UNAMID peacekeepers from Nigeria register locals at a clinic in Labado, East Darfur. War and disease are tightly linked in Africa. (Photo/ Albert González Farran, UNAMID)

Want To Understand The Spread Of Disease In Africa? Follow The Gun Shots

LAST week, a five-day hackathon in Johannesburg, South Africa explored data solutions to health problems that have long cast a shadow on Africa’s well being.

The hackathon, organised by IBM, had medical researchers from around the world join forces with data scientists to map possible solutions to malaria, cancer and tuberculosis, using data—from both inside and outside the body—and IBM’s cognitive computing system Watson.

But perhaps they should have invited army generals too. And to fully appreciate just how much the guns fuel disease, one should follow the story of sleeping sickness in Uganda, starting in the early 20th century.

Spread by tsetse flies carrying trypanosome parasites, the sleeping sickness epidemic in Uganda was caused by two particular strains, Trypanasoma brucei rhodesiense and Trypanasoma brucei gambiense, the latter believed to have been carried down south by Emin Pasha’s Sudanese soldiers returning from eastern Congo, while the former had always existed within areas surrounding the southern shores of Lake Victoria.

The imposition of colonial rule led to serious  social upheaval: internal displacement of native Basoga in eastern Uganda running away from Ganda colonial agents, a three rupee hut tax imposed by the colonial government in 1894, which meant Africans had to open up new land to grow cash crops, and the opening up of trade routes through Busoga region to the Indian Ocean coast.


All these seem to have upset the delicate balance that the disease had maintained within the population.

According to records, somewhere between 250,000 and 300,000 people, one third of the Busoga population, succumbed to the epidemic. Although some accounts put the deaths at 3.5 million, it is disputable since there are no population records for Uganda before 1910.

The response from Britain was immediate: teams of doctors and scientists were dispatched to control the outbreak and people were forcefully moved from the tsetse fly infested areas. Treatment camps were set up in the Ssese islands in Lake Victoria, where the infected where quarantined.

Economic activity stalled as fishing on the lake was suspended, the natives, already weak from sleeping sickness (nicknamed “Negro lethargy”), reduced their labour output and production levels of cash crops like cotton plummeted.

The sleeping sickness epidemic was not limited to British East Africa. It was registered in Belgian Congo (today’s Democratic Republic of Congo), German East Africa (Tanzania), Senegambia, and Southern Africa. In Belgian Congo up to 500,000 people succumbed to the epidemic, caused by the T. b. gambiense strain, as King Leopold’s officers forcefully displaced thousands to provide labour in tsetse fly infested rubber plantations.

The colonial powers faced with such a threat to their imperial ambitions that they set aside their differences and collaborated to find a cure for the disease. A German research station in Lake Victoria’s Ssese islands under Dr Robert Koch experimented with different treatments for the disease, while King Leopold sought the help of British scientists to study the disease in Belgian Congo.


Sleeping sickness epidemics and major political events in Uganda, 1905–2000. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1851948/

By the 1940s, the sleeping sickness epidemic had largely been brought under control in Uganda, Tanzania, Congo, Sudan and parts of West Africa. The colonial governments had established health centres and research stations in areas prone to the disease as well as an extensive spraying campaign using insecticides like DDT.

The disease would decline up until the 1960s –  when most African countries obtained self-rule. The political upheavals in the 1960s and 70s, in places like Zaire, Uganda, Sudan and most of central Africa, led to reduced funding for health services and surveillance programmes, allowing the disease to creep back in endemic areas.

In Uganda’s Idi Amin’s reign of terror led to the collapse of the cotton industry in Busoga in the 70s, causing cotton fields to turn into bush thickets that attracted tsetse flies. By 1980 infections in Uganda had gone up again.

When refugees left villages for the safety of cities and towns, tsetse flies re-established themselves in the now overgrown farms. Also rebels, hiding from government soldiers in thickets and forests found themselves exposed to tsetse fly bites, helping in the re-emergence of the disease.


New cases of sleeping sickness reported in Africa since 1927. Disease peaks tend to correspond to periods of political upheaval. https://openi.nlm.nih.gov/detailedresult.php?img=PMC2253612_pmed.0050055.g001&query=&req=4&npos=-1


With the return to multi party politics in the 1990s in parts of Africa, as well as efforts by donors and international NGOs to curb the disease, sleeping sickness cases on the continent have been on a steep decline, except for places like Angola, DRC and South Sudan that are still undergoing conflict.


Conflict-prone D.R. Congo, Angola and South Sudan are at higher risk of sleeping sickness today


New cases of sleeping sickness on the continent have been in a decline since 1998, partly due to efforts by WHO and governments

As the the soldiers returned to barracks and the new breed of liberators sought to re-establish order, health services resumed working, veterinarians and vector control officers went back to work and refugees returned to their farms cases of the disease went down again.

But new research shows that sleeping sickness is notoriously difficult to eradicate completely, because the trypanosome parasite is adept at hiding undetected beneath the skin. In some cases there can be so few parasites in the person’s blood that current screening methods cannot identify the patients as being infected.

The logic in all this is simple: want to stop the flare up of epidemics on the continent? Make peace with the generals.

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