A risk reduction approach to tsetse and African trypanosomiasis control : case study the canvas method

African trypanosomiasis is an inherently multiscale human-animal-environment problem, with a spatially and environmentally constrained vector, a transnational disease distribution, two distinct disease strains (East and West African), innumerable human and animal reservoirs, and entrenched socio-cultural barriers and policy challenges. Colloquially known as 'sleeping sickness' and 'Nagana' in animals, African trypanosomiasis is a parasitic infection caused by pathogenic protozoa of the genus Trypanosoma. The parasite is transmitted through the salivary glands of tsetse fly during a blood meal. African trypanosomiasis is a major neglected tropical disease endemic to 36 countries in sub-Saharan Africa. Neglected tropical diseases are communicable, viral, parasitic, and bacterial infections that mainly affect poor people. Worldwide, neglected tropical diseases are not allotted the resources necessary to control and eradicate them. As a neglected tropical disease, African trypanosomiasis is given a lower global health priority which hinders control program effectiveness. Despite decades of research to control tsetse, trypanosomiasis continues to threaten the health and well-being of people and animals across sub-Saharan Africa. Compounded by resource constraints for control efforts, African trypanosomiasis is also poorly understood, severely underreported, often misdiagnosed, and fatal. The disease has a case fatality rate of nearly 100%, if untreated. While treatment is available, they are often expensive and toxic. Annual deaths attributed to African trypanosomiasis have a compounding impact across human and animal populations and the landscape. An estimated 60 million Africans and countless livestock are at risk of the infection, illuminating the need for risk reduction approaches to mitigate exposure. This dissertation examines tsetse and African trypanosomiasis control from an interdisciplinary perspective, combining health geography, disease ecology, diffusion of disease epidemiology, development economics, and global health policy. As a more general contribution, this dissertation presents a framework for addressing vector-host problems, using a multifaceted risk reduction and control strategy, innovative methodologies, and community participation to increase long-term success.