|
|
 |
[08/04/2005]
 Djibouti | |
|
Authors: Dr
Francis Louis, IMTSSA, Marseille –
Acknowledgements : Dr Claude Modica, Hôpital
Legouest, Metz
Last Updated: 28th December
2000
| |
General Statistics
Area: 23,500 km²
Population: 650,000 inhabitants
Capital: Djibouti (540,000
inhabitants)
Currency: Djiboutian Franc (1 US$ = 177.100%
FD, fixed exchange rate)
Official Languages: Arabic and French Bordering
Countries: Eritrea, Ethiopia,
Somalia
Out of 192 countries, Djibouti ranks
172nd for life expectancy, 172nd
for infant mortality, 113th for GNP, 132nd
for daily calorie intake, 164th for
literacy, 168th for the percentage of children in
full-time education (source: Atlas Encyclopédique Mondial, Nathan
Ed., Paris 1996, pp.118-119).
The climate is warm and dry with temperatures that vary
from 22 °C in January to 44 °C in July and a rainfall
that does not exceed 25mm in March, the most humid month of the
year and 2 mm in June (11). | Epidemiological Facies
Plasmodiumfalciparum is
virtually the only species of parasite in Djibouti. A few specimens
of Plasmodiumvivax were apparently
noted but come from anecdotal sources (7a).
Malaria is mentioned for the first time in
Djibouti back in 1901, describing two cases situated 4 km
from Djibouti-Town in Gahalmahen and Amboulie (1a). In 1905,
Bouffard stated that the whole country was at risk from Malaria
with the exception of Djibouti-Town (1b).
In around 1910, anopheles and malaria disappeared from the country
for an undetermined reason. There were therefore only a few reports
of imported malaria cases. In 1970, D. Courtois and J. Mouchet
confirmed the absence of the vector (2).
In 1978, B. Carteron and Coll. reported the return of malaria: from
1973 to 1976, they documented 191 cases of autochtonous
malaria (
4a ). Malaria was thus thrived among isolated
homesteads. However, in his thesis, J-F Lipous signals the rarity of malaria
(5): in 1979 out of 140,580 examinations he reported only few
malaria cases
The first malaria epidemic broke out in
1988-1989:
About 3,000 cases were diagnosed (7a). In 1991, 7338 cases were
declared, and 4,770 in 1993 (9). Table I – Notified cases of malaria in Djibouti
Year | Population | Number of cases | % of
Population | source | | 1901 | 15 000 | 13 | 0,086 | Bouffard1 | | 1963 | > 30 000 | 14 | 0,046 | Carteron1 | | 1964 | - | 35 | - | Carteron1 | | 1965 | - | 9 | - | Carteron1 | | 1973 | 106 000 | 16 | 0,015 | Carteron1 | | 1974 | - | 28 | - | Carteron1 | | 1975 | - | 96 | - | Carteron1 | | 1976 | - | 51* | - | Carteron1 | | 1985 | 156 000 | 301 | 0,192 | Louis | | 1986 | - | 425 | - | Louis | 1988-
1989 | 235 000 | > 3000* | 1,276 | Fox | | 1991 | - | 7338 | - | Fox | | 1993 | 300 000 | 4770 | 1,590 | Fox |
(*estimates) The last known epidemic occurred in early 1999.
The number of cases reported was not published.
Nevertheless there remain some elements to go upon. For example,
the Biology Laboratory of the Peltier Hospital takes on average, 60
thick film blood tests per month with 2 or 3 positive results. In
March 1999, the laboratory had 793 tests to run (268 positive
results) and 1,905 tests from 1st to the
25th April (964 positive results). At this
point, the decision was made to no-longer run the tests as the work
load was too heavy to manage. (D. Massenet, comm. pers.).
This epidemic occurred after heavy rainfall from July to September
in 1998 causing the flooding of plains for many months (10).
In 2000, the majority of malaria cases were
diagnosed between November and
December, following the light rainfall of October and
November. In almost every cases, infection was due
to Plasmodiumfalciparum, but a few
cases were attributed to Plasmodiumvivax . Virtually all of
these cases came from Balbala, a shanty town on the edge of
Djibouti. However, it should be noted that these are biased results
as the laboratory in question works almost exclusively with
Djibouti town. Another case, from the Lake Abbe region was
diagnosed in Djibouti by this laboratory which suggests that there
may be other malaria struck regions than just Balbala (Jacques
Bougère, comm. pers.). | Vectors
In 1970,D. Courtois and J. Mouchet confirmed
the absence of malaria vectors but identified 4 species of
anopheles: Anopheles
dthali, Anopheles turkhudi, Anopheles salbaii
and Anopheles
harperi (2).
In 1977, F. Rodhain and Coll. recorded 8
species: Anopheles
rhodesiensis, Anopheles azaniae, Anopheles dthali, Anopheles
macmahoni, Anopheles gambiae, Anopheles turkhudi, Anopheles
salbaii and Anopheles pharoensis. This
was the first time 'Anopheles gambiae was
reported in the country (3).
In 1998, J. Brunhes and Coll. recorded 11
different species of anopheles in the country. The three new
additions were: Anopheles culifacies adenensis,
Anopheles harperi and Anopheles erythraeus
(12). | Chemoresistance
In 1995, G.R. Rodier and Coll. described the unpublished work
conducted by some Americans in 1990 which showed
Plasmodiumfalciparum’s in vivo resistance to chloroquine (type
RII/RIII). This chloroquine-resistance appears to have surfaced in
1990 (9). This is the only publication on the subject.
| Vector control
In the 70’s vector control was essentially targeted on
the anti-larvae action. Some 60 health workers were given
the task of scouring the town in the hunt for potential larvae
infected areas. One off sites were destroyed and permanent sites
treated by Dursban or Abate (4b).
In the 80’s, biological trial treatments were
conducted with excellent results (6). Wide spread trials
were not run.
In the 90’s there was a push for vector control
with the use of K-Othrine. The goal was to limit the potential
Dengue vectors. The program was highly successful and saw almost a
75% reduction in Culex numbers. If the anopheles population was
reduced due to this use of insecticides, which is open to doubt, it
was only by total accident.
| The National Anti Malaria Program
No national anti malaria program exits. Anti-Malaria action falls
under the jurisdiction of the Public health and social Affairs
Minister.
| Research
There is no malaria research in progress.
| Advice to Travelers
The « Centre National Français de Surveillance de la
Chimiosensibilité » (“French National Center for
chimiosensitivity survey”) placed Djibouti in group III, which
includes countries that have " highly chemoresistant Plasmodiumfalciparum or even
polyresistant".
According to the B.E.H. n°24-25 of the 14th june
2005, Djibouti is classified under chloroquine-resistance
group 3. This signifies that a traveler spending less than 3 months
in Djibouti must undergo a treatment course with Mefloquine or with
an Atovaquone-Proguanil combination. This recommendation is rather
surprising considering that no study on the chloroquine-resistance
of Plasmodiumfalciparum has ever been
published and that malaria is virtually absent from the country for
the greater part of the year.
The circumstances of the trip 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 ? etc More often than not
simple measures of precaution against mosquito bites are largely
sufficient. | Bibliography
(Only the first author is mentioned)
1a. BOUFFARD - Quelques cas de fièvre paludéenne observés à
Djibouti, chef-lieu de la Côte des Somalis. Ann. Hyg.
Med. Col. 1901: 4: 440-452.
1b. BOUFFARD - Géographie médicale: Djibouti. Ann. Hyg.
Med. Col. 1905: 8: 333-375.
2. COURTOIS D. - Etude des populations de culicidés en Territoire
Français des Afars et des Issas. Med. Trop. 1970 ; 30:
837-846.
3. RHODAIN F. - Les culicidés du Territoire Français des Afars et
des Issas. I. Le genre Anopheles. Bull. Soc. Path.
Exot. 1977 ; 70: 302-308.
4a. CARTERON B. - Le problème de l'endémie palustre dans la
République de Djibouti. Med. Trop. 1978 ; 38: 299-304.
4b. CARTERON B. - La lutte contre les culicidés dans la ville de
Djibouti. Une expérience de 7 années. Med. Trop. 1979 ; 39:
555-558.
5. LIPOUS J-F. - Le service médical inter-entreprises de Djibouti.
Thèse médecine, Marseille 1981 ; 78 p.
6. LOUIS J-P. - Le paludisme en République de Djibouti. Stratégie
de contrôle par la lutte anti-larvaire biologique: poissons
larvivores autochtones (Aphanius dispar) et toxines bactériennes.
Med. Trop. 1988 ; 48: 127-131.
7a. FOX E. - Le paludisme en République de Djibouti. Résultats
d'une enquête sérologique à Ambouli. Med. Trop. 1989 ; 49:
159-160.
7b. FOX E. - Plasmodiumfalciparum voyage en train
d'Ethiopie à Djibouti. Med. Trop. 1991 ; 51: 185-189.
8. SIDRAK W. - Déficience dissimilaire de la glucose-6-phosphate
deshydrogénase (G-6-PD) chez les Afars et les Somalis de
Djibouti. Med. Trop. 1991 ; 51: 211-214.
9. RODIER G.R. - Recurrence and emergence of infectious diseases in
Djibouti city. Bull. WHO 1995 ; 73: 755-759.
10. KAMIL M.A., MERLE C. - Intervention sanitaire d'urgence face à
une recrudescence de cas de paludisme dans le secteur de Dorra.
Rapport de la mission du 20 au 29 novembre 1998. Doc. S.I.S.S.E.,
Djibouti, 2 décembre 1998 ; 12 p.
11. MASSENET D. - Djibouti: face à une démographie explosive. Med.
Trop. 1997 ; 57: 233-238.
12. HERVY J-P., LE GOFF G., GEOFFROY B., HERVE J-P., MANGA L.,
BRUNHES J. - Les anophèles de la région afro-tropicale, logiciel
ORSTOM Ed., 1998.
13. LOUIS F.J. - Note sur la situation du paludisme à Plasmodium falciparum à Djibouti.
Doc. n°464/IMTSSA/ASOM, I.M.T.S.S.A. Marseille, 29 avril 1999 ; 5
p. |
|
|
|
Version française 
