusters of infections which can be easily targeted for interventions. Objectives The main aim is to trace geospatially where trypanosomiasis cases are coming from in order to find ways of introducing area specific control interventions in Rumphi and Nkhotakota districts Methodology The study is divided into two interacting work packages: Work package one (WP1) is to use case report forms from the hospital archives, to identify villages where trypanosomiasisi casescome from in order to understand factors influencing transmission. Work package two (WP2) is to train communities in WP1 above on how to identify Tsetse high density areas and how they can control transmission by using tsetse targets (insecticide treated cloths). Expected Findings and Dissemination We hope to pinpoint exactly where the interventions should be targeted and inform them what interventions will work in those areas. With current Centre for Disease Control efforts of using Tsetse targets to reduce transmission we want to empower communities to be able to make and deploy targets on their own as a control strategy. The results will be shared with the local communities, the district executive committee and the ministry of health for policy decision making.