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[08/04/2005]
 Burundi | |
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Dr Francis Louis, IMTSSA, Marseille
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General Statistics
Official name: Republic of Burundi
Area: 27,830 km²
Population: 6,000,000 inhabitants (estimation
1996)
Capital: Bujumbura
Currency: Burundi Franc
Official Language: French , Kirundi
Bordering Countries: Rwanda, R.D. Congo,
Tanzania 
Out of 192 countries, Burundi ranks 169th
for life expectancy, 166th for infant mortality,
187th for GNP, 176th for daily calorie
intake, 155th for literacy, 155th
for the percentage of children in full-time education (source:
Atlas Encyclopédique Mondial, Nathan Ed., Paris 1996,
pp.152-153). | Epidemiological facies
The epidemiology of Malaria in Burundi must be understood in the
light of this little country’s climate and geography: Burundi is
located 1,200 km east of the Indian Ocean and 2,000 km from the
Atlantic. Its mountains reach up to 2,600 m, dominating over the
valley in which lake Tanganyika is found. The bottom of the lake is
650 m beneath sea-level. Bujumbura, on the banks of the lake is at
an altitude of 790 m. The average annual temperature is 23.5°C
(24.2 °C in January, 22.4°C in July). Beneath 1,000 m
of altitude, the climate is temperate. Above 2,000 m, temperatures
can drop very low during the night. Rainfall is less abundant than
in the neighboring Democratic Republic of Congo. There is a short
dry season (June-September) and a long rainy season culminating in
March - April. A short dry season is possible in
January-February. These individual features group together to form a
mosaic of micro-climates, in turn forming a mosaic of
epidemiological settings for Malaria: The most densely
populated areas are the hilly regions in the center of the country,
1,500 m above sea-level: Whilst these zones are spared from
malaria, a journey to a malaria infected
zone by these non-immune inhabitants results in deadly
epidemics of the illness, as the events of 1993-1994 demonstrated
(16). Specific
climatological circumstances and modifications to the region
(rice-growing and fish-breeding pools) can lead to a proliferation
of anopheles and also induces sites for epidemics. This occurred in
1991 in the large swamp region in Ruvubu located between 1,420 m
and 1,450 m of altitude (13) The same phenomenon is currently
occurring. However, there are
also endemic malaria zones found below 1,000 m, in other words the
border areas (see map) Nyanza-Lac in the extreme south of the
country is the place where transmission is the highest. Plasmodiumfalciparum is virtually
the exclusive malaria carrier. However in 1987, Coosemans
documented 21 p.100 of Plasmodium malariae carriers in
the Rusizi valley (4). 
Transmission of malaria in Burundi: hypoendemic
(pale yellow); mesoendemic: (golden yellow) ; hyperendemic
unstable: orange ; hyperendemic stable: pink; epidemic zones:
red
(source : M. Barutwanayo, 1998) | Vectors
Two malaria vectors can be clearly identified in Burundi: Anopheles gambiae s.l.,
the main vector found in 96% of Anopheles
arabiensis and 4% of Anopheles gambiae s.s..
There is also a fringe group, Anopheles funestus, (3 to
6% of captured anopheles) (6).
Jacques Brunhes and Coll.(Les anophèles de la région
afro-tropicale, logiciel ORSTOM Ed., 1998) compiled a list
of 23 different species of anopheles in the country,
with very varying medical interest: Anopheles arabiensis, Anopheles
ardensis, Anopheles christi, Anopheles coustani, Anopheles
cydippis, Anopheles demeilloni, Anopheles funestus, Anopheles
gambiae s.l., Anopheles garnhami, Anopheles gibbinsi, Anopheles
implexus, Anopheles letabensis, Anopheles longipalpis, Anopheles
marshalii, Anopheles moucheti moucheti, Anopheles natalensis,
Anopheles nili, Anopheles pharoensis, Anopheles seydeli, Anopheles
squamosus, Anopheles theileri, Anopheles wellcomei s.l. and
Anopheles ziemanni.
| Chemoresistances
1. Resistance to chloroquine The first
documented case of chloroquine-resistance was reported in September
1983 by J. Le Bras and Coll. The case occurred in a 19 year old
French man working in the Rusizi valley near Bujumbura (1). The
second case, also in September 1983, was reported by S. Matheron
and Coll. (2). In fact, it appears that this resistance was known
as of 1981, even if the cases went unpublished. (3). In 1985, an in
vivo study took place on 74 children, classified as asymptomatic
carriers. They were given a chloroquine 25 mg/kg treatment over
three days and the results obtained showed a level of resistance of
35% (3). In 1995 in
Bujumbura, of the 716 adult expatriates examined, 25 were suffering
from fever. Amongst them 23 were not taking any chemoprophylaxis.
Malaria was diagnosed 8 times (1.1% consultations), one of which
was a European undergoing a treatment of chloroquine + proguanil
(19). 2. Resistance to other antimalarial drugs amodiaquine : no resistance in 1984 (1), (2), nor in 1985
(3). quinine : no resistance in 1985 (5 ). mefloquine : no resistance in 1985 (3 ). | The National Anti-Malaria Program
There is no national anti malaria program in Burundi as such, but
an anti-malaria program exists as part of the “Programme National
de Lutte contre les Maladies Transmissibles et Carentielles”
(National program for the fight against Contagious and
deficiency-linked diseases) (PNLMTC). This section is directed by
Dr Mariane Barutwanayo who is employed there on a full time
basis.
One of the main aims of the program is the promotion of the use of
insect repellent treated mosquito nets (8), (7) and the spraying of
the home with Long lasting insecticide (6).
| Activities and Research Centers
There are no malaria research centers in Burundi.
| Advice to travelers.
In a 1986, 17 week long study, M.H. Coosemans and
Coll. noted a prophylaxis failure rate of 60% in
patients undergoing a chloroquine only
treatment, 72% in those taking chlorproguanil and 61%
in those taking the chloroquine-chlorproguanil combination
(9).
According to the B.E.H. n°24-25 dated 14th June
2005, Burundi, like neighboring Rwanda, is classified
under chloroquine-resistance group 3 , which signifies that a
traveler spending less than 3 months in this country, classified as
"High and or multiresistant to chloroquine" must undergo a
treatment with Mefloquine or with the Atovaquone-Proguanil combined
treatment.
| Bibliography
1. LE BRAS J., DECAZES J-M., DELORON P. et Coll. - R-II
chloroquine-resistant falciparum malaria from Burundi. Trans. R.
Soc. Trop. Med. Hyg. 1984 ; 78 : 410-411.
2. MATHERON S., LE BRAS J., FASSIN D. et Coll. - Paludisme
à Plasmodium falciparum résistant à
la chloroquine et de sensibilité diminuée à la quinine contracté au
Burundi. Bull. Soc. Path. Exot. 1984 ; 77 :
466-468.
3. COOSEMANS M.H., HENDRIX L., BARUTWANAYO M. et Coll. -
Pharmacorésistance de Plasmodium falciparum au Burundi.
Bull. OMS 1985 ; 63 : 331-338.
4. COOSEMANS M.H. - Comparaison de l'endémie malarienne dans une
zone de riziculture et dans une zone de culture de coton dans la
plaine de la Risizi, Burundi. Ann. Soc. belge Med.
trop. 1985 ; 65 suppl.2 : 187-200.
5. COOSEMANS M.H., BARUTWANAYO, ONORI E. et Coll. - Double-blind
study to assess the efficacy of chlorproguanil given alone or in
combination with chloroquine for malaria chemoprophylaxis in an
area with Plasmodium falciparum resistance
to chloroquine, pyriméthamine and cycloguaniul. Trans. R.
Soc. Trop. Med. Hyg. 1987 ; 81 : 151-156.
6. COOSEMANS M.H., LAROCHE R., BUHETURA S., KADENDE P. - Réponse
de Plasmodium falciparum à la
quinine en milieu hospitalier dans une zone de
chloroquinorésistance, Bujumbura, République du Burundi.
Med. Trop. 1988 ; 48 : 139-143.
7. COOSEMANS M.H., BARUTWANAYO M. - Malaria control by
antivectorial measures in a zone of chloroquine-resistant malaria :
a successful programme in a rice growing area of the Rusizi valley,
Burundi. Trans. R. Soc. Trop. Med. Hyg. 1989
; 83 : 97-98.
8. BARUTWANAYO M., COOSEMANS M.H., DELACOLLETTE C. et Coll. - La
lutte contre les vecteurs du paludisme dans le cadre d'un projet de
développement rural au Burundi. Ann. Soc. belge Méd.
trop. 1991 ; 71 suppl.1 : 113-125. 9. COOSEMANS M. - Développement d'une stratégie de lutte contre
le paludisme dans une région rizicole au Burundi. Bull. Mem.
Acad. R. Med. Belg. 1991 ; 146 : 157-165.
10. DELACOLLETTE C., VAN DER STUYFT P. - High parasitaemia
incidence rates can be used to estimate malaria morbidity
rates. Ann. Trop. Med. Parasitol. 1993 ; 87 :
537-539.
11. DELACOLLETTE C., BARUTWANAYO M. - Mortalité et morbidité aux
jeunes âges dans une région à paludisme hyperendémique stable,
commune de Nyanza-Lac, Imbo sud, Burundi. Bull. Soc.
Path. Exot. 1993 ; 86 : 373-379.
12. DELACOLLETTE C., VAN DER STUYFT P., BARUTWANAYO M. -
Développement d'une méthode simple et fiable pour estimer la
morbidité palustre à partir du modèle de Muench modifié. Rev.
Epidem. Sante Publ. 1993 ; 41 : 416-421.
13. MARIMBU J., NDAYIRAGIJE A., LE BRAS M., CHAPERON J. -
Environnement et paludisme au Burundi. A propos d'une épidémie de
paludisme dans une région montagneuse non endémique. Bull.
Soc. Path. Exot. 1993 ; 86 : 399-401.
14. NIYONGABO T., DELORON P., AUBRY P. et Coll. - Prognostic
indicators in adult cerebral malaria : a study in Burundi, an area
of high prevalence of HIV infection. Acta Trop. 1994 ; 56 :
299-305.
15. COOSEMANS M.H., VAN DER STUYFT P., DELACOLLETTE C. - A hundred
per cent of fields positive in a thick film : a useful indicator of
relative changes in morbidity in areas with seasonal
malaria. Ann. Trop. Med. Parasitol. 1994 ; 88 :
581-586.
16. EONO P., MIGLIANI R., PHILIPPE B., LAMARQUE D. - Burundi :
mission humanitaire (janvier-avril 1994). Med. Trop. 1995 ; 55
: 172-177.
17. DI PERRI G., DI PERRI I.G., MONTERIO G.B. et Coll. -
Pentoxifylline as a supportive agent in the treatment of cerebral
malaria in children. J. Inf. Dis. 1995 ; 171 : 1317-1322.
18. DELORON P., AUBRY P., NDAYIRABIJE A. et Coll. - Pefloxacin does
not potentiate quinine efficacy against Plasmodium falciparum
malaria. Am. J. Trop. Med. Hyg. 1995 ; 53 : 646-647.
19. LEGEE H. - Importance du paludisme parmi les états fébriles
dans une population d'adultes expatriés au Burundi. Mémoire pour le
D.U. de Pathologie et santé pour les pays en développement,
Université d'Aix-Marseille II, 1996, 48 p.
20. VAN BORTEL W., BARUTWANAYO M., DELACOLLETTE C., CUYSEMANS M. -
Motivation à l'acquisition et à l'utilisation des moustiquaires
imprégnées dans une zone à paludisme stable au Burundi. Trop.
Med. Int. Health 1996 ; 1 : 71-80.
21. VAN BORTEL W., DELACOLLETTE C., BARUTWANAYO M., COOSEMANS M. -
Deltamethrin-impregnated bednets as an operational tool for malaria
control in a hyper-endemic region of Burundi : impact on vector
population and malaria morbidity. Trop. Med. Int. Health 1996 ; 1 :
824-835.
22. CROWE S. - Malaria outbreaks hits refugees in Tanzania. Lancet
1997 ; 350 : 41.
23. DI PERRI G., OLLIARO P., WARD S. et Coll. - Rapid absorption
and clinical effectiveness of intragastric mefloquine in the
treatment of cerebral malaria in African children. J. Antimicrob.
Chemother. 1999 ; 44 : 573-576.
24. CARNEVALE P., GUILLET P., ROBERT V. et Coll. - Diversity of
malaria in rice growing areas of the Afrotropical region.
Parassitologia 1999 ; 41 : 273-276. |
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