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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.