CAXITO, Angola, (AlertNet) – Angola risks being ravaged by deadly sleeping sickness as hundreds of thousands of internally displaced people return home in peacetime, spreading the parasite that causes the disease, Médicins Sans Frontières (MSF) warned.

The global medical-relief organisation said the scourge -- officially known as Human African Trypanosomiasis (HAT) – was in danger of making a lethal comeback after being almost eradicated before Angola’s devastating 27-year civil war, which ended almost two years ago.

“Sleeping sickness is spreading,” said Richard Mathela, an MSF doctor who runs a screening and treatment centre in Caxito, Bengo province. “It can only increase with the movement of people.”

The World Health Organisation (WHO) estimates that up to half a million people in sub-Saharan Africa suffer from the disease, which is unique to the region and is spread by bites from infected tsetse flies.

If left untreated, it kills by attacking the central nervous system and provoking severe neurological disorders.

In parts of Angola, the Democratic Republic of Congo and southern Sudan, prevalence rates are between 20 and 50 percent, and WHO has said sleeping sickness is more deadly than HIV/AIDS in some places.

MSF partner the national Institute to Combat and Control Trypanosomiasis (ICCT) said the disease killed 96 people in Angola last year. But the figure only takes into account those undergoing treatment in the seven provinces monitored by medical groups.

The total number of deaths is likely to be much higher, with MSF warning that the tsetse fly has been found in 14 of Angola’s 18 provinces, putting 4.3 million – one third of Angola’s population – at risk.

HANDS FULL

The disease’s spread is exacerbated by the movement of millions of displaced Angolans following a 2002 peace accord between the government and its arch foe, the UNITA rebel movement.

Angola, struggling to get back on its feet after three decades of civil war, already has its hands full rebuilding the shattered infrastructure and services, as well as trying to curb the spread of HIV/AIDS.

“I don’t think sleeping sickness is a priority,” Mathela said. “If it is, it’s one of many.”

The illness typically shows few symptoms for up to 10 years. Even then, the early signs include fever, headaches and muscle pain – complaints associated with a host of diseases including malaria and influenza.

Only when the parasite passes from the blood into the brain does the victim start to suffer sleep disruption and other neurological complaints.

“In this second phase, patients sleep a lot during the day, but not at night, hence the name,” Mathela said. “They become foolish, their behaviour changes and sometimes they look like they’re on drugs.

“Once the parasite is in the brain, the patient cannot survive for more than three years without treatment. They slip into a coma and die.”

Because sleeping sickness is difficult to detect, many sufferers are only diagnosed by chance.

Manuel Joao Andre, a painter from Luanda, was worried because he was losing weight and suffering headaches, drowsiness and stiffness in his neck.

“I had no idea what was wrong with me,” he said. “Then I heard from someone about sleeping sickness and about this centre here in Caxito. I came yesterday for a test and was admitted to the hospital immediately.”

His spirits were high, mostly due to relief that his puzzling condition has finally been diagnosed.

Across the ward, 18-year-old Engracia was not so cheery. Staring like a zombie into space, she seemed barely aware that her mother and sister are visiting.

Five years ago, she and her family moved to Luanda from Kwanza-Norte, one of the worst affected provinces. Mathela fears that cases like Engracia’s are only the tip of the iceberg, and that as others return home, the disease will spread unchecked.

TOXIC DRUGS

Both Manuel and Engracia were to be put on drips containing the drug eflornithine (DFMO) to fight the infection coursing through their brains.

DFMO, supplied free by French drug giant Aventis, is only slightly less toxic than the main drug used to treat the disease, Melarsoprol (Arsobal), which is based on arsenic and can cause inflammation of the brain.

Melarsopal kills around seven percent of patients who use it.

Mathela is calling for more research and development to find less toxic, more effective drugs that can treat the disease over the long term.

“Yes, we can treat patients, but more and more people are dying every day because of these old, toxic drugs,” he said. “There is sometimes a resistance to the drugs and the patients have a relapse.

“What we need is good organisation, good collaboration to improve our strategies, make active screenings and improve our coverage. We need to find an alternative drug, and to improve our technique for screening patients so that not so many slip through the net.”

MSF said it could not do this alone, and needed the support of public- and private-sector research institutes, governments and the international community to improve screening, control and treatment if the disease’s spread was to be curbed.