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