[The Mandoul human African trypanosomiasis focus in Chad: from evaluation to control]

The Mandoul focus of human African trypanosomiasis in southern Chad was first described by Gaston Muraz in the 1920s. After 40 years of control measures, case reports became rare and the focus was forgotten. However the number of cases began to increase in 1993 and coordinated control measures were implemented in 2002. The first phase of control consisted of mapping out the focus that was shown to involve 45 villages and camps on both sides of the Mandoul River. The estimated number of inhabitants in the area is 20.000 and the endemic prevalence was 3.78%. Dynamic passive screening and regular active screening undertaken in the framework of the Chadian human African trypanosomiasis control program with the assistance of expert technicians from the subregion reduced the prevalence to 0.77% in 2006. Although this reduction is encouraging, control measures must be maintained and greater involvement of the health care system will be needed to achieve sustainable control of the disease and ultimately to eliminate human African trypanosomiasis as a public health problem.