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[08/03/2005]
 Senegal
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Author: Dr Francis LOUIS, Yaounde, Cameroon
Acknowledgements: Mme Dominique LOUIS-LUTINIER, Yaounde, Cameroon - Mme Odile SOSSAT, Marseille, France


> General Statistics | > Epidemiological Facies | > Parasites and Chemoresistance | > Malaria Vectors | > Fight against Malaria | > Advice to travelers | > 112 bibliographical references for further reading:

 General Statistics
Area: 192,550 km2
Population: 8,700,000 inhabitants (1993 census) 
Main Towns: 
· Dakar (1,869,323 inhabitants), 
· Thiès [1,114,036 inhabitants], 
· Kaolack [947,870 inhabitants], 
· Diourbel [749,957 inhabitants], 
· Saint-Louis [748,517 inhabitants], 
· Kolda (688,933 inhabitants], 
· Fatick [568,688 inhabitants], 
· Louga [525,467 inhabitants], 
· Ziguinchor [466,832 inhabitants 
· Tambacounda [448,517 inhabitants]. 
Official Language: French 
Bordering Countries: Mauritania, Mali, Guinea, Guinea Bissau 

 Epidemiological Facies
Malaria in Senegal can be globally described as endemic and stable with seasonal outbreaks (23). The rainy season lasts from July to October and so consequently malaria reaches its peak from September to December. 

Certain distinctions can be made according to the area: 
- In the north: a Sahelian zone with less than 400mm rainfall per year, and for a few years now this has been less than 300 mm per year. In this zone malaria is hypo-endemic, unstable and there is no relative immunity. The risk of an epidemic is very high during the rainy period and severe forms of the disease occur in all age groups. 
- In the Centre: a Sudani-sahelian zone characterized by less than 600mm rainfall peryear. Malaria here is endemic with seasonal outbreaks. Relative immunity occurs quite late, at around the age of 10. Severe forms of the disease also occur in all age groups. 
- In the South: a Guinean-sudanese zone characterized by more than 800mm of rainfall per year and often even higher than 1,000mm. Malaria is hyper-endemic with seasonal outbreaks. Relative immunity to malaria occurs during the first five years of life. 
- On a 20 km stretch of coastline from Dakar to Saint-Louis, the Niayes zone presents its own particularities: perpetual pools of water collect at the foot of the dunes and the inhabitants use this for market gardening. Malaria is hyper-endemic and stable. 
- Dakar and Saint-Louis are hit with an urban form of malaria. However, the anopheles density is very low and malaria occurs seasonally. In practice, the transmission period is reduced to August-December, with October being the peak month. 
- Finally, the River Senegal delta has its own particular ecosystem: the rise and fall of the water level, reinforced by the barrages built upstream, lead to a high level of malaria with two peaks a year: one in the rainy season and the other in the dry season when the water level is low. 



Almost all the malaria studies conducted in Senegal have centered around 5 regions of the country (see map): Dakar and its suburbs (1), The Niayes zones (2), The Senegal River (3), The Fatick region, notably the villages of N’Diop and Dielmo (4) and the Niakhar region (5). 
Very few studies have been carried out in the rest of the country notably in the regions of Tambacounda, Kédougou and Casamance. 

 Parasites and Chemoresistance
Plasmodium falciparum is the almost exclusive malarial parasite in Senegal. However, 2 studies conducted in Dielmo seem contradictory: in 1994, out of 8,539 thick blood film tests, P. falciparum was found in 72% of cases, P. malariae in 21.1% and P. ovale in 6.0% (40). In 1998, P. ovale was found in 48.5% of children and 32.4% of adults (77). 

Resistance to chloroquine 

This was first witnessed in vitro in Senegal in 1984 in Kaolack (13) and then in 1987 in vivo in a Senegalese woman living in Sweden (14). In 1988, J.F. Trape also reported a case (18), then 3 in Pikine in 1989 and 1 case in Richard-Toll in 1990 (19). In 1988 also in Dakar, O. Gaye reported 2 cases of resistance out of 35 patients (5.7%) (20). 
In 1996, 28% of malaria strains in the Fatick region were in vitro resistant (56). In 1997, resistance to chloroquine was evaluated in vivo to be at 30% (71) and at 44% in 2000 (105). 
All in all, the chloroquine-resistance in Senegal appears to be much less worse than in other African countries where malaria exists on a hyper-endemic level (Cameroon, Gabon, etc.). However, since 1998, J.F. Trape et al. have proved that there has been a significant rise in malaria morbidity as well as malaria linked infant mortality and that this rise is in direct relation with the chloroquine resistance (84, 94,102,109). 

Resistance to amodiaquine 

This is poorly documented. 
In 1999, a comparative study between amodiaquine dosed at 30 mg/kg over 3 days and chloroquine at 25 mg/kg over 3 days, amodiaquine proved to be much more effective than chloroquine, with an Odd Ratio of 7.8 for success against parasites and 6.3 for clinical success (91). 
In 2000, 16% of 87 strains were in vivo resistant (105). In 2001, the combined use of amodiaquine-artesunate had a 93% success rate for the treatment of simple malaria attacks compared with 94% when amodiaquine was used on its own (108). 

Resistance to quinine 

In 1996, 37 patients were put on a three day course of quinine which proved to be highly successful (55). In 1997, the same drug had a 10.8% failure rate (71). In Fatick in 1996, the in vitro rate of resistance was at 1% (56). 

Resistance to other antimalarial drugs 

- Mefloquine: 4.2% of in vitro resistance in 1992 (28), 22% in 1996 (56). The first prophylaxis failure was cited in 2002 (107). 
- Sulfadoxine-pyrimethamine combination: 7% of drug trails failed in 2000 (105) - Halofantrine: 100% effective in 1991 on 14 children and 15 adults suffering from the disease in Dakar (22), 8% resistance in vitro in 85 cases of Plasmodium falciparum in the Fatick region in 1996 (56). 
- Doxycycline: no in vitro resistance was observed in the 71 cases of Plasmodium falciparum in 2000 (98). In addition, B. Pradines et al. showed in the same study the absence of any correlation between the results obtained with doxycycline and those with artemether, chloroquine, amodiaquine, quinine, pyrimethamine or cycloguanil. 
 Malaria Vectors
Twenty species of anopheles have been documented in Senegal (37): 
- Principal vectors: An. gambiae, An. arabiensis, An. pharoensis, An. rufipes rufipes, An. ziemanni, An. funestus (absent inthe north and the centre of the country), An. paludis (being eradicated), An. melas (on the coast), 
- Less importantly and only in the south: An. coustani, An. brohieri, An. brunnipes, An. domicola, An. flavicosta, An. freetownensis, An. hancocki, An. maculipalpis, An. nili, An. pretoriensis, An. squamosus and An. wellcomei. 
Senegal’s principal malaria vectors are Anopheles gambiae s.l. and An. funestus. An. gambiae s.l is a complex group of 6 related species of which An. gambiae and An. arabiensis are the most widespread and effective malaria vectors. 

There is a classic distribution in Senegal of the species within the An. gambiae family group: An. gambiae s.s. and An. arabiensis are sympatric throughout the country and the frequency with which they occur is linked to the climate. An. arabiensis is found more often in the dry savannah (sahelian and sudani-sahelian zones), whilst An. gambiae s.s. is predominant in the humid savannah regions but is also found in the Sahelian zone and along the Senegal river as well as along the coast. 

In the zones covered by the two species, the proportion of An . arabiensis rises during the dry season whilst that of An. gambiae s.s. rises with the rainy one. An. melas is found in the coastal zone (mangrove swamp area) that reaches from the River Senegal delta to the southern tip of the country, and inland along a few rivers until they become salty by the sea backwash. It is supposed to be more zoophilic and exophile than An. gambiae s.s. and An. arabiensis and occupies only a secondary role in the transmission of malaria in Senegal. 

An. funestus used to be very widespread in the country but seems to be dying out in a number of regions. The reduction of its breeding grounds is linked to a) the use of insecticides (agriculture) to which it is highly sensitive; b) the development of the land for agricultural purposes and c) changes in the climate (sahelisation) It was found in a few places in the Niayes zone, in Sine-Saloum and in the Tambacounda region. 

In Dakar and its suburbs, 98% of captured culicides are of the culex. variety (Culex quinquefasciatus). Anopheles gambiae s.l. is the only malaria vector found. (An. arabiensis = 97.6% ; An. pharoensis = 2.4%) (08, 29, 80, 99). The « bite rate » per person per night is 0.3 and the rate of annual malaria attacks is 1.5%. 

In the Niayes zone An. gambiae s.l.. is predominant. An. funestus and An. pharoensis are scarce (48.53) 

Along the banks of the River Senegal, An. gambiae s.l. (An. gambiae s.s., An. arabiensis, An. melas) are predominant (15); An. rufipes rufipes and An. pharoensis are rare (12), whereas in the stagnant delta water, An. pharoensis easily dominates to the detriment of the others An. gambiae (An. gambiae, An. arabiensis, An. melas)(21.36,44,93). 

In the sudani-sahelian zone, An. arabiensis is the dominant species (31). 

In Dielmo and N’Diop An. gambiae s.s., An. arabiensis et An. funestus represent more than 98% of species captured. An. pharoensis, An. rufipes rufipes, An. squamosus and An. ziemanni represent less than 2%. In the rainy season, An. gambiae s.l. dominates and in the dry season it is An. funestus (38, 68). In Dielmo, 74.2% of female An. gambiae and 73.8% of female An. arabiensis captured were gorged with human blood (68). 

In the Niakhar region, An. arabiensis represents 97% of the females captured on humans (9). 

In the mangrove swamp area of the Saloum delta, An. melas, (predominant along the coast) and An. arabiensis, (predominant on the banks of the river) live along side each other and are responsible for the transmission of malaria from July to March (112). 

 Fight against Malaria
In 1953, Senegal set up a Vector Control program whose aim was the eradication of Anopheles gambiae. The program was closed in 1961 in light of its failure (11) 

In 1963 a « preventive chloroquinisation» program consisted in giving children under the age of 14 a weekly 10 mg/kg dose during the months of July - November. This strategy proved to be highly successful but had to be abandoned due to insufficient funding (10.11). As soon as the program ended, morbidity and infant mortality rose significantly (10). 

The National Anti Malaria Program was created in 1995. 

In 1995, a study in the sudanese-savannah (Wassadou) on the use of mosquito nets treated with long lasting pesticide during the rainy season, (June-November) had the following results: 
(i) a 69% reduction of Anopheles gambiae aggressiveness towards humans, 
(ii) a 91% reduction of the culicide density (at rest) inside the home, 
(iii) a 76% reduction in the sporozoitic index of females captured on humans and
(iv) a 88% reduction in the entomological inoculation rate (83). 

The Senegalese army was put under prophylaxis by chloroquine during the transmission period. This strategy was abandoned in 1995 in favor of the promotion of the use of treated mosquito nets and the spraying of the home with long lasting insecticides(104). 

In 1999, F. Chandre et al. showed that Anopheles gambiae was still not resistant to pyrethrinoïdes, contrary to what had been described in other countries such as the Ivory Coast (89).
 Advice to travelers
Senegal 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. (BEH n°24-25 of the 14th june 2005). 
 112 bibliographical references for further reading:
01 Payet M, Pene P, Sankale M. – Expressions cliniques et immunologiques du paludisme au Sénégal. Bull. Soc. Pathol. Exot. 1966;59:677-83. 

02 Michel R, Pene P, Courtney KO. – Tolérance du Plasmodium falciparum à la pyriméthamine, au proguanil et au CI.501 dans la région des Niayes (Sénégal). Bull. Soc. Pathol. Exot. 1966;59:797-803. 

03 Kane Y, Kane O, Maffre E. – Contribution à l’étude de l’endémie palustre dans la ville de Dakar. Bull. Soc. Med. Afr. Noire Lang. Fr. 1968;13:189-94. 

04 Rey M, Camerlynck P, Mar ID, Lafaix C, Sow A. – Le paludisme dans l’agglomération dakaroise (d’après une expérience hospitalière). Bull. Soc. Med. Afr. Noire Lang. Fr. 1968;13:353-65. 

05 Niang I, Sanokho A, Senghor G. – Utilisation du Fansidar injectable dans le paludisme de l’enfant à Dakar. Bull. Soc. Med. Afr. Noire Lang. Fr. 1975;20:15-19. 

06 Vercruysse J, Jancloes M; - Etude entomologique sur la transmission du paludisme humain dans la zone urbaine de Pikine (Sénégal). Cah. ORSTOM Sér. Entomol. Med. Parasitol. 1981;19:165-78. 

07 Monjour L, Richard-Lenoble D, Sidatt M, Druilhe P, Mogahed A, Gentilini M. – Répartition géographique du paludisme dans la vallée du fleuve Sénégal: enquête en milieu scolaire (évaluation séro-immunologique, année 1973). Bull. Soc. Pathol. Exot. 1982;75:491-6. 

08 Vercruysse J, Jancloes M, Van de Velden L. - Epidemiology of seasonal falciparum malaria in an urban area of Senegal. Bull. World Health Organ. 1983;61:821-31. 

09 Diallo S, Victorius A, N’dir O, Diouf F, Bah IB. – Prévalence et évolution du paludisme congénital en zone urbaine: cas de la ville de Thiès (Sénégal). Dakar Med. 1983;28:133-41. 

10 Diallo S, Diouf F, Bah IB, N’dir O, Victorius A. – Conséquences cliniques de la chimioprévention à la chloroquine et de son interruption dans une zone d’hyperendémie palustre. Dakar Med. 1983;28:43-65. 

11 Laing ABG. - The impact of malaria chemoprophylaxis in Africa with special reference to Madagascar, Cameroon, and Senegal. Bull. World Health Organ. 1984;62(Suppl):41-8. 

12 Vercruysse J. – Etude entomologique sur la transmission du paludisme humain dans le bassin du fleuve Sénégal (Sénégal). Ann. Soc. Belge Med. Trop. 1985;65 Suppl 2:171-9

13 Brandicourt O, Druilhe P, Diouf F, Brasseur P, Turk P, Danis M. - Decreased sensitivity to chloroquine and quinine of some Plasmodium falciparum strains from Senegal in September 1984. Am. J. Trop. Med. Hyg. 1986;35:717-21. 

14 Hellgren U, Ardal OK, Lebbad M, Rombo L. - Is chloroquine-resistant Plasmodium falciparum malaria emerging in Senegal or The Gambia? Trans. R. Soc. Trop. Med. Hyg. 1987;81:728. 

15 Petrarca V, Vercruysse J, Coluzzi M. - Observations on the Anopheles gambiae complex in the Senegal River Basin, West Africa. Med. Vet. Entomol. 1987;1:303-12. 

16 Gaye O, Bah IB, Diallo S, Faye O, Baudon D. – Une étude de la morbidité palustre en milieux rural et urbain au Sénégal. Med. Trop. 1989;49:59-62. 

17 Gaye O, Bah IB, Bengue E, Diallo S, Faye O. – Morbidité palustre en milieu urbain. Etude de 353 accès fébriles. Med. Trop. 1989;49:401-4. 

18 Trape JF, Legros F, Ndiaye P, Konate L, Bah IB, Diallo S, Verdier F, Hatin I, Le Bras J. - Chloroquine-resistant Plasmodium falciparum malaria in Senegal. Trans. R. Soc. Trop. Med. Hyg. 1989;83:761. 

19 Trape JF, Legros F, Konate L, Verdier F, Vassal J. – A propos d’un cas de paludisme résistant à la chloroquine au Sénégal. Bull. Soc. Pathol. Exot. 1990;83:669-70. 

20 Gaye O, Bah IB, Diallo S, Victorius A, Bengua E, Faye O, Faye Oumar. – Emergence du paludisme chloroquinorésistant à Dakar, Sénégal. Ann. Soc. Belge Med. Trop. 1990;70:33-7. 

21 Carrara GC, Petrarca V, Niang M, Coluzzi M. - Anopheles pharoensis and transmission of Plasmodium falciparum in the Senegal River delta, West Africa. Med. Vet. Entomol. 1990;4:421-4. 

22 Diallo S, Gaye O, Bah IB, Trape JF, Konate L, Legros C, Dieng Th, Faye O. - Essai de l’halofantrine dans le traitement de l’accès palustre à Plasmodium falciparum à Dakar (Sénégal). Bull. Soc. Pathol. Exot. 1991;84:298-303. 

23 Diop BM, Faye-Ndao MA, Sow P, Feller-Dansokho E, Sene I, Ndour CT, Coll-Seck A. – Le paludisme à Dakar: aspects épidémiologiques cliniques et parasitologiques. Dakar Med. 1991;36:163-9. 

24 Botella de Maglia J, Valls Ferrer JM, Martinez Paz ML, Espacio Casanovas A - [Plasmodium falciparum resistant to sulfadoxine/pyrimethamine in Senegal]. An. Med. Interna. 1991;8:79-81. Spanish. 

25 Guiguemde TR, Gbary AR, Ouedraogo JB, Gayibor A, Lamizana L, Maiga AS, Boureima HS, Comlanvi CE, Faye O, Niang SD. – Point actuel sur la chimiorésistance du paludisme des sujets autochtones dans les états de l’OCCGE (Afrique de l’Ouest). Ann. Soc. Belge Med. Trop. 1991;71:199-207. 

26 Gaye O, Faye O, Bah IB, Diallo S, Diouf M, Ndiaye P, Ndiaye A, Trape JF. – Evolution de la chloroquinorésistance en zone urbaine. Résultats d’enquêtes menées à Dakar et Pikine. Ann. Soc. Belge Med. Trop. 1991;71:329-30. 

27 Faye O, Gaye O, Diallo S. – Evaluation de la sensibilité d’Anopheles gambiae s.l au fénitrothion, au malathion et au DDT au Sénégal. Dakar Med. 1991;36:170-77. 

28 Hatin I, Trape JF, Legros F, Bauchet J, Le Bras J. - Susceptibility of Plasmodium falciparum strains to mefloquine in an urban area in Senegal. Bull. World Health Organ. 1992;70:363-7. 

29 Trape JF, Lefebvre-Zante E, Legros F, Ndiaye G, Bouganali H, Druilhe P, Salem G. - Vector density gradients and the epidemiology of urban malaria in Dakar, Senegal. Am. J. Trop. Med. Hyg. 1992;47:181-9. 

30 Pison G, Trape JF, Lefebvre M, Enel C. - Rapid decline in child mortality in a rural area of Senegal. Int. J. Epidemiol. 1993;22:72-80. 

31 Faye O, Fontenille D, Herve JP, Diack PA, Diallo S, Mouchet J. - Le paludisme en zone sahélienne du Sénégal. I. Données entomologiques sur la transmission. Ann. Soc. Belge Med. Trop. 1993;73:21-30. 

32 Faye O, Gaye O, Herve JP, Diack PA, Diallo S. - Le paludisme en zone sahélienne du Sénégal. 2. Indices parasitaires. Ann. Soc. Belge Med. Trop. 1993;73:31-6. 

33 Rogier C, Trape JF. - Malaria attacks in children exposed to high transmission: who is protected? Trans. R. Soc. Trop. Med. Hyg. 1993;87:245-6. 

34 Trape JF, Lefebvre-Zante E, Legros F, Druilhe P, Rogier C, Bouganali H, Salem G. - Malaria morbidity among children exposed to low seasonal transmission in Dakar, Senegal and its implications for malaria control in tropical Africa. Am. J. Trop. Med. Hyg. 1993;48:748-56. 

35 Gaye O, Babou I, Faye O, Fall A, Molez JF, Bah IB, Diallo S. - Morbidité palustre et efficacité thérapeutique des antipaludéens. Etude menée dans la région de Dakar. Med. Trop. 1993;53:479-85. 

36 Faye O, Gaye O, Faye O, Diallo S. - La transmission du paludisme dans des villages éloignés ou situés en bordure de la mangrove au Sénégal. Bull. Soc. Pathol. Exot. 1994;87:157-63. 

37 Diagne N, Fontenille D, Konate L, Faye O, Lamizana MT, Legros F, Molez JF,Trape JF. – Les anophèles du Sénégal. Liste commentée et illustrée. Bull. Soc. Pathol. Exot. 1994;87:267-77. 

38 Konate L, Diagne N, Brahimi K, Faye O, Legros F, Rogier C, Petrarca V, Trape JF. – Biologie des vecteurs et transmission de Plasmodium falciparum, P. malariae et P. ovale dans un village de savane d’Afrique de l’Ouest (Dielmo, Sénégal). Parasite 1994;1:325-33. 

39 Feller-Dansokho E, Ki-Zerbo G, Badiane S. – Prise en charge diagnostique et thérapeutique de l’accès palustre simple dans la région de Dakar, Sénégal. Ann. Soc. Belge Med. Trop. 1994;74:291-300. 

40 Trape JF, Rogier C, Konate L, Diagne N, Bouganali H, Canque B, Legros F, Badji A, Ndiaye G, Ndiaye P, Brahimi K, Faye O, Druilhe P, Pereira da Silva L - The Dielmo project: a longitudinal study of natural malaria infection and the mechanisms of protective immunity in a community living in a holoendemic area of Senegal. Am. J. Trop. Med. Hyg. 1994;51:123-37. 

41 Saissy JM, Vitris M, Diatta B, Kempf J, Adam F, Sarthou JL. - Severe malaria in African adults living in a seasonal endemic area. Intensive Care Med. 1994;20:437-41. 

42 Aikins MK, Pickering H, Greenwood BM. - 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;97:81-6. 

43 Salem G, Legros F, Lefebvre-Zante E, Ndiaye G, Bouganali H, Ndiaye P, Badji A, Trape JF. – Espace urbain et risque anophélien à Pikine (Sénégal). Cahiers Santé 1994;4:347-57. 

44 Faye O, Fontenille D, Gaye O, Sy N, Molez JF, Konate L, Hebrard G, Herve JP, Trouillet J, Diallo S, Mouchet J – Paludisme et riziculture dans le delta du fleuve Sénégal (Sénégal). Ann. Soc. Belge Med. Trop. 1995;75:179-89. 

45 Faye O, Ndir O, Gaye O, Bah IB, Dieng Y, Dieng Th,Diallo S. – Le paludisme en milieu pédiatrique sénégalais. Dakar Med. 1995; 40,1:21-4. 

46 Diallo S, Ndir O, Dieng Y, Dieng T, Ba FD, Bah IB, Diop BM, Gaye O. – Prévalence du paludisme à Dakar (Sénégal): étude comparative des indices plasmodiques chez des femmes enceintes et non enceintes. Dakar Med. 1995 ;40:123-28. 

47 Faye O, Konate L, Fontenille D, Gaye O, Sy N, Hebrard JP, Toure YT. – Variations saisonnières des populations d’Anopheles gambiae s.l et transmission du paludisme dans un village de savane soudanienne du sud est du Sénégal. Bull. Inst. Fond. Afr. Noire C.A.D.,1995,série A,48,5-66. 

48 Faye O, Gaye O, Fontenille D, Hebrard G, Konate L, Sy N, Herve JP, Toure Y, Diallo S, Molez JF, Mouchet J.– La sécheresse et la baisse du paludisme dans les Niayes du Sénégal. Cahiers Santé 1995;5:299-305. 

49 Rogier C, Trape JF. – Etude de l’acquisition de la prémunition en zones d’holo- et de méso-endémie palustre à Dielmo et à Ndiop (Sénégal): résultats préliminaires, 1990-1994. Med Trop. 1995;55:71S-76S. 

50 Faye O, Ndir O, Gaye O, Bah IB, Dieng T, Dieng Y, Diallo S, Diagne AK. – Pratiques des personnels de santé et des populations en matière de diagnostic du paludisme et d’utilisation des antipaludéens à Dakar. Med. Trop. 1995;55:47-50. 

51 Demaziere J, Fourcade JM, Busseuil CT, Adeleine P, Meyer SM, Saissy JM. - The hazards of chloroquine self prescription in West Africa. J. Toxicol. Clin. Toxicol. 1995;33:369-70. 

52 Faye O, Gaye O, Fontenille D, Sy N, Konate L, Hebrard G, Herve JP, Trouillet J, Diallo S, Mouchet J, Molez JF – Comparaison de la transmission du paludisme dans deux faciès épidémiologiques du Sénégal: la zone côtière et la zone méridionale soudanienne. Dakar Med. 1995;40:201-7. 

53 Mouchet J, Faye O, Julvez J, Manguin S. - Drought and malaria retreat in the Sahel, West Africa. Lancet 1996;348:1735-6. 

54 Rogier C, Commenges D, Trape JF. - Evidence for an age-dependent pyrogenic threshold of Plasmodium falciparum parasitemia in highly endemic populations. Am. J. Trop. Med. Hyg. 1996;54:613-9. 

55 Rogier C, Brau R, Tall A, Cisse B, Trape JF. - Reducing the oral quinine-quinidine-cinchonin (Quinimax®) treatment of uncomplicated malaria to three days does not increase the recurrence of attacks among children living in a highly endemic area of Senegal. Trans. R. Soc. Trop. Med. Hyg. 1996; 90:175-8. 

56 Pradines B, Rogier C, Fusai T, Tall A, Trape JF, Doury JC. – Sensibilité in vitro de 85 isolats de Plasmodium falciparum dans la région de Fatick, Sénégal. Med. Trop. 1996;56:141-5. 

57 Faye O, Faye B, Dieng B, Faye C, N'Dir O, Gaye O, Diallo S. – Soins informels dans le paludisme. Déterminants de la demande et inventaire de l’offre. Etude menée dans la ville de Touba (Sénégal). Bull. Soc. Pathol. Exot. 1996;89:35-40. 

58 Daubersies P, Sallenave-Sales S, Magne S, Trape JF, Contamin H, Fandeur T,Rogier C, Mercereau-Puijalon O, Druilhe P. - Rapid turnover of Plasmodium falciparum populations in asymptomatic individuals living in a high transmission area. Am. J. Trop. Med. Hyg. 1996;54:18-26. 

59 Tall A, Rogier C, Gning M, Ndiaye F, Diane Sarr F, Ly AB, Sarr O, Mbengue EHT, Badiane A, Bouganali C, Bouganali H, Bassene H, Ndiaye P, Trape JF. – Prévalence élevée de résistance de Plasmodium falciparum à la chloroquine en l’absence de pression de sélection. Bull. Epiter. 1996;9:14-16. 

60 Fontenille D, Lochouarn L, Diatta M, Sokhna C, Dia I, Diagne N, Lemasson JJ, Ba K, Tall A, Rogier C, Trape JF. - Four years’ entomological study of the transmission of seasonal malaria in Senegal and the bionomics of Anopheles gambiae and A. arabiensis. Trans. R. Soc. Trop. Med. Hyg. 1997;91:647-52. 

61 Faye O, Fall M, Gaye O, Bah IB, Dieng T, Dieng Y, Ndir O, Diallo S. – Impact de l’accessibilité aux antipaludéens sur la morbidité palustre et la chloroquinorésistance. Etude menée à Touba (Sénégal). Bull. Soc. Pathol. Exot. 1997;90:318-20. 

62 Carme B, Peguet C, Nevez G. – Chimioprophylaxie du paludisme: tolérance et observance de la méfloquine et de l’association proguanil/chloroquine chez des touristes français. Bull. Soc. Pathol. Exot. 1997;90:273-6. 

63 Parzy D, Doerig C, Pradines B, Rico A, Fusai T, Doury JC. - Proguanil resistance in Plasmodium falciparum African isolates: assessment by mutation-specific polymerase chain reaction and in vitro susceptibility testing. Am. J. Trop. Med. Hyg. 1997;57:646-50. 

64 Carme B, Peguet C, Nevez G. - Compliance with and tolerance of mefloquine and chloroquine + proguanil malaria chemoprophylaxis in French short-term travellers to sub-Saharan Africa. Trop. Med. Int. Health. 1997;2:953-6. 

65 Diagne N, Rogier C, Cisse B, Trape JF. - Incidence of clinical malaria in pregnant women exposed to intense perennial transmission. Trans. R. Soc. Trop. Med. Hyg. 1997;91:166-70. 

66 Lemasson JJ, Fontenille D, Lochouarn L, Dia I, Simard F, Ba K, Diop A, Diatta M, Molez JF. - Comparison of behavior and vector efficiency of Anopheles gambiae and An. arabiensis (Diptera:Culicidae) in Barkedji, a sahelian area of Senegal. J. Med. Entomol. 1997;34:396-403. 67 Faye O, Lo M, Diop B, Gaye O, Bah IB, Dieng T, Dieng Y, N'Dir O, Diallo S. – Connaissances et circuits thérapeutiques relatifs au paludisme en zone rurale sénégalaise. Med. Trop. 1997;57:161-4. 

68 Fontenille D, Lochouarn L, Diagne N, Sokhna C, Lemasson JJ, Diatta M, Konate L, Faye F, Rogier C, Trape JF. - High annual and seasonal variations in malaria transmission by anophelines and vector species composition in Dielmo, a holoendemic area in Senegal. Am. J. Trop. Med. Hyg. 1997;56:247-53. 

69 Molez JF, Gaye O. – Un gamétocytocide associé au traitement antipaludique schizonticide sera-t-il bientôt nécessaire en zone de chimiorésistance? Med. Trop. 1997;57:97. 

70 Gaye O, Dansokho EF, Faye Oumar, Faye O, Sene MJ, Dieng Y, Diallo S. – Evaluation du traitement du paludisme par la quinine en cure de trois jours à Dakar. Med. Trop.1997;57:47-8. 

71 Sokhna CS, Molez JF, Ndiaye P, Sane B, Trape JF. – Tests in vivo de chimiosensibilité de Plasmodium falciparum à la chloroquine au Sénégal: évolution de la résistance et estimation de l’efficacité thérapeutique. Bull. Soc. Pathol. Exot. 1997;90:83-9. 

72 Imbert P, Sartelet I, Rogier C, Ka S, Baujat G, Candito D. - Severe malaria among children in a low seasonal transmission area, Dakar, Senegal: influence of age on clinical presentation. Trans. R. Soc. Trop. Med. Hyg. 1997;91:22-4. 

73 Faye O, Mar M, Diop M, Gaye O, Bah IB, Dieng T, Dieng Y, N'Dir O, Diallo S. - [Evaluation of malaria chemoprevention among 359 pregnant women attending a health center in Dakar]. Dakar Med. 1997;42:87-90. French. 

74 Faye O, Ndir O, Gaye O, Dieng T, Dieng Y, Bah IB, Diallo S. - [Prevalence of malaria in the Senegal river basin in 1991]. Dakar Med. 1997;42:83-6. French. 

75 Diallo S, Bah IB, Dieng Y, Ndir O, Ba FD, Diop BM, Gaye O, Dieng T. - Prévalence du paludisme à Dakar(Sénégal). Résultats d’une enquête sérologique chez des femmes enceintes et non enceintes. Dakar Med. 1997;42:63-7. 

76 Gaye O, Faye O, Ndir O, Feller-Dansokho E, Faye O, Dieng Y, Lakh NC, Diallo S. – Paludisme en milieu urbain: cas de la ville de Rufisque au Sénégal. Dakar Med. 1997;42:54-8. 

77 Faye FBK, Konate L, Rogier C, Trape JF. - Plasmodium ovale in a highly malaria endemic area of Senegal. Trans. R. Soc. Trop. Med. Hyg. 1998;92:522-5. 

78 Faye O, Gaye O, Konate L, Molez JF, Feller-Dansokho E, Herve JP.– Prévision et prévention des épidémies de paludisme dans la vallée du fleuve Sénégal. Cahiers Santé. 1998;8:347-52. 

79 Robert V, Awono-Ambene HP, Thioulouse J. - Ecology of larval mosquitoes, with special reference to Anopheles arabiensis (Diptera: Culicidae) in market-garden wells in urban Dakar, Senegal. J. Med. Entomol. 1998;35:948-55. 

80 Diallo S, Ndir O, Faye O, Diop BM, Dieng Y, Bah IB, Dieng T, Gaye O, Konate L, Faye O. – Le paludisme dans le District sanitaire sud de Dakar (Sénégal). 1. Parasitémie et accès paludéens. Bull. Soc. Pathol. Exot. 1998;91:208-13. 

81 Diallo S, Konate L, Faye O, Ndir O, Faye M, Gueye A, Diouf M – Le paludisme dans le District sanitaire sud de Dakar (Sénégal). 2. Données entomologiques. Bull. Soc. Pathol. Exot. 1998;91:259-63. 

82 Faye O, Correa J, Camara B, Dieng T, Dieng Y, Gaye O, Bah IB, N'Dir O, Fall M, Diallo S. – Létalité palustre en milieu pédiatrique dakarois: étude des facteurs de risque. Med. Trop. 1998;58:361-4. 

83 Faye O, Konate L, Gaye O, Fontenille D, Sy N, Diop A, Diagne M, Molez JF. Impact de l’utilisation des moustiquaires pré-imprégnées de perméthrine sur la transmission du paludisme dans un village hyperendémique du Sénégal. Med. Trop. 1998;58:355-60. 

84 Trape JF, Pison G, Preziosi MP, Enel C, Desgrees du Lou A, Delaunay V, Samb B, Lagarde E, Molez JF, Simondon F. - Impact of chloroquine resistance on malaria mortality. C. R. Acad. Sci. Paris. Sciences de la vie/Life sciences. III 1998;321:689-97. 

85 Robert V, Dieng H, Lochouarn L, Traore SF, Trape JF, Simondon F, Fontenille D. – La transmission du paludisme dans la zone de Niakhar, Sénégal. Trop. Med. Int. Health 1998;3:667-77. 

86 Mouchet J, Manguin S, Sircoulon J, Laventure S, Faye O, Onapa AW, Carnevale P, Julvez J, Fontenille D. - Evolution of malaria in Africa for the past 40 years: impact of climatic and human factors. J. Am. Mosq. Control Assoc. 1998;14:121-30. 

87 Robert V, Trape JF. – Dynamiques de la gamétocytémie à Plasmodium falciparum en fonction de la réponse thérapeutique à la chloroquine en zone de mésoendémie palustre. Bull. Soc. Pathol. Exot. 1998;91:142-5. 

88 Pradines B, Rogier C, Fusai T, Tall A, Trape JF, Doury JC. - In vitro activity of artemether against African isolates (Senegal) of Plasmodium falciparum in comparison with standard antimalarial drugs. Am. J. Trop. Med. Hyg. 1998;58:354-7. 

89 Chandre F, Darrier F, Manga L, Akogbeto M, Faye O, Mouchet J, Guillet P - Status of pyrethroid resistance in Anopheles gambiae sensu lato. Bull. World Health Organ. 1999;77:230-4. 

90 Pradines B, Tall A, Fusai T, Spiegel A, Hienne R, Rogier C, Trape JF, Le Bras J, Parzy D. - In vitro activities of benflumetol against 158 Senegalese isolates of Plasmodium falciparum in comparison with those of standard antimalarial drugs. Antimicrob. Agents Chemother. 1999;43:418-20. 

91 Brasseur P, Guiguemde R, Diallo S, Guiyedi V, Kombila M, Ringwald P, Olliaro P. - Amodiaquine remains effective for treating uncomplicated malaria in West and Central Africa. Trans. R. Soc. Trop. Med. Hyg. 1999;93:645-50. 

92 Faye O, N'Dao O, Camara B, Soumare M, Dieng T, Bah IB, Dieng Y, Gaye O, N'Dir O, Diallo S. – Prise en charge du paludisme grave de l’enfant dans un pays en développement. Elaboration d’un protocole d’évaluation médico-économique. Med.Trop. 1999;59:283-6. 

93 Carnevale P, Guillet P, Robert V, Fontenille D, Doannio J, Coosemans M, Mouchet J. - Diversity of malaria in rice growing areas of the Afrotropical region. Parassitologia. 1999;41:273-6. 

94 Rogier C, Tall A, Diagne N, Fontenille D, Spiegel A, Trape JF. - Plasmodium falciparum clinical malaria: lessons from longitudinal studies in Senegal. Parassitologia. 1999;41:255-9. 

95 Zwetyenga J, Rogier C, Spiegel A, Fontenille D, Trape JF, Mercereau-Puijalon O. - A cohort study of Plasmodium falciparum diversity during the dry season in Ndiop, a Senegalese village with seasonal, mesoendemic malaria. Trans. R. Soc. Trop. Med. Hyg. 1999;93:375-80. 

96 Hovette P, Petrognani R, Bureau B, Barberet G, Camara P, Theobald X. – Le retard thérapeutique: principal facteur de gravité de l’accès à P. falciparum? Presse Med. 1999 11;28:1419-20. 

97 Gaye O, Soumare M, Sambou B, Faye O, Dieng Y, Diouf M, Bah IB, Dieng T, N’dir O, Diallo S. – Hétérogénéité du paludisme chloroquinorésistant au Sénégal. Bull. Soc. Pathol. Exot. 1999;92:149-52. 

98 Pradines B, Spiegel A, Rogier C, Tall A, Mosnier J, Fusai T, Trape JF, Parzy D. - Antibiotics for prophylaxis of Plasmodium falciparum infections: in vitro activity of doxycycline against Senegalese isolates. Am. J. Trop. Med. Hyg. 2000;62:82-5. 

99 Diallo S, Konate L, Ndir O, Dieng T, Dieng Y, Bah IB, Faye O, Gaye O. – Le paludisme dans le district sanitaire centre de Dakar (Sénégal). Données entomologiques, parasitologiques et cliniques. C.E.R.F./Santé. 2000;10:221-9. 

100 Rogier C. - Natural history of Plasmodium falciparum malaria and determining factors of the acquisition of antimalaria immunity in two endemic areas, Dielmo and Ndiop (Senegal). Bull. Mem. Acad. R. Med. Belg. 2000;155:218-26. 

101 Delaunay V, Etard JF, Preziosi MP, Marra A, Simondon F. - Decline of infant and child mortality rates in rural Senegal over a 37-year period (1963-1999).Int. J. Epidemiol. 2001;30:1286-95. 

102 Trape JF. - The public health impact of chloroquine resistance in Africa. Am. J. Trop. Med. Hyg. 2001;64(1-2 Suppl):12-7. 

103 Ndiaye O, Le Hesran JY, Etard JF, Diallo A, Simondon F, Ward MN, Robert V. – Variations climatiques et mortalité attribuée au paludisme dans la zone de Niakhar, Sénégal, de 1984 à 1996. C.E.R.F./Santé. 2001;11:25-33. 

104 Fall IS, Ba-Fall KM, Gning SB, N'doye S, Diop I, Wade B. – Prophylaxie du paludisme dans les armées: l’expérience du Sénégal. Med. Trop. 2001;61:83-6. 

105 Sokhna CS, Trape JF, Robert V. - Gametocytaemia in Senegalese children with uncomplicated falciparum malaria treated with chloroquine, amodiaquine or sulfadoxine + pyrimethamine. Parasite 2001;8:243-50. 

106 Sokhna CS, Faye FBK, Spiegel A, Dieng H, Trape JF. - Rapid reappearance of Plasmodium falciparum after drug treatment among Senegalese adults exposed to moderate seasonal transmission. Am. J. Trop. Med. Hyg. 2001;65:167-70. 

107 Gari-Toussaint M, Pradines B, Mondain V, Keundjian A, Dellamonica P, Le Fichoux Y. – Sénégal et paludisme: échec prophylactique vrai de la méfloquine. Presse Med. 2002;31:1136. 

108 Adjuik M, Agnamey P, Babiker A, Borrmann S, Brasseur P, Cisse M, Cobelens F, Diallo S, Faucher JF, Garner P, Gikunda S, Kremsner PG, Krishna S, Lell B, Loolpapit M, Matsiegui PB, Missinou MA, Mwanza J, Ntoumi F, Olliaro P, Osimbo P, Rezbach P, Some E, Taylor WR. - Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children: a randomised, multicentre trial. Lancet 2002;359:1365-72. 

109 Trape JF, Pison G, Spiegel A, Enel C, Rogier C. - Combating malaria in Africa. Trends Parasitol. 2002;18:224-30. 

110 Imbert P, Gerardin P, Rogier C, Ka AS, Jouvencel P, Brousse V, Guyon P. - Severe falciparum malaria in children: a comparative study of 1990 and 2000 WHO criteria for clinical presentation, prognosis and intensive care in Dakar, Senegal. Trans. R. Soc. Trop. Med. Hyg. 2002;96:278-81. 

111 Faye FB, Spiegel A, Tall A, Sokhna C, Fontenille D, Rogier C, Trape JF. - Diagnostic criteria and risk factors for Plasmodium ovale malaria. J. Infect. Dis. 2002;186:690-5. 

112 Diop A, Molez JF, Konate L, Fontenille D, Gaye O, Diouf M, Diagne M, Faye O. Rôle d’Anopheles melas Theobald (1903) dans la transmission du paludisme dans la mangrove du Saloum (Senegal). Parasite. 2002;9:239-46.
 

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