|
|
 |
[08/04/2005]
 Ethiopia | |
|
Authors: Dr Francis Louis, Yaounde, Cameroon
Acknowledgements : Dr Yemane TEKLAI, Addis Ababa
| |
General Statistics
Area: 1,104,300 km²
Population: 56,000,000 inhabitants
Capital: Addis Ababa
Currency: birr
Official language: Amharic
Bordering countries: Eritrea, Sudan, Kenya,
Somalia, Djibouti 
Out of 192 countries, Ethiopia ranks
174th for life expectancy, 176th for infant
mortality, 190th for GNP, 189th for daily
calorie intake, 188th for literacy, 171st for
the percentage of children in full-time education (source: Atlas
Encyclopédique Mondial, Nathan Ed., Paris 1996, pp.118-119).
The climate in Ethiopia is generally temperate, with the exception
of the Danakil Desert and Ogaden, which are low altitude regions
with high temperatures all year round. Other than in these two
regions, there is a dry season from October to May and a humid
season from June to September during which rainfall often reaches
300mm per month. | Epidemiological Facies
According to Mouchet et al’s classification (Typologie du
paludisme en Afrique. Cahiers Santé 1993 ; 3: 220-238),
malaria in Ethiopia is essentially of the intermediary Sahelian
variety. Transmission of the disease occurs in short seasonal
outbreaks (less than 6 months) with between 2 and 20 infectious
bites per person per year. During the transmission season, nearly
70% of all fevers are malarial in origin. Relative immunity takes a
long time to acquire, thus explaining the numerous cases of
pernicious malaria occurring in adults and children
alike. The region of the south western boarder with Sudan suffers from
a much longer transmission period.
The regions that border with Somalia and Djibouti are malaria free,
as is the belly of the country. This is due to the fact that there
are no vectors in these regions (see map) There is no malaria
either in the city of Addis Ababa. 
The most dominant malarial vector is Plasmodiumfalciparum,
but Plasmodiummalariae
(23)and Plasmodiumvivax are also present
(41). | Vectors
Anopheles wellcomei, Anopheles funestus, Anopheles gambiae,
Anopheles pharoensis, Anopheles nili and Anopheles ziemanni
16).
B. Ameneshewa and M.W. Service placed Anopheles arabiensis in
the centre of the country (57).
J. Brunhes et al.(Les anophèles de la région afro-tropicale,
logiciel ORSTOM Ed., 1998) compiled a list of 43 different
anopheles species in the country: Anopheles arabiensis, Anopheles
ardensis, Anopheles christyi, Anopheles cinereus cinereus,
Anopheles confusus, Anopheles coustani, Anopheles cydippis,
Anopheles dancalicus, Anopheles demeilloni, Anopheles domicola,
Anopheles dthali, Anopheles ethiopicus, Anopheles funestus,
Anopheles garnhami, Anopheles gibbinsi, Anopheles harperi,
Anopheles implexus, Anopheles kingi, Anopheles leesoni, Anopheles
letabensis, Anopheles longipalpis, Anopheles maculipalpis,
Anopheles marshalii, Anopheles multicinctus, Anopheles natalensis,
Anopheles nili, Anopheles obscurus, Anopheles pharoensis, Anopheles
pretoriensis, Anopheles quadriannulatus, Anopheles rhodesiensis
rhodesiensis, Anopheles rhodesiensis rupicolus, Anopheles
rivulorum, Anopheles rufipes rufipes, Anopheles sergentii
macmahoni, Anopheles seudeli, Anopheles squanosus, Anopheles
tenebrosus, Anopheles theileri, Anopheles turhudi, Anopheles
wellcomei wellcomei and Anopheles ziemanni.
| Chemoresistance
1. Resistance to
chloroquine: (14, 15). The first proved
occurrence was in 1986: 22 out of 98 malaria patients (22.5%)
treated in Addis Ababa with chloroquine dosed at 25
mg/kg over a 3 day period were found to still be carrying the
parasite on day 28. 14 resistances were found of the types RI, 6
RII and 2 RIII. In the same study, 7 of 10 levels of in vitro
chloroquine-resistance were found (30). In the period
between August 1989 and July 1991, 39,824 patients received
chloroquine treatment. Amongst them 1,706 (4.3%) complained that
they were not cured. They underwent treatment again, this time
under medical supervision and daily thick film blood
tests. If by the third day the parasite count hadn’t
dropped by at least 25%, the patients were given the
sulfadoxine-pyrimethamine (Fansidar®) combined treatment. This was
the case for 1,488 of the 1,706 patients, in other words
87.2% (62). Another study
conducted from April 1993 to March 1994 showed a level of in vivo
chloroquine-resistance of 86% for Plasmodium falciparum (29
patients tested) and 2% for Plasmodium vivax (459 patients tested)
(61). 2. Resistance to
other antimalarial drugs: Not documented A 1975 study suggested strong sensitivity to amodiaquine, yet
the dosage used at the time (10 mg/kg) and the number of tests run
(10) were not sufficient to allow any kind of interpretation
(13). Another study obtained mediocre results with primaquine,
mefloquine or doxycycline in malarial prophylaxis but the parasite
concerned was essentially Plasmodiumvivax (80). | The National Anti Malaria Program
There is no national program so to speak. Since 1992, anti malaria
action was integrated with first line health care, under the «
Community-Based Malaria Control Program » (Y. Teklai, comm. pers.).
| Research
No research is being conducted today in Ethiopia.
| Advice to Travelers
The B.E.H. « Bulletin Épidémiologique Hebdomadaire » n°24-25 of the
14th june 2005, placed Ethiopia in chloroquine-resistance
group III , which means that travelers are recommended to take a
chemoprophylaxis based on Mefloquineor with Atovaquone-Proguanil
combined treatment. This recommendation should be adjusted
according to the area visited, as, for example, it should be
remembered that there is no malaria in the capital city.
| Bibliography
(only the first author is mentioned)
1. ARMSTRONG J.C. - Plasmodiumovale endemic in
Ethiopia. Trans. R. Soc. Trop. Med. Hyg. 1969 ;
63: 287-288.
2. KRAFSUR E.S. - Anopheles nili as a vector of malaria in lowland
region of Ethiopia. Bull. OMS 1970 ; 42: 466-471.
3. MEKURYA Y. - Malaria survey in North and North Eastern
Ethiopia. Ethiop. Med. J. 1970 ; 8: 201-206.
4. COLLINS W.E. - Serological malaria survey in the Ethiopian
highlands. Am. J. Trop. Med. Hyg. 1971 ; 20:
199-205.
5. KRAFSUR E.S. - Malaria transmission in Gambela, Illubabor
Province. Ethiop. Med. J. 1971 ; 9: 75-94.
6. VYSLOUZIL J. - Does malaria exist in Assab at the present time
? Ethiop. Med. J. 1971 ; 9: 153-154.
7. WATKINS R.P. - Immunoglobulin response in malaria in Ethiopia:
association of splenomegaly with increased concentration of
IgM. Proc. Soc. Exp. Biol. Med. 1972 ; 141:
708-711.
8. LOBEL H.O. - Interpretation of IHA titres for the study of
malaria epidemiology. Bull. OMS 1973 ; 49: 485-492.
9.- MOUSA W. - Serum glycoproteins and malaria in Ethiopia. J. Lab.
Clin. Med. 1973 ; 82: 924-929.
10. WHITE G.B. - Biological effects of intraspecific chromosomal
polymorphism in malaria vector populations. Bull. OMS 1974 ; 50:
299-306. 11. RIECKMANN K.H. - Sporozoite induced immunity in man against
an Ethiopian strain of Plasmodiumfalciparum. Trans. R.
Soc. Trop. Med. Hyg. 1974 ; 68:
258-259.
12. DENNIS D.T. - Chloroquine tolerance of Ethiopian strains
of Plasmodiumfalciparum. Trans. R.
Soc. Trop. Med. Hyg. 1974 ; 68:
241-245.
13. DENNIS D.T. - Response of Ethiopian strains of Plasmodiumfalciparum to
amodiaquine. Trans. R. Soc. Trop.
Med. Hyg. 1975 ; 69: 522-523.
14. ARMSTRONG J.C. et Coll. - Chloroquine sensitivity
of Plasmodiumfalciparum in Ethiopia. I.
Results of an in vivo test. Am. J. Trop. Med. Hyg. 1976 ; 25:
5-9. 15. PALMER T.T. et Coll. - Chloroquine sensitivity
of Plasmodiumfalciparum in Ethiopia.
II. Results of an in vitro test. Am. J. Trop. Med. Hyg. 1976 ;
25: 10-13.
16. KRAFSUR E.S. - The bionomics and relative prevalence of
Anopheles species with respect to the transmission of Plasmodium to man
in western Ethiopia. J. Med. Entomol. 1977 ; 14: 180-194.
17. ARMSTRONG J.C. - Susceptibility to vivax malaria in
Ethiopia. Trans. R. Soc. Trop. Med.
Hyg. 1978 ; 72: 342-344.
18. KRAKSUR E.S. - An integrated view of entomological and
parasitological observations on falciparum malaria in Gambela,
Western Ethiopian Lowlands. Trans. R. Soc. Trop.
Med. Hyg. 1978 ; 72: 348-356.
19. SUROSO T. - The activity of chloroquine against Plasmodiumfalciparum in Bandar
Abbas, Southern Iran, 1976.
20. MENGISTU M. - Malaria in Gondar, Ethiopia, 1975-1978: a review
of 435 cases with specialemphasis on cerebral malaria. Ethiop.
Med. J. 1979 ; 17: 57-62. 21. MATHEWS H.M. - Duffy blood types and vivax malaria in
Ethiopia. Am. J. Trop. Med. Hyg. 1981 ; 30:
299-303.
22. HABTE-GABR E. - Falciparum malaria among military recruits:
emphasis of early diagnosis and treatment. Ethiop. Med.
J. 1981 ; 19: 71-75.
23. KRAFSUR E.S. - Epidemiology of Plasmodiummalariae infection in
Gambela, Ethiopia. Parassitologia 1982 ; 24: 105-120.
24. MEKURIA Y. - Cytogenetic studies on the malaria vector mosquito
Anopheles arabiensis Patton in the Awash valley, Ethiopia.
Parassitologia 1982 ; 24: 237-243.
25. SCHUBERT S. - Current status of malaria in
Ethiopia. Z. Gesamte Inn. Med. 1983 ; 38: 56-58.
26. ABREHA A. - Observations on splenomegaly in Ethiopia.
Ethiop. Med. J. 1984 ; 22: 101-104.
27. SMEATON M.J. - Malaria fron a "commuter" mosquito. Lancet 1984
; i: 845-846.
28. ELITSUR Y. - Malaria in children of new immigrants from
Ethiopia. Harefuah 1984 ; 106: 398-400.
29. JUEL-JENSEN B. - Personal experiences of medical problems among
Ethiopian refugees in the Ethio-Sudanese borderland. J. Infect.
1985 ; 11: 221-223.
30. TEKLEHAIMANOT A. - Chloroquine-resistant Plasmodium falciparum
in Ethiopia. Lancet 1986 ; ii: 127-129. 31. LONDNER M.V. - Dot-ELISA, a potential immunoassay for the
detection of Plasmodiumfalciparum
antibodies. Trans. R. Soc. Trop. Med.
Hyg. 1988 ; 82: 686-688.
32. SPIELMAN A. - Malaria diagnosis by direct observation of
centrifuged samples of blood. Am. J. Trop.
Med. Hyg. 1988 ; 39: 337-342.
33. BERGER S.A. - Infectious disease among Ethiopian immigrants in
Israel. Arch. Intern. Med. 1989 ; 149: 117-119.
34. BAYOUMI R.A. - Chloroquine-resistant Plasmodium falciparum
in eastern Sudan. Acta Trop. 1989 ; 46: 157-165.
35. KLOOS H. - Health aspects of resettlement in Ethiopia. Soc.
Sci. Med. 1990 ; 30: 643-656.
36. ENDESHAW Y. - Cerebral malaria. Factors affecting outcome of
treatment in a suboptimal clinical setting. J. Trop. Med. Hyg.
1990 ; 93: 44-47.
37. TOOLE M.I. - Prevention of excess mortality in refugee and
displaced populations in developing countries. JAMA 1990 ; 263:
3296-3302.
38. ENDESHAW Y. - Clinical and laboratory features of severe and
complicated falciparum malaria: the experience from Gonder
Hospital. Ethiop. Med. J. 1991 ; 29: 21-26.
39. SLATER P.E. - Malaria in Israel: the Ethiopian connection. Isr.
J. Med. Sci. 1991 ; 27: 284-287.
40. ENDESHAW Y. - Malaria in pregnancy: clinical features and
outcome of treatment. Ethiop. Med. J. 1991 ; 29:
103-108. 41. KLOOS H. - Onchocerciasis, malaria and trypanosomiasis in
three resettlement schemes in western Ethiopia. Parassitologia 1991
; 33: 187-197.
42. GISH O. - Malaria eradication and the selective approach to
health care: some lessons from Ethiopia. Int. J. Health Serv. 1992
; 22: 187-197.
43. NIGATU W. - Plasmodiumvivax and Plasmodiumfalciparum epidemiology in
Gambella, south-west Ethiopia. Trop. Med. Parasitol. 1992 ; 43:
181-185.
44. TEKLEHAIMANOT A. - Using fish against malaria: a local
initiative. World Health Forum 1993 ; 14: 176-177.
45. YENENEH H. - Antimalarial drug utilization by women in
Ethiopia: a knowledge-attitude-practice study. Bull. OMS 1993 ; 71:
24-28. 46. FLETCHER M. - Prospects for the use of larvivorous fish for
malaria control in Ethiopia: search for indigenous species and
evaluation of their feeding capacity for mosquito larvae. J.
Trop. Med. Hyg. 1993 ; 96: 12-21.
47. SLATER P.E. - Imported malaria from Ethiopia: end of an era ?
Isr. J. Med. Sci. 1993 ; 29: 383-384.
48. ELCHALAL U. - Management of chloroquine-resistant Plasmodium falciparum
malaria in a pregnant Ethiopian immigrant: a case report. Isr. J.
Med. Sci. 1993 ; 29: 385-387.
49. WEZAM A. - Plasmodiumfalciparum sensitivity to
antimalarials at Humera, northwestern Ethiopia. Ethiop.
Med. J. 1993 ; 31: 271-276.
50. LOWENTHAL M.N. - The Ethiopian immigrations to Israel: medical,
epidemiological and health aspects. Isr. J. Med. Sci. 1993 ; 29:
818-819. 51. WEZAM A. - Malaria survey at Humera, northwestern
Ethiopia. Ethiop. Med. J. 1994 ; 32: 41-47.
52. BRICKFIELD F.X. - Malaria diagnosis. J. Fam. Pract. 1994 ; 38:
332.
53. WOLDE B. - Chloroquine chemoprophylaxis in children during peak
transmission period in Ethiopia. J. Trop. Med. Hyg. 1994
; 97: 215-218.
54. ADUGNA N. - Determination of the human blood index of some
anopheline mosquitos by using ELISA. Ethiop. Med. J.
1996 ; 34: 1-10.
55. RIBEIRO J.M. - Temporal and spatial distribution of anopheline
mosquitos in an ethiopian village: implications for malaria control
strategies. Bull. OMS 1996 ; 74: 299-305.
56. GHEBREYESUS T.A. - Community participation in malaria control
in Tigray region Ethiopia. Acta Trop. 1996 ; 61: 145-156.
57. AMENESHEWA B. - The relationship between female body size and
survival rate of the malaria vector Anopheles arabiensis in
Ethiopia. Med. Vet. Entomol. 1996 ; 10: 170-172.
58. YOHANNES M. - Urban malaria in Nazareth, Ethiopia:
parasitological studies. Ethiop. Med. J. 1996 ; 34:
83-96.
59. LOBAN K.M. - The characteristics of the clinical course of
malaria in Ethiopia. Med. Parazitol. 1996 ; n°2: 10-13.
60. POPOVA S.P. - the course of malignant forms of tropical malaria
in the native population of endemic foci in Ethiopia. Med.
Parazitol. 1996 ; n°2: 13-15. 61. TULU A.N. - Failure of chloroquine treatment for malaria in
the highlands of Ethiopia. Trans. R. Soc. Trop.
Med. Hyg. 1996 ; 90: 556-557.
62. ALENE G.D. - Chloroquine resistance of Plasmodiumfalciparum malaria in
Ethiopia and Eritrea. Trop. Med. Int. Health 1996 ; 1:
810-815.
63 LULU M. - Detection of Plasmodiumfalciparum sporozoites in
naturally infected anopheline species using a fluorescein-labelled
DNA probe. Acta Trop. 1997 ; 63: 33-42.
64. SELVAAG E. - Chloroquine-induced vitiligo-like
depigmentation. Ann. Trop. Paediatr.
1997 ; 17: 45-48.
65. WORKU S. - Lymphocyte activation and subset redistribution in
the peripheral blood in acute malaria illness: distinct gammadelta+
T cell patterns in Plasmodiumfalciparum
and Plasmodiumvivax infections. Clin.
Exp. Immunol. 1997 ; 108: 34-41.
66. HADIS M. - Host choice by indoor-resting Anopheles arabiensis
in Ethiopia. Trans. R. Soc. Trop. Med. Hyg. 1997 ;
91: 376-378.
67. WOUBE M. - Geographical distribution and dramatic increases in
incidence of malaria: consequences of the resettlementscheme in
Gambela, SW Ethiopia. Indian J. Malariol. 1997 ; 34: 140-163.
68. SEBOXA T. - Epidemiological features of severe paediatric
malaria in north western Ethiopia. East Afr. Med. J. 1997 ; 74:
780-783.
69. SCHWARTZ E. - New aspects of malaria imported from
Ethiopia. Clin. Infect. Dis. 1998 ; 26: 1089-1091.
70. MOUCHET J. - evolution of malaria in Africa for the past 40
years: impact of climatic and human factors. J. Am.
Mosq. Control Ass. 1998 ; 14: 121-130. 71. GHEBREYESUS T.A. - Pilot studies on the possible effects on
malaria of small-scale irrigation dams in Tigray regional state,
Ethiopia. J. Public Health Med. 1998 ; 20: 238-240.
72. DAN M. - Malaria imported by travelers: the Israeli experience.
J. Travel Med. 1998 ; 3: 182-185.
73. SELVAAG E. - Vitiligo caused by chloroquine phototoxicity. J.
R. Army Med. Corps 1998 ; 144: 163-165.
74. ALEMAYEHU T. - Malaria, schistosomiasis, and intestinal
helminths in relation to microdams in Tigray, northern Ethiopia.
Parassitologia 1998 ; 40: 259-267.
75. BIRKU Y. - Comparison of rectal artemisinin with intravenous
quinine in the treatment of severe malaria in Ethiopia. East Afr.
Med. J. 1999 ; 76: 154-159. 76. MUHE L. - Clinical algorithm for malaria during low and high
transmission season. Arch. Dis. Child. 1999 ; 81: 216-220.
77. BREWSTER D. - Environmental management for vector control. Is
it worth a dam if it worsens malaria ? BMJ 1999: 319:
651-652.
78. GHEBREYESUS T.A. - Incidence of malaria among children living
near dams in northern Ethiopia: community based incidence survey.
BMJ 1999 ; 319: 663-666.
79. MANGUIN S. - Anopheline population genetics. Bull. Soc. Pathol.
Exot. 1999 ; 92: 229-235.
80. SCWARTZ E. - Primaquine as prophylaxis for malaria for
nonimmune travelers: a comparison with mefloquine and
doxycycline. Clin. Infect. Dis. 1999 ; 29: 1502-1506.
81. MASALA G. - Italian Development Cooperation: the commitment
for the struggle against malaria in Africa. Parassitologia 1999 ;
41: 361-366.
82. GHEBREYESUS T.A. et Coll. - Community-based malaria control in
Tigray, northern Ethiopia. Parassitologia 1999 ; 41: 367-371.
83. MENGESHA T. - Parasight-F dipstick antigen test in the
diagnosis of falciparum malaria in Ethiopia. East Afr. J. Med. 1999
; 76: 626-629.
84. KASSAKOGNO Y. - Aperçu sur le programme de lutte contre le
paludisme africain pour la période 1996-1997. Malaria and
Infectious Diseases in Africa 1999 ; n°9bis: 52-61.
85. GHEBREYESUS T.A. - Household risk factors for malaria among
children in the Ethiopian highlands. Trans. R. Soc.
Trop. Med. Hyg. 2000 ; 94: 17-21. |
|
|
|
Version française 
