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There are three stages to case management:
· Screening is the initial sorting of people who might be infected. This involves checking for clinical signs or the use of serological tests.· Diagnosis shows whether the parasite is present. The only sign, one that has been known for centuries, is swollen cervical glands.
· Phase diagnosis shows the state of progression of the disease. It entails examination of cerebro-spinal fluid obtained by lumbar puncture and is used to determine the course of treatment.
The long, asymptomatic first phase of T.b. gambiense sleeping sickness is one of the factors that makes treatment difficult. Diagnosis must be made as early as possible in order to preclude the onset of irreversible neurological disorders and prevent transmission. Case detection is difficult and requires major human, technical and material resources. Since the disease is rife in rural areas among poor people with little access to health facilities, this problem is all the more difficult.
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