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[08/04/2005]
 Botswana
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Dr Francis Louis, IMTSSA, Marseille


> General Statistics | > Epidemiological facies | > Vectors | > Chemoresistance | > The Fight against Malaria | > Research Institutions | > Advice to Travelers | > Bibliography

 General Statistics

Area: 581,730 km²
Population: 1,464,167 inhabitants (estimated 1999)
Capital: Gaborone
Currency:  pula
Official language: English
Bordering Countries:  Zambia, Namibia, South Africa, Zimbabwe

Out of 192 countries, Botswana ranks 122nd   for life expectancy, 112th for infant mortality, 65th for GNP, 141st   for daily calorie intake, 134th   for literacy, 57th   for the percentage of children in full-time education (source: Atlas Encyclopédique Mondial, Nathan Ed., Paris 1996, pp.118-119).

Monthly rainfall is very low, not exceeding 10 mm from October to March and virtually non-existent from March to October. Average temperatures are less than 10°C for the months of June, July and August, but rise to 30°C during December, January and February.

It is commonly considered that there is a Southern gradient which receives less than 100 mm of rain per year. (Kalahari desert) and in the north where the yearly rainfall is more than 600 mm (Okavango Delta) 

 Epidemiological facies

Malaria in Botswana occurs as a result of the country’s hilly nature, temperature and rainfall. 

The vast majority of the country is spared malaria because of drought;

The Northern part of the country can be divided into two areas:

The band where transmission is seasonal and short, inferior to 3 months.

 

The band corresponding to the Okavango delta where the transmission of malaria is seasonal and long, in the range of 4 to 6 months.

 

According to Mouchet and Coll’s classification, the malaria here is of an unstable nature with southern settings: the transmission period is very short and there are even years where no transmission occurs. There is no acquisition of relative immunity. Malaria occurs in epidemic form during transmission periods and can affect the totality of the population. The 1988 epidemic is an example of such a case. (2).

Plasmodiumfalciparum represents more than 95% of the   parasites isolated (3).

 Vectors
Jacques Brunhes et al.(Les anophèles de la région afro-tropicale, logiciel ORSTOM Ed., 1998) compiled a list of 23 different species of anopheles in the country, of varying medical interest :Anopheles arabiensis, Anopheles argenteolobatus, Anopheles caliginosus, Anopheles cinereus cinereus, Anopheles coustani, Anopheles cydippis, Anopheles demeilloni, Anopheles distinctus, Anopheles funestus, Anopheles listeri, Anopheles maculipalpis, Anopheles nili, Anopheles pharoensis, Anopheles pretoriensis, Anopheles rhodesiensis rhodesiensis, Anopheles rivulorum, Anopheles rufipes rufipes, Anopheles squamosus, Anopheles tchekedii, Anopheles tenebrosus, Anopheles walravensis, Anopheles wellcomei ugandae  and Anopheles ziemanni. 
 Chemoresistance
 In 1988, M.J. Robinson noted an in vivo rate of  chloroquine-resistance RI + RII of 30% to 40%, without resistance RIII, but points out that in prophylaxis, the chloroquine + proguanil combination is ineffective whilst the dapsone + pyrimethamine (Maloprim®) combination remains very effective. In drug trials the sulfadoxine + pyrimethamine (Fansidar®) combination is consistently effective (2).

In 1993, J.M. Pridgeon reported the failures of    the chloroquine + proguanil combination and those, though rarer of the dapsone + pyrimethamine + chloroquine combination and proposed the treatment of patients with a halofantrine + chloroquine combination or a sulfadoxine + pyrimethamine + chloroquine combination, and even a sulfadoxine + pyrimethamine + halofantrine combination, however these statements and the treatments proposed have no grounding in any scientific studies (3).
 The Fight against Malaria
Not documented
 Research Institutions
Not documented.
 Advice to Travelers

The « Centre National de Surveillance de la Chimiosensibilité » (The national centre for the Monitoring of Chemosensitivity) placed Botswana in group III, which includes countries suffering from «highly chemoresistant plasmodium falciparum bordering on poly-resistant". According to the B.E.H. n°24-25 of the 14th June 2005, Botswana is classified in chloroquine-resistance group III. This signifies that a traveler spending less than 3 months in the country should take the Mefloquine or the Atovaquone-Proguanil combined treatment.

This recommendation is all the more surprising given the fact that there have been no published studies on the chloroquine-resistance of Plasmodiumfalciparum    plus, malaria is virtually absent from the country for the most part of the year. It can only be assumed that the author recommended this because of the malaria situation in neighboring Zimbabwe.

We feel that the circumstances of the journey must be taken into account: humid season Vs dry ? Staying in towns or in the countryside ? Staying at a hotel or in a traditional dwelling? More often than not simple measures of precaution against mosquito bites are largely sufficient. 

 Bibliography
(only the first author is mentioned)

1. HARRIS J.R. - David Livingstone, 1813-1873 : his contribution to medicine.  J. Trop. Med. Hyg. 1973 ; 76 : 103-104.

2. ROBINSON M.J. - Malaria in north-eastern Botswana. S. Afr. Med. J. 1988 ; 74 : 427.

3. PRIDGEON J.M. - Malaria prophylaxis and treatment. S. Afr. Med. J. 1993 ; 83 : 692-693.

4. CHANDRE F. et Coll. - Status of pyrethroid resistance in Anopheles gambiae sensu lato. Bull. OMS 1999 ; 77 : 230-234.
 

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