Developing gendered One Health understandings of sleeping sickness across communities and the veterinary, conservation, and medical sectors in the Luangwa Valley in Zambia

This thesis explores how gender roles, institutional processes, environmental and climatic changes interact to shape exposure, risk, vulnerability, and responses to the East and Southern African trypanosomiasis in Mambwe District, Zambia. This thesis examines sleeping sickness within a Game Management Area ecological and socio-political context where conversation and health policies shape the health and livelihoods of people. While global evidence on the health impacts of human African trypanosomiasis, particularly the western African form, is well documented, there is limited research on the systemic factors influencing risk and persistence of the acute form found in East and Southern Africa. Rooted in intersectionality and gender performativity theory, vulnerability theory, and social systems thinking, I employ a qualitative methodology drawing on in-depth interviews, key informant interviews, and observations to examine how macro processes intersect with individual characteristics to shape the experience of risk of contracting sleeping sickness; suffering from associated consequences and the systemic pathways through which vulnerability to the disease is produced and sustained. The findings reveal three key insights. First, that gender norms and role socialisation of children shapes disease exposure, risk, vulnerability, and utilisation of healthcare. The performance of gendered roles and livelihood activities by women, men, and children increases their exposure to tsetse-infested areas. Second, that limited diagnostic and treatment capacity in rural healthcare facilities, combined with health and conservation policy gaps, inadvertently result in structural violence, producing a cycle of suffering and unaddressed disease burden in the three chiefdoms. The findings also reveal significant gaps in community knowledge of sleeping sickness, contributing to symptom normalisation and late health seeking. Third, that environmental and climatic changes such as prolonged droughts and floods, affect the farmers’ mobility and access to already distant healthcare facilities. The findings show that conservation policies and limited investment in infrastructure in GMAs intersect to constrain transport options for the farmers further delaying timely access to diagnosis and treatment. When considered together, lack of equitable distribution of health resources and infrastructure such as roads and healthcare facilities constrain the participants’ ability to access healthcare services, receive diagnosis and treatment of possible cases of sleeping sickness. These findings highlight the urgent need for interdisciplinary One Health responses that incorporate non-biomedical evidence and account for both proximate and structural drivers of vulnerability to sleeping sickness.