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Table 1 Impacts of social conflict on sleeping sickness in sub-Saharan Africa

From: Civil conflict and sleeping sickness in Africa in general and Uganda in particular

Impacts and vulnerabilities associated with conflict

Impact on transmission determinants

Parameter impact

Economic and global effects

• Reliance of governments on external funding for control resources and donor reluctance due to political insecurity

Reduction in provision of public health services

↑ 1/r in people

• Reduced reliability of economy for international investment and aid

  

• Collapse of businesses and local economies. Loss of employment, income &provision of products & services

Decreased treatment and control of animal infection and transmission

↑ 1/r in animal reservoirs

• Abandonment or appropriation of land; changes in land ownership and land use. Possible increased vector habitat

  

• Loss of educated and business elite in cases of emigration, exile, or purging; decreased overall response capacity and economic stability

Decreased vector control

↑ 1/u, ↑m

Decline of health systems and services

• Absence of public health funding due to economic collapse, corruption, or re-allocation of funds to security or military expenses

Reduction in provision of public health services

↑ 1/r in people

• Collapse or decline in training programs for public health, veterinary, and vector control workers; decline in personnel and expertise; limited surge capacity for outbreak response

Decreased treatment and control of animal infection and transmission

↑ 1/r in animal reservoirs

• Total absence of case surveillance or reporting in some rebel-controlled areas or high-conflict zones; limited screening/treatment

  

• Demotivation of health care, veterinary and vector control personnel caused by insecurity, inflation, or no pay

Decreased vector control

↑ 1/u, ↑m

• Collapse of vector control and veterinary health programs

  

Forced migration and internal displacement of populations

• Increased mortality and morbidity due to conflict violence

Increased exposure of people and cattle to tsetse habitat

↑ a

• Transport of people and animal hosts, vectors, and parasites into potentially naïve or uninfected populations

  

• Loss of livelihoods – increased stress, reduced household resources, reduced health &nutritional status

Increased vector habitat

↑m

• Decreased access to health facilities; decreased population health

Increased mortality

-

• Separation of household units

  

• Abandonment of land; vegetation re-growth; increased vector habitat

  

Regional insecurity and restricted access for external humanitarian support

•Treatment facilities prone to looting and insurgent attacks

Reduction in provision of public health services

↑ 1/r in people

• Insecurity in affected regions constrains or prevents control and implementation logistics; access of mobile teams limited

Increased mortality

-

• Lack of integration and continuity in primary care where a range of NGOs are the dominant providers of health and intervention services.

  

• Patients delay seeking medical help due to travel insecurity or unavailable transport; higher proportion of late-stage or unreported and untreated cases.

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