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[11/09/2005]
 Equatorial Guinea
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Authors: Dr Francis Louis, Yaounde, Cameroon
Acknowledgements : Dr Franck Fontvielle, Malabo, Equatorial Guinea; Mme Dominique Louis-Lutinier, Yaounde, Cameroon


> General Statistics | > Epidemiological Facies | > Vectors | > Chemoresistance | > The National Anti Malaria Program | > Research Institutions | > Advice to Travelers | > Bibliography

 General Statistics

Area: 28,051 km²
Population: 465,746 habitants (estimation July 1999)
Capital:  Malabo
Currency:  CFA Franc
Official Language:  Spanish
Bordering Countries: Cameroon, Gabon 

Equatorial Guinea is situated just above the Equator and comprises 5 islands (2,051 km² in total), including the Isle of Bioko where the capital city, Malabo, is located. There is also a section on the continent called “Mbini”, formerly known as Rio Muni (26,000 km²). 

Out of 192 countries Equatorial Guinea ranks 174 th for life expectancy, 175th for infant mortality, 157th for GNP, 126th for daily calorie intake, 155th for literacy, 104th for the percentage of children in full-time education (source: Atlas Encyclopédique Mondial, Nathan Ed., Paris 1996, pp.278-279).

Climate is of the equatorial type with temperatures that vary little during the year, between 20°C and 30°C, and with a high rainfall. However, there is a short ‘dry season’ from December to January.
 Epidemiological Facies
According to J. Mouchet et al’s classification, malaria in this country is mainly due to Plasmodium falciparum, and is of the   equatorial type, which means that transmission by anopheles is intense and permanent,   with up to 1,000 infectious bites   (female anopheles being the carriers of sporozoites) per person per year. This does however allow for the early acquisition of relative immunity at around the age of 5. 30% to 50% of fevers suffered by children are malaria linked. Morbidity is year long. Severe   forms of malaria in particular pernicious malaria, are common in young children but rare in adults as they are immune.

A 1986 study conducted on Bioko Island on 323 children, aged under 15 showed a spleen rate of 59.1% ± 8.2%. The plasmodium prevalence rate was at 49.7% (4). In 1987 in Nsork, in continental Guinea the spleen rate was superior to 70% in children aged between 2 and 14 and the plasmodium prevalence rate was 25.6% (7).

 Plasmodium falciparum  aside, Plasmodium vivax seems to be generally present but its exact frequency is unknown (3), and certainly very low (4, 7). Plasmodium malariae  has been recorded on Annobon island at a rate of 8% (12) and in Malabo at a rate of 10.7% (13).
 Vectors
In 1993, R. Molina and Coll. showed the occurrence of Anopheles funestus and Anopheles gambiae s.l., the latter having a 4% rate of resistance to DDT in Rio Muni but at 0% on Bioko Island (14).

Jacques Brunhes et al.(Les anophèles de la région afro-tropicale, logiciel ORSTOM Ed., 1998) compiled a list of only 3 species of   anopheles in the   country of varying interest for the study of malaria: Anopheles cinctus, Anopheles gambiae   and Anopheles melas.
 Chemoresistance

The first cases of resistance to chloroquine were documented in 1987 (56). However, studies into the chemoresistance of Plasmodium falciparum in vivo and in vitro were only carried out in the 1990’s. 

1. in vivo Studies:

                                                                                                                 

Year

site Antimalarial   drugNumber tested% RII-RIIIReference
1991BiokoChloroquine 25 mg432519
1991BiokoChloroquine 25 mg7116,911
1992BiokoChloroquine 35 mg6523,119
1993BiokoChloroquine 35 mg15616,519
1997MalaboChloroquine 25 mg511924
1991BiokoAmodiaquine 25 mg42019
1992BiokoAmodiaquine 25 mg82419
1997MalaboAmodiaquine 30 mg331124
1991BiokoQuinine 24 x 5 mg39019
1992BiokoQuinine 30 x 5 mg66019
1993BiokoQuinine 30 x 5 mg933,219
1991BiokoFansidar®424,819
1992BiokoFansidar®651,519
1993BiokoFansidar®392,619
1993BiokoMéfloquine67019
1994MalaboHalofantrine50021
1992BataChloroquine 35 mg42019
1992BataFansidar®52219


2. in vitro Studies

 

                                                           

Year

Site Antimalarial   drugNumber tested% RII-RIIIReference
1990-2BiokoChloroquine691620
1990-2BiokoAmodiaquine 466,520
1990-2BiokoQuinine46920
1990-2BiokoFansidar®431420
1990-2BataChloroquine58920
1990-2BataAmodiaquine 58220
1990-2BataQuinine58020
1990-2BataFansidar®58320
1990-2BataMéfloquine58020



3. Recommendations of the National Anti Malaria Program : 

The NAMP recommends the artesunate + amodiaquine association in first line (this association is delivered free on the island of Bioko, but not in the continental part of the country) and the coartem in second line. 

 

 The National Anti Malaria Program
Although Equatorial Guinea has set up a National Anti Malaria Program, its results and details have not yet been published. The WHO representatives have a scientist in charge of helping the program whom acts as the link between the large international programs such as Rollback Malaria and the country’s own Fight Program. A few NGOs also work towards the fight against malaria, essentially by organizing bilateral agreements between Equatorial Guinea and Spain. Finally the O.C.E.A.C., a regional organization whose headquarters are based in Yaounde, run limited action plans that essentially target epidemiology.
 Research Institutions
No real research is being conducted in Equatorial Guinea itself to date as this is conducted for the most part in Spanish Universities and research centers (25). On the other hand, operational research programs are regularly run on Bioko Island and on Continental Guinea, for the most part lead by the O.C.E.A.C. (Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, siège: Yaoundé, Cameroun), of which Equatorial Guinea is a member (24).
 Advice to Travelers

According to the BEH (« Bulletin épidémiologique hebdomadaire ») n°24-25 of hte 14 june 2005, Equatorial Guinea is classified under Chemoresistance group III which implies that any visitors to the country should take Mefloquine or an Atovaquone-Proguanil combined treatment. The results of the chemoresistance of Plasmodium falciparum confirm this classification especially for those going to Bioko Island. For continental Guinea (Mbini), one could also suggest the chloroquine + paludrine combination 

In any case, travelers should not forget to also take individual measures of protection against insect bites.
 Bibliography

(Only the first author is mentioned)

1. FRANCIA A.J. - (Aspects cliniques et sanitaires du paludisme chez les enfants en Guinée Equatoriale). Med. Trop. (Madr) 1967 ; 43: 21-115.   En espagnol.

2. GONZALES V. et Coll. - Importancia de las grandes enfermedades transmisibles en la sanidad publica de Guinea Ecuatorial y su relacion con las grandes campañas de masas.  Med. Trop. (Madr) 1968 ; 44: 282-297. 

3. GONZALES GARCIA J.J. et Coll. - An outbreak of Plasmodiumvivax malaria among heroin users in Spain. Trans. R. Soc.    Trop. Med. Hyg. 1986 ; 80: 549-552.

4. MERLIN M. et Coll. - Evaluation des indices cliniques, parasitologiques et immunologiques du paludisme dans la région de la Baie de Bonny en Afrique Centrale.    Bull. Soc. Path. Exot. 1986 ; 79: 707-720.

5. ALVAR J. et Coll. - In vitro chloroquine-resistant falciparum malaria in Malabo, Equatorial Guinea: case reports. Diagn. Microbiol. Infect.    Dis. 1987 ; 7: 51-53.

6. GUERRERO VASQUEZ J. et Coll. - Malaria importada de Guinea Ecuatorial por Plasmodiumfalciparum probablemente resistente a la cloroquina. An. Esp. Pediatr.    1987 ; 27: 49-52.

7. JOSSERAN R. et Coll. - Evaluation des indices paludométriques dans le district de Nsork, région continentale (Guinée Equatoriale). Bull. liais. doc. OCEAC 1987 ; n°80: 49-57.

8. SALES ENCINAS R. et Coll. - Programme de soins de santé primaires dans le district de Mongomo (République de Guinée Equatoriale). II. Evaluation du niveau de santé des enfants de moins de 5 ans (état nutritionnel, couverture vaccinale, indice splénique, diarrhée). Bull. liais. doc. OCEAC 1988 ; n°84: 33-36.

9. TOMAS S. et Coll. - (Paludisme importé: description clinique et épidémiologique de 49 cas). An. Med. Interna 1989 ; 6: 523-526. En espagnol.

10. ROCHE J. et Coll. - An epidemiological study of malaria in Bioko and Annobon islands (Equatorial Guinea).    Ann. Trop. Med. Parasitol. 1991 ; 85: 477-487.

11. EDO M. et Coll. - Chimiosensibilité de Plasmodiumfalciparum à la chloroquine in vivo dans l'île de Bioco, Guinée Equatoriale (1991). Bull. liais. doc. OCEAC 1992 ; n°102: 37-38.

12. ROCHE J. et Coll. - Le paludisme dans l'île d'Annobon, Guinée Equatoriale, 1991. Bull. liais. doc. OCEAC 1992 ; n°101: 23-25.  

13. BENITO A. et Coll. - Incidence pédiatrique du paludisme dans l'Hôpital Général de Malabo, Guinée Equatoriale (1990-1991). Bull. liais. doc.  OCEAC 1992 ; n°101: 33-35.

14. MOLINA R. et Coll. - Baseline entomological data for a pilot malaria control program in Equatorial Guinea. J. Med. Entomol. 1993 ; 30: 622-624.

15. ROCHE J. et Coll. - Resistance of Plasmodiumfalciparum to antimalarial drugs in Equatorial Guinea. Ann. Trop. Med.   Parasitol. 1993 ; 87: 443-449.

16. BURATTINI M.N. et Coll. - Malaria transmission rates estimated from serological data. Epidemiol. Infect. 1993 ; 111: 503-523.

17. BENITO A. et Coll. - Application and evaluation of QBC malaria diagnosis in a holoendemic area. Appl. Parasitol. 1994 ; 35: 266-272.

18. NGUEMA NTUTUMU M. et Coll. - Enquête sur les connaissances, attitudes et pratiques face au paludisme sur l'île de Bioko, Guinée Equatoriale, novembre 1993. Bull. liais. doc. OCEAC 1995 ; 28: 81-85.

19. ROCHE J. et Coll. - Evaluation in vivo de la chimiosensibilité de Plasmodiumfalciparum en Guinée Equatoriale, 1991-1993. Bull. liais. doc. OCEAC 1995 ; 28: 73-80.

20. BENITO A. et Coll. - In vitro susceptibility of Plasmodiumfalciparum to chloroquine, amodiaquine, quinine, mefloquine, and sulfadoxine/pyrimethamine in Equatorial Guinea. Am. J. Trop. Med. Hyg. 1995 ; 53: 526-531.

21. VILLOTA ARRIETA J. et Coll. - Tratamiento con halofantrina del paludismo por el Plasmodium falciparum. Experiencia clinica. An. Esp. Pediatr. 1996 ; 44: 117-120.

22. SASALLO MATILLA F. et Coll. - Atypical Plasmodiumvivax and Plasmodiumovale morphology in two imported cases of malaria in Spain. Parassitologia 1997 ; 39: 33-35.

23. CHAMBON R. et Coll. - Surveillance in vivo de la sensibilité de Plasmodiumfalciparum aux antimalariques dans les Etats du "réseau paludisme OCEAC": résultats des enquêtes effectuées à Yaoundé (Cameroun), Malabo (Guinée Equatoriale) et Brazzaville (Congo). Bull. liais. doc. OCEAC 1997 ; 30: 40-44.

24. CHAMBON R. et Coll. - Surveillance de la sensibilité in vivo de Plasmodiumfalciparum aux anti-malariques: résultat des premiers tests du réseau paludisme OCEAC. Med. Trop. 1997 ; 57: 357-360.

25. RUBIO J.M. et Coll. - Semi-nested, multiplex polymerase chain reaction for detection of human malaria parasites and evidence of Plasmodiumvivax infection in Equatorial Guinea.  Am. J. Trop. Med. Hyg. 1999 ; 60: 183-187.

26. KASSANKOGNO 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.  


27. GONZALES-VICENTE D.  - El Anopheles gambiae en Fernando Poo. Revista de Sanidad e Higiene Publica 1949 ; 9: 685-93.

28. GIL-COLLADO J. - Los anofelinos de Fernando Poo. La Medicina Colonial 1953 ; 2: 1-14.

29. PARELLADA N, CAYLA JA, BATALLA J, PLASENCIA JA.  [ Malaria. Analysis of 149 cases (1981-1987).].  Enferm Infecc Microbiol Clin. 1990 ;8:25-31.  En espagnol.

30. ALVAR EZQUERRA JP. - [ Hazards of insect vectors of parasites: from theory to practise.]. An R Acad Nac Med.  (Madr). 1995;112:617-46. En espagnol.

31. ROCHE J, AYECABA S, AMELA C, ALVAR J, BENITO A. - Epidemiological characteristics of malaria in Equatorial Guinea. Research and Reviews in Parasitology 1996; 56: 99-104.

32. MOLINA R, BENITO A, BLANCA F, ROCHE J, OTUNGA B, ALVAR J. - The anophelines of Equatorial Guinea. Ethology and susceptibility studies. Research and reviews in Parasitology 1996; 56: 105-10

33. BENITO A, ALVAR J, AYECABA S, MOLINA R, AMELA C, ROCHE J. - Epidemiology of malaria drug resistance in Equatorial Guinea. Research and Reviews in Parasitology 1996; 56: 111-17.

34. ROCHE J, AYECABA S, MOLINA R, AMELA C, ALVAR J, BENITO A. - Trial of malaria control with impregnated bed nets in a hyper-holoendemic focus in Equatorial Guinea. Research and Reviews in Parasitology 1996; 56: 119-126.

35. PUENTE S, SURIBATS M, INIGUEZ A, LAGO M, MARTINEZ ML, ALVAR J, GONZALES-LAHOZ JM. - Hyperreactive malarial splenomegaly in natives of Equatorial Guinea. Research and Reviews in Parasitology 1996; 56: 127-130.

36. enquêtes effectuées à Yaoundé (Cameroun), Malabo (Guinée Equatoriale) et Brazzaville (Congo). Bull liais doc OCEAC 1997; 30: 40-44.

37. VASALLO MATILLA F, PEREZ SANTOS MJ, ORTEGA MORENO E, ORTEGA TORRES MG, DIAZ MOLINA M, DE ZULUETA J. - Atypical P. vivax and P. ovale morphology in two imported cases of malaria in Spain.  Parassitologia 1997; 39: 33-5.

38. PUENTE S, RUBIO JM, SUBIRATS M, LAGO M, GONZALEZ-LAHOZ J, BENITO A. - The use of PCR in the diagnosis of hyper-reactive malarial splenomegaly (HMS).  Ann Trop Med Parasitol. 2000;94: 559-63.

39. BERZOSA PJ, CANO J, ROCHE J, RUBIO JM, GARCIA L, MOYANO E, GUERRA A, MATEOS JC, PETRARCA V, ROSARIO VD, BENITO A. - Malaria vectors in Bioko Island (Equatorial Guinea): PCR determination of the members of Anopheles gambiae Giles complex (Diptera: Culicidae) and pyrethroid knockdown resistance (kdr) in An. gambiae sensu stricto.  J Vector Ecol. 2002; 27: 102-6.
 

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