Socio-economic and cultural impacts of human African trypanosomiasis and coping strategies of households in the Busoga focus
This study was designed to investigate the socio-economic and cultural impacts of Human African Trypanosimiasis (HAT) and the coping strategies of households in the Busoga focus. Fieldwork for the study was conducted in Busia, Teso and Bunqoma districts of western Kenya, and Busia and Teso districts of southeast Uganda between January 2004 and June 2005. The main assumptions that guided the study were: health-seeking behaviour (HSB) perpetuates the impacts of HAT on affected individuals and households; HAT disrupts the social functioning of households; and HAT affects the economic base of affected households. Data was obtained through: review of hospital records; structured interviews; key informant interviews; in-depth interviews and focus group dlscusslona.Purposive sampling was used ~- ; to obtain the sample size of 481 from b0tt}.,HAT and non HAT respondents. The quantitative data obtained through structured interviews was analyzed using descriptive statistics and Xlll presented in the form of frequency and", percentage tables. On the other hand, the qualitative data, obtained through review-of hospital records, key informant interviews, indepth interviews and focus group discussions, was analyzed according to emerging themes using a grounded theory approach and presented in the form of case studies, excerpts and quotes. The main findings of this study indicate that delayed diagnosis of HAT led to severe somatic effects on the patients. The findings also reveal that the mental effects of HAT are pronounced among young patients who subsequeptly face diff'iculties fitting back into the community. Households affected by HAT experience increased financial burden as a result of seeking treatment from much different health service providers. The median time lag for starting HAT treatment was between three and four months and much of this time lag is attributable to the health service provider's failure to diagnose HAT. The disease was also sometimes erroneously attributed to HIV/AIDS or witchcraft, causing patients to be stigmatized, delay seeking treatment or to seek treatment from wrong sources. The findings also show that HAT disrupts the normal functioning of affected households. This is manifest through conflicts within marriages, families and the community and reversal of roles, which increased the burden and responsibilities of women and children. On the socio-economic front, the study reveals that HAT impoverishes households through reallocation of household resources to meet the increased financial expenses for seeking treatment and care. Other economic impacts,were school drop-outs, school absenteeism, -" reduced productivity and increased funeral and burial expenses. . -~ This study therefore recommends the in-sti,jutinq' of continuous, concerted inter-border r .: measures to reduce the incidences of HAT. In line with this, it is necessary to put in place strategies for effective case finding of HAT at an early stage of HAT. This can be achieved by building the capacity of primary health care personnel to diagnose HAT and to increase ~ . their awareness about the same. Similarly, people at risk of HAT should be empowered with relevant information to help them recognize the symptoms of the disease early. Finally the I study recommends the establishment of strategies that would assist HAT patients to be integrated back into the community. This study contributes rich information on the socioeconomic and cultural impacts of HAT that can be used by policy makers and programme implementersto make informed decisions that will help abate the impacts of HAT, as well as give HAT the attention and priority it deserves, considerinq that it is one of the neglected diseases. Additionally, this study reveals that diseases like HAT are an important chain in the cycle of poverty.