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[08/04/2005]
 Mauritania | |
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Authors: Dr Francis Louis, Yaounde, Cameroon
Acknowledgements : Dr Patrick Besnard, Massugas
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General Statistics
Area: 1,030,700 km²
Population: 2,493,073 inhabitants (1998
estimation)
Capital: Nouakchott
Currency: ouguiya
Official Language: French
Bordering Countries: Algeria, Morocco
(and Western Sahara), Senegal, Mali 
Out of 192 countries, Mauritania ranks 169th for life
expectancy, 165th for infant mortality, 155th
for GNP, 91st for daily calorie intake,
178th for literacy,
154th for the percentage of children in
full-time education (source: Atlas Encyclopédique Mondial, Nathan
Ed., Paris 1996, pp.118-119).
The whole country can be described as desert-like. Annual rainfall,
restricted to the month of August, does not exceed 100mm. The only
exception is the southern border of the country, where the river
Senegal flows, which records from 400 mm to 500 mm of rainfall per
year, spread out over the months from June to October (1). | Epidemiological Facies
Malaria in Mauritania is unstable, with a very short seasonal
transmission period and years where there is no transmission at
all. There is however no acquisition of relative immunity. Malaria
occurs in the form of epidemics that break out during the
transmission period and can infect virtually the whole population.
In a 1987 study, Gasquet found a splenomegaly rate of 12.7% in the
regions near the river, which rose to 24.4% in children aged from 1
to 9 years old. (7).
The number of cases diagnosed varies from year to year: 42,112
cases in 1991, 214,478 in 1995 (P. Besnard, comm. pers.).
Three parasites are
present: Plasmodiumfalciparum
for the most part (> 90%), but
also Plasmodiumvivax
and Plasmodiummalariae
(1 ). | Vectors
According to Sautet et al., Anopheles gambiae
is largely dominant but Anopheles funestus, Anopheles
pharoensis and Anopheles rufipes can also be found.
However the authors do insist on the nature of permanent sites
(canary, ornamental ponds, ponds) and that of temporary ones
(stagnant pools of water following rain) (Sautet).
Jacques Brunhes et al.(Les anophèles de la région afro-tropicale,
logiciel ORSTOM Ed., 1998) registered 12 different species of
anopheles in the country but not all are of medical
interest: Anopheles arabiensis, Anopheles dhtali,
Anopheles flavicosta, Anopheles funestus, Anopheles gambiae,
Anopheles melas, Anopheles pharoensis, Anopheles pretoriensis,
Anopheles rhodesiensis rhodesiensis, Anopheles rufipes rufipes,
Anopheles squamosus and Anopheles ziemanni.
In 1987, Petrarca et al. charted the distribution of
the Anopheles gambiae group in relation to the
isohyets along the length of the River Senegal, which acts as the
border between Senegal and Mauritania (6).
| Chemoresistance
In 1990, T.R. Guiguemde et al. wrote
that " all the countries within the OCCGE (Organization
for Coordination and Cooperation Against Endemic Diseases) suffer
from Plasmodiumfalciparum
chloroquine-resistance, with the exception of Mauritania, a country
in which malaria is rare" (8).
In 1994, The first recorded study took place
in Kifa, 600 km east of Nouakchott and 200 km
north of the River Senegal: Out of 31 parasite carrier
patients treated with chloroquine dosed at 25 mg/kg over 3 days, 3
(9.7%) continued to have a positive parasite count or clinical
symptoms by day 7 (7).
| The National Anti Malaria program
There is hardly any available information on current anti
malaria action.
In 1948, J. Sautet et al. believed that an
effective vector control program could be run, due to the very
nature of the sites (1 ). It is not known if this program was
indeed carried out, nor what results, if any, it brought to
light. In 1997, Mauritania was selected by the World
Health Organization for an accelerated anti malaria action plan:
this program concerned 1,876,600 inhabitants of 7 of the 13
districts that make up the country (10). The program started in
April 1997 with a national workshop for partners which allowed a
charter for the plan to be drawn up. The program
received a cash injection from the WHO of US$231,124 (P. Besnard,
comm. pers.). 
Wilayas selected for the Accelerated
Anti-Malaria Action Plan | Research
There is no research program currently being run in Mauritania.
| Advice To Travellers
The B.E.H. n°24-25 of the 14th june 2005 states that
Mauritania in is in chemoresistance group II which characterizes
zones of moderate resistance to chloroquine. A prophylaxis of the
Chloroquine-Proguanil or Atovaquone-Proguanil combination would
thus be appropriate.
In fact, this doesn’t really seem necessary: the specific
conditions of the voyage should 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, simple
measures of precaution against mosquito bites seem to be
sufficient. | Bibliography
(only the first author is mentioned )
1. SAUTET J. et Coll. - Quelques notes parasitologiques sur
le paludisme et l'anophélisme en Mauritanie. Med. Trop. 1948 ; 8:
32.
2. HAMON J. et Coll. - Notes sur les moustiques de la République
Islamique de Mauritanie (Dipt. Culicidea). Bull. Soc.
Entomol. Fr. 1964 ; 69: 233-253.
3. MONJOUR L. et Coll. - Influence de la sécheresse sur l'immunité
antipaludéenne. Presse Med. 1978 ; 19: 1651.
4. MONJOUR L. et Coll. - A sero-epidemiological survey of malaria
in desert and semi-desert regions of Mauritania. Ann. Trop.
Med. Parasitol. 1984 ; 78: 71-73.
5. BAUDON D. et Coll. - Impact de la construction d'un barrage avec
retenue d'eau sur la transmission du paludisme. Enquête
paludologique menée dans le sud-est de la Mauritanie. Bull.
Soc. Path. Exot. 1986 ; 79: 123-129.
6. PETRARCA V., VERCRUYSSE J., COLUZZI M. - Observations on the
Anopheles gambiae complex in the Senegal River Basin, West Africa.
Med. Vet. Entomol. 1987 ; 1: 303-312.
7. GASQUET M. - Enquête épidémiologique polyvalente dans la région
du Gorgol, Mauritanie. Mémoire D.U. Pharmacie Tropicale, Marseille
1990, 171 p.
8. GUIGUEMDE T.R. et Coll. - Point actuel sur la chimiorésistance
du paludisme des sujets autochtones dans les Etats de l'OCCGE
(Afrique de l'Ouest). Ann. Soc. belge Med. trop. 1991 ; 71:
199-207.
9. GASQUET M. et Coll. - Chloroquine-resistant falciparum malaria
in Mauritania. Lancet 1995 ; 346: 1556.
10. 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.
11. COLLINS W.E. et Coll. - Adaptation of a strain
of Plasmodiumvivax from
Mauritania to New World monkeys and anopheline mosquitoes.
Ann. Trop. Med. Parasitol. 1999 ; 93: 25-30.
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