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[08/03/2005]
 Guinea Bissau | |
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Dr Francis Louis, Yaoundé, Cameroon
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General Statistics
Official Name: Republic of
Guinea-Bissau
Area: 36,120 km²
Population: 1,000,000 inhabitants
(estimation)
Capital: Bissau
Currency: Guinean Peso
Official language: Portuguese
Bordering countries: Senegal, Guinea 
Out of 192 countries Guinea-Bissau ranks 190th for life expectancy,
187th for infant mortality, 178th for GNP, 113th for daily calorie
intake, 173th for literacy, 161st for the percentage of children in
full-time education (source: Atlas Encyclopédique Mondial, Nathan
Ed., Paris 1996, pp.276-277).
Guinea-Bissau’s climate is tropical, with the influence of the
Sahel in the north, (dry) and the Atlantic to the south (humid) The
rainy season, characterized by very strong rainfall superior to
2,500 mm/year, lasts from May to October. Temperature varies little
averaging at 20°C from December to February and 32°C from March to
May
| Epidemiological Facies
According to Mouchet et al’s classification, malaria in
Guinea-Bissau is stable and tropical: transmission is perpetual
with long seasonal outbreaks (6 to 8 months), and each person
receives anything from 100 to 400 infectious bites per year.
Relative immunity occurs at the age of about 5. Morbidity rises
during the rainy season (approx. 80% cases of fever in children).
Severe forms of malaria are found up until a relatively old age
(11).
Plasmodiumfalciparum is the cause of 90%
cases of malaria. Plasmodiumovale
and Plasmodiummalariae together
account only for 10% of cases In 1994 working the North- West of
the country, T.G.T. Jaenson et al. found 98%
of Plasmodiumfalciparum, 1 p.100
of Plasmodiummalariae and 1% of
mixed infections(13).
Bissau, the capital, presents its own individual facies: the city
is spread out over a large area and is located next to mangrove
swamp and marsh land. The larvae breeding grounds are abundant and
there is an intense transmission rate all year long. Malaria
represents 15% of all reasons why people visit health clinics (25).
| Vectors
The main malaria vectors in Guinea Bissau are Anopheles gambiae,
Anopheles funestus and Anopheles melas which easily reproduce in
stagnant water (25).
Jacques Brunhes et al. (Les anophèles de la région afro-tropicale,
logiciel ORSTOM Ed., 1998) compiled a list of 11 different
anopheles species in the country: Anopheles arabiensis,
Anopheles coustani s.l., Anopheles funestus, Anopheles gambiae,
Anopheles hargreavesi, Anopheles maculipalpis, Anopheles melas,
Anopheles nili, Anopheles pharoensis, Anopheles rufipes rufipes and
Anopheles squamosus.
| Chemoresistance
The issue of chloroquine resistance is quite poorly
documented: It was first mentioned back in December 1989
(6), that is to say 2 or 3 years after the other countries in the
region. In February 1990, 5 cases were noted in some Swedish people
living in Bissau (7). Another case was noted in 1992 in a Spanish
woman doubly infected
by Plasmodiumfalciparum
and Plasmodiumovale (10).There are
no other published works on the subject.
Plasmodium falciparum’s
sensitivity to quinine was very high in 1991 (8), in 1997 (23) and
in 1999 (27).
| The National anti Malaria Program
Very little has been published on this subject.
In 1994, M.K. Aikins et al. noted that 69% homes used mosquito nets
around the bed but didn’t state whether or not this was due to the
influence of the National Program (18). T.G.T. Jaenson et al.
studied the effectiveness of using permethrine treated mosquito
nets (13).
In 1998, J-F. Lefait and R. Lefait-Robin reiterate the drug choice
put forward by the National Anti malaria Program: first line-
treatment : chloroquine dosed at 25 mg/kg over 3 days ; second-line
treatment : the sulfadoxine-pyrimethamine combination ; quinine for
the severe cases or those of multi-resistance (25).
| Research Institutions
Not documented
| Advice to Travelers
According to the B.E.H. n°24-25 of the 14th June 2005, Guinea
Bissau 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.
| Bibliography
1. MEUWISSEN J.H.E.T. - Fluorescent antibodies in human malaria,
especially in Plasmodiumovale. Trop.
Geograph. Med. 1966 ; 18: 250-259.
2. COLUZZI M., SABATINI A., PETRARCA V., DI DECO M.A. - Chromosomal
differentiation and adaptation to human environments in the
Anopheles gambiae complex. Trans. R. Soc. Trop. Med. Hyg. 1979 ;
73: 483-497.
3. SWART J., PRIBILLA O. - Das Duffy-System: eine
populationsgenetische unter-suchung in Portugal, Guinea-Bissau und
Brasilien. Anthrop. Anz. 1985 ; 43: 285-297.
4. SMEDMAN L., SILVA M.C., GUNNLAUGSSON G. et Coll. - Augmented
antibody response to live attenuated measles in children with
Plasmodium falciparum parasitaemia. Ann. Trop. Paediatrics 1986 ;
6: 149-153.
5. GARCIA DOMINGUEZ J., GOMEZ E.D., JUSTIZ F.R. - Paludismo
congenito en Guinea-Bissau. Rev. Cubana Med. Trop. 1987 ; 39:
77-85.
6. BERGER M., BEYTOUT J., RINGWALD P. et Coll. - Un cas de
paludisme à Plasmodium falciparum
contracté en Guinée-Bissau survenant sous chimioprophylaxie par la
chloroquine. Presse Med. 1990 ; 19: 1682.
7. HELLGREN U., JOHANSSON I., DIAS F. et Coll. - Chloroquine
resistant Plasmodium
falciparum malaria in Guinea-Bissau. Trans. R. Soc. Trop. Med. Hyg.
1991 ; 85: 36.
8. BRUCHFELD J., DIAS F., HELLGREN U. et Coll. - Low doses of
quinine during a short time period are effective for clearence
of Plasmodiumfalciparum in
asymptomatic children in Guinea Bissau. Trop. Med. Parasitol. 1991
; 42: 153-154.
9. BRUCHFELD J., DIAS F., HELLGREN U. et Coll. - Clearence
of Plasmodiumfalciparum after
reduced single daily doses of quinine in asymptomatic children in
Guinea Bissau. Trop. Med. Parasitol. 1991 ; 42:
386-388.
10. CABEZOS J., BADA J.L. - Comentarios al fracaso de la
quimioprofilaxis antipaludica en un viajero. Med. Clin. 1992 ; 99:
54.
11. MOUCHET J., CARNEVALE P., COOSEMANS M. et Coll. - Typologie du
paludisme en Afrique. Cahiers Santé 1993 ; 3: 220-238.
12. SNOUNOU G. - Population dynamics of human parasites.
Parassitologia 1993 ; 35 suppl.: 113-116.
13. JAENSON T.G.T., GOMES M.J., BARRETO DOS SANTOS R.C. et Coll. -
Control of endophagic Anopheles mosquitoes and human malaria in
Guinea Bissau, West Africa by permethrin-treated bed nets. Trans.
R. Soc. Trop. Med. Hyg. 1994 ; 88: 620-624.
14. THOMAS A.W., TRAPE J-F., ROGIER C. et Coll. - High prevalence
of natural antibodies
against Plasmodium falciparum
83-kilodalton apical membrane antigen (Pf83/AMA-1) as detected bu
capture-enzyme-linked immunosorbent assay using full-length
baculovirus recombinant Pf83/AMA-1. Am. J. Trop. Med. Hyg. 1994 ;
51: 730-740.
15. OOSTERBAAN M.M. - Guinea-Bissau: maternal mortality assessment.
Rapp. trimestr. statist. sanit. Mond. 1995 ; 48: 34-38.
16. SNOUNOU G., PINHEIRO L., GONCALVES A. et Coll. - The importance
of sensitive detection of malaria parasites in the human and insect
hosts in epidemiological studies, as shown by the analysis of field
samples from Guinea Bissau. Trans. R. Soc. Trop. Med. Hyg. 1993 ;
87: 649-653.
17. LISSE I.M., AABY P., WHITTLE H., KNUDSEN K. - A community study
of T lymphocyte subsets and malaria parasitaemia. Trans. R. Soc.
Trop. Med. Hyg. 1994 ; 88: 709-710.
18. AIKINS M.K., PICKERING H., GREENWOOD B.M. - Attitudes to
malaria, traditional practices and bednets (mosquito nets) as
vector control measures: a comparative study in five West African
countries. J. Trop. Med. Hyg. 1994 ; 97: 81-86.
19. VIGARIO A.M., EGGELTE T.A., COSTA A. et Coll. - Investigation
of chloroquine intake in Biombo region, Guinea Bissau. Appl.
Parasitol. 1994 ; 35: 237-241.
20. GONCALVES A., FERRINHO P., DIAS F. - The epidemiology of
malaria in Prabis, Guinea-Bissau. Mem. Inst. Oswaldo Cruz 1996 ;
91: 11-17.
21. ARIYOSHI K., BERRY N., WILKINS A. et Coll. - A community-based
study of human immundeficiency virus type 2 provirus load in a
rural village in West Africa. J. Inf. Dis. 1996 ; 173:
245-248.
22. FONSECA L.F., DI DECO M.A., CARRARA G.C. et Coll. - Anopheles
gambiae complex (Diptera: Culicidae) near Bissau City, Guinea
Bissau, West Africa. J. Med. Entomol. 1996 ; 33: 939-945.
23. KOFOED P-E., MAPABA E., LOPES F. et Coll. - Comparison of 3, 5
and 7 days' treatment with Quinimax® for falciparum malaria in
Guinea-Bissau. Trans. R. Soc. Trop. Med. Hyg. 1997 ; 91:
462-464.
24. AREZ A.P., PALSSON K., PINTO J. et Coll. - Transmission of
mixed malaria species and strains by mosquitoes, as detected by
PCR, in a study area in Guinea-Bissau. Parassitologia 1997 ; 39:
65-70.
25. LEFAIT J-F., LEFAIT-ROBIN R. - Le paludisme au centre médical
de la mission française de coopération à Bissao. Med. Trop. 1998 ;
58: 98-102.
26. SODEMANN M., JAKOBSEN M.S., MOLBAK K. et Coll. - Malaria
parasitemia and childhood diarrhea in a peri-urban area of
Guinea-Bissau. Am. J. Trop. Med. Hyg. 1999 ; 6:
336-338.
27. KOFOED P-E., LOPES F., JOHANSSON P. et Coll. - Low-dose quinine
for treatment
of Plasmodiumfalciparum malaria in
Guinea-Bissau. Trans. R. Soc. Trop. Med. Hyg. 1999 ; 93:
547-549.
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