Area: 1,266,700 km² 

Population: 1,648,270 inhabitants (1999 estimation) 

Capital: Niamey 

Currency: CFA Franc 

Official Language: French

Bordering Countries: Algeria, Mali, Burkina Faso, Benin, Nigeria, Chad. 

Out of 192 countries, Niger ranks 179th for life expectancy, 180th for infant mortality, 179th for GNP, 144th for daily calorie intake, 185th for literacy, 171st for the percentage of children in full-time education (source: Atlas Encyclopédique Mondial, Nathan Ed., Paris 1996, pp.118-119) 

There is virtually no rainfall in the north of the country. In the south, there is an irregular rainy season from May to September but the rainfall does not exceed 200mm a month. Temperatures reach the 40°C mark from March to May, 30°C from June to November, and 15 °C from December to February. Malaria is observed from September to January. 

Thanks to its airport, the town of Niamey has meteorological reports for the years between 1995 and 1999 (D. Brault-Noble, comm. pers.): 

minimum (°C) and maximum (°C) temperatures, Average monthly rainfall (mm) calculated over a 5 year period (1995-1999): 

Plasmodium  falciparum is virtually the only malaria agent in the country. 

Concerning transmission, Niger can be divided into 3 zones (map): 

Zone I: A stable malaria region in the extreme south where transmission is seasonally long, lasting more than 6 months. This region corresponds to the River Niger basin and its tributaries ; 

Zone II: A region of intermediary Sahelian malaria, where transmission is seasonally short, less than 6 months 

Zone III:A region of unstable desert malaria, in the north of the country where transmission is short and uncertain 

The zones of Malaria Transmission 

(S.H. Boureïma, comm. pers.) 

In practice, the situation is more complex than this: 

A1986 study in Maradi and its surrounding area (map), Michel Le Bras et al. showed a late sero-conversion in urban regions (100% between the ages of 20 and 29 ), and one much earlier in rural regions (100% between the ages of 10 and 15) . The spleen rate and plasmodium prevalence rate were also much lower in urban regions (9). 

In 1992, Jean Julvez et al. insisted that the varying distribution of Anopheles funestus, was linked to the varying seasonal hosting grounds. This instability in the culicide population leads to unstable transmission leaving the population vulnerable to the disease and some years causing harsh epidemics (18). 

The regression of Lake Chad and low rainfall served to greatly reduce the anopheles population. In Zinder, the parasite prevalence was at 80% in 1968; this plummeted to 3% in the dry season of 1994. In Diffa, this rate was only at 6.7% in October 1994 after heavy rainfall. In these regions there is a major risk of epidemic (map) (27). 

The River Niger valley has its own particular ecosystem: since 1970, drought and a rise in birthrates have combined to change the epidemiological facies: Anopheles funestus has disappeared, to the advantage of Anopheles gambiae and Anopheles arabiensis ; The parasite prevalence rate in Niamey is about 5% ; this goes up 5 to 10 times at the end of the rainy season. The quarters along the banks of the river are the most badly affected whilst those further away are less affected. This is the opposite of what is described for other large African towns (28). 

Djibo and A. Cénac conducted a study in 1993 in Niamey during the transmission season (July and September/October), and showed that 54.4% of mothers and 13.3% of new born children were parasite carriers without displaying any clinical signs of malaria (38). 

For example: The laboratory in the maternal and infant health center (CSMI) in Niamey recorded 155 positive thick blood film tests in September 1999, 103 in October, 81 in November, 19 in December, 4 in January 2000, 8 in February, 11 in March, 2 in April, 4 in May, 2 in June, 26 in July and 231 in August (L.Cassagnou, comm. pers.).

In 1981, Smith laid traps in 21 sites along the trans-Sahara route: the presence of Anopheles was thus proved in Iferouane, Agadez, Aderbissinat, Takoukout, Tanout, Gezaoua, Zinder and Mai Jirgui. The species isolated in adult or larvae form were: Anopheles dthali, Anopheles hispaniola, Anopheles arabiensis, Anopheles gambiae s.l., Anopheles pharoensis andt Anopheles squamosus (4). 

In 1998, Jean Julvez et al. published a report on the anopheles present in Niger. They registered 19 species of anopheles: Anopheles gambiae, Anopheles arabiensis, Anopheles funestus, Anopheles nili, Anopheles ziemanni, Anopheles flavicosta, Anopheles pharoensis, Anopheles rufipes rufipes, Anopheles rufipes broussesi, Anopheles squamosus, Anopheles rhodesiensis, Anopheles wellcomei , Anopheles rivulorum, Anopheles domicolus, Anopheles maculipalpis, Anopheles dthali, Anopheles hispaniola, Anopheles multicolor and Anopheles salbaii. Only Anopheles gambiae, Anopheles funestus and Anopheles arabiensis are of epidemiological concern (30). 

Jacques Brunhes et al. (Les anophèles de la région afro-tropicale, logiciel ORSTOM Ed., 1998) registered 13 different species of anopheles in the country, of varying medical interest: Anopheles arabiensis, Anopheles dthali, Anopheles flavicosta, Anopheles funestus, Anopheles gambiae, Anopheles hervyi, Anopheles pharoensis, Anopheles rhodesiensis rhodesiensis, Anopheles rufipes broussesi, Anopheles rufipes rufipes, Anopheles squamosus, Anopheles wellcomei wellcomei and Anopheles ziemanni. 

The first mention of a resistance to chloroquine appears to have been made in 1988 in the Pitié-Salpétrière hospital in Paris. The results of the in vivo study are displayed in the table below:

(1): Tchintabaraden; 

(2): Drug trial failures 

Two series of chloroquine-resistance tests were conducted in vitro: in November 1989 in Tillabery, 6 strains out of 42 (14.3%) were found to be chloroquine-resistant ; in Gaya, only one strain out of 12 (8.3%) was resistant in the same period (S.H. Boureïma, comm. pers.).

There is no information concerning Plasmodium  falciparum‘s sensitivity to other antimalarial drugs. 

Niger runs a National Anti Malaria Program (PNLP), directed by Dr Fatima DJERMAKOYE, who is assisted by an entomologist and a laboratory technician. The PNLP has set up a program to monitor the chemosensitivity of Plasmodium  falciparum: they thus divided the country up into 7 zones, each one having a sentinel post (marked in green on the map) and / or a regional antenna of the program (marked in red).

Chemosensitivity Monitoring Posts 

(S.H. Boureïma, comm. pers.) 

According to Y. Kassankogno, Niger focused its action plan for the period from 1994-2000 along 2 main paths: the handling of patients and the spraying with insecticides (36). 

S. Boureïma and B. Fouta describe the Program for Vector Control set up by the « division de l'hygiène et de l'assainissement de la Direction de l'Hygiène et de la Médecine Mobile ». The plan is built upon 3 points (24): 

Daily treatment of private homes in Niamey, free of charge and on demand ; 

Sprinkling of insecticide powder in the urban community of Niamey

Intensive treatment of stagnant water during the rainy season in Niamey.

According to the B.E.H. « Bulletin épidémiologique hebdomadaire » n°24-25 of the 14th june 2005, Niger is classified under chemoresistance group II so travelers are advised to undergo a treatment of chloroquine-Proguanil or Atovaquone-Proguanil. This recommendation seems reasonable only for those going to the south-west of the country during the transmission period. For the remaining regions a chemoprophylaxis would only be necessary for the brief period at the end of the rainy season. 

On the other hand, individual measures of protection against insect bites should not be forgotten.

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