Current situation of African trypanosomiasis.

African trypanosomiasis (sleeping sickness) is fatal, if untreated, and occurs in 36 African countries, south of the Sahara, where some 50 million people are at risk of acquiring infection. In the absence of adequate control measures epidemics occur, which are costly and difficult to control. The history of sleeping sickness has been characterized by waves of epidemics, resurgences and outbreaks. Nevertheless, sleeping sickness has been brought practically under control in the early 1950s, in West and Central Africa, through systematic surveillance of the population at risk and in East Africa, mainly by vector control. Following the attainment of independence from colonial rule in subsequent years, failure by national health authorities to give due attention to sleeping sickness control, due to civil and political unrest, lack of adequate resources and competing national health priorities, has resulted in epidemics and the recrudescence of many old foci and the appearance of new ones. Thus, sleeping sickness is currently a major concern among many countries, particularly in East and Central Africa. During the past decade, progress has been achieved through research in the development of new tools for diagnosis, which are simple to use by national health personnel and for vector control, which can be used at the community level. Eflornithine, a new drug, has been registered for the treatment of gambiense sleeping sickness, and although it is expensive, it is relatively safe and provides an alternative therapy to the existing treatment, which may cause severe adverse effects. These tools have raised hopes for improved control, but their integration into health care systems, which could improve surveillance of the population at risk, has been slow. In view of the worsening economic situation of endemic countries, and the focus of attention and resources on the AIDS pandemic, prospects of any significant improvement in the sleeping sickness situation would largely depend on the successful mobilization of external resources.