Illustration of a young man resting with closed eyes against the trunk of a large tree in a forest, wearing a sleeveless shirt and green shorts, while a tsetse fly hovers nearby

Neglected No More: Transforming African Sleeping Sickness Care

ByHayley Frend

A new study shows a safer, simpler treatment for the deadly, neglected disease that has long challenged rural communities in Africa.

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Imagine being bitten by a fly and falling so ill that you are told your only treatment option carries serious dangers of its own. A tiny parasite has long challenged doctors in rural Africa, but a new study may finally make treatment simpler and safer.

What is Sleeping Sickness?

Human African trypanosomiasis (commonly known as sleeping sickness) is a parasitic disease caused by a protozoan, a single-celled organism. It’s transmitted by the bite of an infected tsetse fly, which lives only in sub-Saharan Africa.

There are two types of human African trypanosomiasis (HAT) based on which parasite species has caused the disease:

1-Trypanosoma brucei gambiense (West & Central Africa)

  • Causes over 95% of cases.
  • Progresses slowly. Symptoms may not appear for months or even years.
  • More common, but somewhat easier to treat and control.

2- Trypanosoma brucei rhodesiense (East & Southern Africa)

  • Much rarer but more dangerous.
  • Symptoms appear within weeks, and the disease progresses quickly.
  • Without treatment, often fatal within months.

The fast-acting, acute form produces symptoms that appear quickly, often within a few weeks of infection. Early signs usually include fever, headache, muscle and joint pain, and swollen lymph nodes. It can also cause skin rashes and swelling at the site of the tsetse fly bite. As the disease progresses, the parasite invades the central nervous system, leading to neurological symptoms such as confusion, poor coordination, personality changes, and disruption of the sleep cycle, the hallmark feature that gives the disease its name. Without treatment, the illness is typically fatal. 

The recent Lancet study focuses on this rarer, but faster form.  

If it’s rare: why do we care? 

Human African trypanosomiasis (HAT) is one of a group of illnesses called Neglected Tropical Diseases (NTDs). Although some of these diseases are relatively rare, together they affect a huge number of lives, with 1.5 billion people needing treatment for an NTD every year. They mostly affect people in low-income countries, yet attract little research or funding compared with high-profile illnesses such as HIV or malaria.

 Result:

  • Less funding for research, new treatments, or healthcare delivery.
  • Fewer incentives for pharmaceutical companies to develop new drugs.
  • Communities affected by these diseases are “neglected” in terms of global health priorities.

It is important to remember that behind the statistics are countless personal, tragic stories. Sleeping sickness, in particular, primarily affects adults in their working years. When the family’s main provider becomes seriously ill, the consequences ripple outward: lost income, interrupted education for children, and added strain on already stretched resources.

Being sick in a rural village adds another layer of difficulty: clinics may be far away, medicines scarce, and even basic tests can be hard to come by. Every day becomes a challenge, as families balance caring for the ill with keeping the household running. 

Rare…for now

In recent years, great progress has been made in reducing the number of HAT cases across many countries. In fact, in August 2025, Kenya won a remarkable victory: the World Health Organisation officially validated it as having eliminated rhodesiense human African trypanosomiasis as a public health problem. It is now the tenth country globally, and the second in Africa after Rwanda, to reach this milestone. 

However as rare as the HAT-rhodensiense is, it is also unpredictable. Outbreaks have appeared suddenly in the past, often reemerging years after the last known case. The ability of the disease to be carried by animals and the unpredictable way in which it passes to humans mean future outbreaks are always a concern.

And in the meantime, in those areas where human African trypanosomiasis rhodesiense is still a problem, patients face a tough and not always effective treatment regimen. 

Toxic and Time-Consuming: The Burden of Traditional HAT Therapy

Picture this-

A farm worker living in a rural African village has just begun his morning’s work at the forest edge when he feels a sharp sting. By lunch time, the bite mark is swollen and sore. Within a couple of days, he has a fever and swollen lymph nodes. He carries on working but is trying to ignore the weakening he can feel creeping into his body.

In the next few weeks, his symptoms worsen- his muscles hurt, he loses weight, and his fever never goes away. At this point, he attends the local clinic. Had he not, the parasite would have reached the brain, causing him to become confused, unable to sleep at night, but drowsy during the day. If he had remained untreated, he would have experienced severe neurological decline, eventually slipping into a coma and dying. 

At the clinic, they conduct a lumbar puncture to detect if the parasite has yet reached his central nervous system. They use a long hollow needle to remove cerebrospinal fluid and analyse it for the presence of the parasite. This procedure is painful and can be frightening. Not every local clinic has access to the appropriate sterile needles, gloves, and antiseptics to make this procedure as safe as possible.

In our farmer’s case, they can see the parasite has not yet reached the central nervous system. Therefore, they treat him with Suramin. This treatment requires a series of slow IV infusions over several weeks. This can be prohibitively disruptive for many families. 

An IV drop in a basic hospital room. The room is in shadow with a shard of light from a window falling on the IV stand.

Image by Bushra Islam

If our farmer had been found to already have the parasite within his central nervous system, a different treatment approach would be needed. He would have been treated with Melarsoprol– an arsenic-based medicine first used in the 1940s. Historically, it has been the only possible treatment for late-stage HAT- Rhodesiense, but its toxic nature means it is more of a last-resort treatment than a safe therapy. It is so toxic that it causes dangerous brain inflammation in 5-10% of patients, and half of these cases are fatal. 

So to conclude, the traditional landscape is bleak- a lack of treatment is fatal, accurate diagnosis is painful, early treatment is lengthy and inconvenient and late treatment is often toxic. Clearly, new approaches are desperately needed. 

The Breakthrough Treatment Changing HAT Forever

The new treatment approach presented in a recently published research paper is a huge game-changer. 

The multinational team from Kenya, Malawi and Switzerland tested whether fexinidazol, a drug recently discovered to be effective for the other, slower type of African sleeping sickness, could also help patients with HAT-rhodesiense . They treated 45 patients with fexinidazol and found it successfully treated both early and late stage sufferers. Importantly, no late-stage patients died from fexinidazol treatment, as would be expected with the toxic melarsoprol treatment. This means the new drug is far safer than melarsoprol, the old late-stage last-resort option. Not only this, but the treatment can be given as a tablet- making it much easier and more convenient than the traditional early-stage treatment, which requires lengthy stays in hospital to get medicine through an IV. 

Another crucial difference is that this is the first time a treatment has been shown to be safe and effective for both early and late-stage HAT- Rhodesiense. This is a huge leap forward, as it means clinics can do away with the painful and complicated lumbar puncture. 

Study flow diagram showing enrolment, treatment, and outcomes for patients with Rhodesiense African sleeping sickness treated with fexinidazole. The chart tracks how many people were screened, included, treated, and followed up, with most completing treatment successfully and only a small number lost to follow-up or with adverse outcomes.

Image from original study paper. Matovu, E., Nyirenda, W., Eriatu, A., Alves, D., Perdrieu, C., Lemerani, M., … Valverde Mordt, O. (2025). Fexinidazole as a new oral treatment for human African trypanosomiasis due to Trypanosoma brucei rhodesiense: a prospective, open-label, single-arm, phase 2–3, non-randomised study. Lancet Global Health, 13(5), e910–e919. https://doi.org/10.1016/S2214-109X(25)00016-6

Hope, Safety, and Fairness: What This Breakthrough Means

This breakthrough offers more than just another drug. It offers easier, safer and more humane treatment for those who desperately need it. It offers reassurance that, should this disease turn epidemic once again, modern medicine is ready with effective tools. And it offers hope– that the world will no longer turn its back on sufferers of neglected tropical diseases.

Science is showing us new paths forward, but only if we continue to invest. After all, why should the poorest communities still be asked to endure century-old, toxic treatments when safer, smarter options are within reach?

Tonights Dinner Table Discussion

Here’s some ideas to spark a fascinating discussion.

  • Why do you think diseases that mainly affect poorer countries often get less research funding than conditions like cancer or diabetes?
  • Why do some health stories (like Ebola or COVID-19) make headlines worldwide while others remain invisible?
  • How might new medicines change not only patients’ health but also the wellbeing of whole families and communities?
  • Should high-income countries invest in diseases they don’t face at home? Why or why not?
  • Is developing new medicines enough if health systems in remote areas can’t deliver them?

Big Family Question:

If you were in charge of global health spending, how would you decide which diseases to prioritise?

Looking for more family-friendly discussion prompts? Explore our child-focused version of this blog here.

Curious but cautious?

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