Prevalence of human African trypanosomiasis and its associated risk factors in Itezhi-tezhi district of Zambia.

Abstract

Human African Trypanosomiasis (HAT) is a debilitating zoonotic disease caused by trypanosomes which are transmitted by tsetse flies of the genus Glossina. This study aimed to determine the prevalence and risk factors of HAT in Itezhi-Tezhi (ITT) District of Zambia through active surveillance. Human infective trypanosomes have been demonstrated to be in circulation in cattle and tsetse flies as well as wildlife. Equally, ITT has HAT epidermic and sporadic case history. This was a cross-sectional study that collected 114 blood samples from febrile patients aged 11 years and above with history of tsetse fly bites in ITT district. Samples were subjected to four tests namely packed cell volume (PCV), microscopy, internal transcribed spacer (ITS)/serum resistance antigen (SRA) polymerase chain reaction (PCR) and SRA loop mediated isothermal Amplification (SRA-LAMP). Structured questionnaires collected data on risk factors as well as the district’s health delivery system through patients and health worker interviews respectively. Chi-square test was used to check for association between PCV and risk factors. P- values under 0.05 were considered statistically significant. A total of 22 samples had PCV below the minimum acceptable value of which 13 were males and nine were females. Low PCV was more in individuals in the age range of 21-30 and least observed in age range of 31-40 years. Low PCV was also observed more in farmers and least in unemployed individuals. Low PCV was statistically associated with participants source of water for domestic use and animals kept at home with p=values of 0.028 and 0.012. There was no discrepancy in results for microscopy, PCR and LAMP tests as all samples tested negative on the three platforms giving zero % prevalence. Risk analysis revealed that people in ITT district were at a higher risk of contracting HAT due to their activities, including proximity to Kafue National Park and availability of tsetse fly vector. There were inadequate health personnel trained in HAT, HAT treatment guidelines, basic tools for HAT diagnoses, HAT education to the community and referrals of patients with ceaseless fever. Health delivery systems present were inadequate to support robust HAT surveillance. Key words: Human African Trypanosomiasis, surveillance, risk factors, health delivery system, Itezhi-Tezhi.