Diagnosis and TreatmentThe diagnosis for rHAT is the detection

 Diagnosis and TreatmentThe diagnosis for rHAT is the detection of trypanosomes from blood or chancre aspirate by microscopy. T.b. rhodesiense can be more frequently observed in blood in the first stage than T.b. gambiense, but the two species cannot be differentiated by microscopy. Lumbar puncture follows to define the clinical stage and chemotherapeutic choice from presence of the parasites and the number of white cells in the cerebrospinal fluid (CSF). Molecular diagnosis is available using Real Time Polymerase Chain Reaction (qPCR) or Loop-Mediated Isothermal Amplification (LAMP) to detect the serum resistance-associated (SRA) gene, which can differentiate the species.  There are no rapid diagnostic tests (RDTs) for T.b. rhodesiense, in contrast, RDTs are used for screening T.b. gambiense in health facilities. The treatment for the first stage is suramin, given by intravenous injection.  Adverse reaction is frequent but usually mild and reversible. Since suramin does not cross the blood–brain barrier to kill trypanosomes in the CSF, patients at the second stage are treated with melarsoprol, which is the only drug available for the second stage. However, It causes severe adverse reactions such as reactive encephalopathy and polyneuropathy, it leads to death in 1-5% of patients with an 8.4% of fatality rate(7). All drugs are provided free of charge by the World Heath Organization.   In cattle, the clinical diagnosis is difficult because symptoms are unspecific. Microscopic examination of blood is used for the detection of trypanosomes. Curative treatment is diminazene diaceturate. Drugs such as isometamidium chloride and quinapyramine sulphate and chloride can be used as prophylaxes.  No vaccines are available for humans and cattle. SurveillanceIn human health, the National Sleeping Sickness Control Program by the Ministry of Health is responsible for HAT national surveillance in Uganda. Due to the transition from active surveillance to passive in 2005, it now relies on case reports from the health care system. In newly affected districts, namely, Dokolo, Kaberamaido, Sotori and Serere, three county-level hospitals provide diagnosis and free treatment for any referral patients. It is very important that health care workers at a lower level in the health system, where people at risk of the infection can visit, have knowledge about HAT and refer the suspected patients to those referral hospitals. A previous study showed that only 60 % of the health care workers at parish level in those four districts were aware of HAT and the major source of information was radio and newspaper accounting for 40%(8). The reinforcement of the referral system and the training of health care workers at the community level are vital to find cases at an early stage. The prevalence infection of trypanosomes among cattle is unknown. The official policy, Uganda’s Animal Disease Act, restricts the movement of livestock from endemic areas of AAT to non-endemic areas and all cattle in endemic areas must be treated with trypanocidal treatment by a veterinary officer(9). According to the interviews with farmers in Sotori and Serere Districts, it is not regularly enforced and even when it is done, they are not informed of what treatment was given to cattle by the veterinary officer(10). In these areas, the livestock movement restriction is strictly enforced due to the past outbreaks of Foot and Mouth Disease. Strengthening the enforcement of the veterinary policy will prevent not only AAT but also brucellosis and bovine tuberculosis, which can be threats to human health. Control There are three main methods for controlling T.b. rhodesiense: tsetse control, mass treatment of cattle, and early detection and management of rHAT cases. In terms of vector control, there are a wide range of techniques such as sequential aerial spraying or ground spraying of pyrethroids, tsetse trapping, odor baits, selective bush clearing and the release of sterile males to reduce transmissions. However, spaying of insecticides has to be implemented widely, which is expensive and dependent on donor support.Decreasing the prevalence of T.b. rhodesiense in cattle interrupts transmission among human and cattle populations; cattle are the main reservoir for T.b. rhodesiense. Restricted application (RAP) is a method of spraying insecticides on tsetse predilection sites, the legs and belly of cattle, which is effective and three times cheaper than the traditional pour-on method(11). This also can prevent tick bites, which causes other infectious diseases and anemia in cattle. In the SOS program, approximately 500,000 cattle were treated with insecticides and a single dose of trypanocides. The result shows a 75% decrease in the prevalence of T.b. rhodesiense in cattle in seven districts(12). This approach is more feasible and sustainable for farmers with limited resources.ConclusionTo prevent the further expansion of T.b. rhodesiense, firstly, the health services and training health care workers should be reinforced, which will increase number of detecting cases. Secondly, the enforcement of veterinary policy should be strengthened in terms of preventing cattle and humans from contracting the infection and increasing the productivity of livestock. Finally, better communication and coordination among health care workers veterinary personnel, and communities will enable them to localize the affected areas immediately to address the disease control.