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[08/04/2005]
 Somalia | |
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Author: Dr Francis Louis, Yaounde, Cameroon
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General Statistics
Area: 627, 660 km²
Population: 7,140,643 inhabitants (1999
estimation)
Capital: Mogadishu
Currency: Somalia Shillings
Official Languages: Somali and Arabic
Out of 192 countries, Somalia ranks 179th for life expectancy,
178th for infant mortality, 125th for GNP, 192nd for daily calorie
intake, 189th for literacy, 174th for the percentage of children in
full-time education (source: Atlas Encyclopédique Mondial, Nathan
Ed., Paris 1996, pp.562-563).
The climate in Somalia is dry. Other than the coastal regions, the
country is arid desert. Rainfall is very low, always less than
200mm per year.
| Epidemiological Facies
There is relatively little documentation concerning Malaria
in Somalia. In 1971, K.M. Cahill stated that desert
regions aside, Somalia should be divided into two parts: the North
where malaria thrives in the form of epidemics (from November to
May) and the South where it exists in a weak form all year round,
increasing with rainfall. It is virtually absent from Mogadishu due
to a lack of vectors (1).
In 1987, a study on 62 nomads showed that 26 were carriers
of Plasmodium falciparum (41.9%) and
in a study on 90 semi-nomads, 30 were carriers (33.3%)
(4).
In December 1988 an epidemic was reported in Balcad, situated 40 km
north of Mogadishu, and running the length of the River Schebelle
(8).
In 1989, another epidemic claimed 600 lives in the Berbera region
(11).
In 1993, M.R. Wallace et al. suggested that following the influx of
refuges to Mogadishu during the civil war, malaria became endemic
to the capital (17).
The species of anopheles present in Somalia
are Plasmodium falciparum
(90%), Plasmodium vivax
and Plasmodium malariae (11).
| Vectors
The main vectors reported are Anopheles gambiae which
live in very small pools of water, Anopheles funestus
and Anopheles
dthali (1).
Jacques Brunhes et al.(Les anophèles de la région afro-tropicale,
logiciel ORSTOM Ed., 1998) registered 20 different
species of anopheles but not all are malaria vectors: Anopheles arabiensis, Anopheles
azaniae, Anopheles cinereus cinereus, Anopheles coustani s.l.,
Anopheles daudi, Anopheles demeilloni, Anopheles dhtali, Anopheles
funestus, Anopheles merus, Anopheles nili, Anopheles paludis,
Anopheles pharoensis, Anopheles pretoriensis, Anopheles
rhodesiensis rhodesiensis, Anopheles salbaii, Anopheles sergentii
macmahoni, Anopheles somalicus, Anopheles tenebrosus and Anopheles
turkhudi.
| Chemoresistance
1. Resistance to chloroquine:
Resistance to chloroquine was first mentioned in 1986: out of 13
children tested in vivo, none were found to be positive by the
seventh day. In vitro, 3 of the 39 strains tested (10.3%) proved to
be resistant (5).
In 1989, 7 children out of 29 showed an in vivo resistance of type
RII/RIII (24.1%) and 12 strains out of 19 (63.2%) showed in vitro
resistance too. (9).
In 1990, concerning the 1988 epidemic in Balcad, out of 36
patients, 31 (86.1%) were resistant to chloroquine: 5 of type RI
and 26 of type RII-RIII. In vitro, out of 37 isolated cases, 33
were resistant (89.2%).
2. Resistance to mefloquine:
In 1986, 11 strains were tested with mefloquine in vitro: not one
was found to be resistant (5).
In 1989, 19 isolates tested were sensitive (9).
Some American and Italian in vivo statistics exist concerning the
use of mefloquine in chemoprophylaxis during operation "Restore
hope" (cf infra).
3. Resistance to other anti malarial
drugs:
A 1988, in vitro study on 25 strains of Plasmodium falciparum did
not show resistance to the sulfadoxine-pyrimethamine combination
(8).
| The National Anti Malaria Program
Not documented.
| Advice to Travelers
1. Results from the Italian
research:
Under the chloroquine + proguanil combination, the rate of malaria
attacks was at 0.16 cases/100/month for those who correctly
followed the prophylaxis and 2.9 for those who did not (Cali). In
total, out of 11,600 members of the army tested, there were only 18
cases of malaria due to Plasmodium
falciparum, in other words, a rate of attack of 0.4/100/month
(31).
2. Results from the American
research:
The American troops were given mefloquine and there were many
failures: 2 cases were reported in 1993 on return from Somalia (19)
then 83 others in the same year (MMWR) and finally a total of 112
cases (22). The peculiarities of these cases were
that Plasmodium vivax was uniquely
identified in 87% of cases and in conjunction
with Plasmodium falciparum in 5%
(22). Only 50% of patients said that they had correctly taken their
chemoprophylaxis (22). In the field, Wallace et al. did not confirm
these figures. They listed « only » 48 cases of which 41 were due
to Plasmodium falciparum (85.4%)
(17).The American military would therefore have suffered from
malaria attacks due to Plasmodium
falciparum in Somalia rather than attacks due
to Plasmodium vivax on their return
to the United States.
3. Evaluation of doxycycline:
Sanchez et al. documented better compliance with doxycycline (98%)
than with mefloquine (81%), but malaria attacks of 5.5 p. 10 000
people / week with doxycycline compared with 1.5 p. 10 000 people /
week with mefloquine (13).
4. This concerned measures of protection taken by
intervening troops during the civil war. For the ordinary
traveler, Somalia is classified in chloroquine-resistance group III
(B.E.H. n°24-25 du 14 juin 2005), which signifies that a
chemoprophylaxis with Mefloquine or Atovaquone-Proguanil
combination is recommended. However, given the climate in the
country, individual measures of protection against insect bites
should be sufficient. | Bibliography
(Only the first author is mentioned)
1. CAHILL K.M. - Studies in Somalia. Trans. R. Soc. Trop. Med. Hyg.
1971 ; 65: 28-42.
2. MURRAY M.J. et Coll. - The adverse effect of iron repletion on
the course of certain infections. Br. Med. J. 1978 ; 2:
1113-1115.
3. TEKLEHAIMANOT A. -
Chloroquine-resistant Plasmodium
falciparum malaria in Ethiopia. Lancet 1986 ; 2:
127-129.
4. ILARDI L. et Coll. - Epidemiological study of parasitic
infections in Somali nomads. Trans. R. Soc. Trop. Med. Hyg. 1987 ;
81: 771-772.
5. WARSAME M. et Coll. - Susceptibility
of Plasmodium falciparum to
chloroquine and mefloquine in Somalia. Trans. R. Soc. Trop. Med.
Hyg. 1988 ; 82: 202-204.
6. WARSAME M. et Coll. - The seroreactivity against Pf155 (RESA)
antigen in villagers from a mesoendemic area in Somalia. Trop. Med.
Parasitol. 1989 ; 40: 412-414.
7. TANGANELLI E. et Coll. - Malaria and pregnancy. Theorical
premises and practical behavior. Minerva Gynecol. 1990 ; 42:
35-43.
8. WARSAME M. et Coll. - Isolated malaria outbreak in Somalia: role
of chloroquine-resistant Plasmodium
falciparum demonstrated in Balcad epidemic. J. Trop. Med. Hyg. 1990
; 93: 284-289.
9. WARSAME M. et Coll. - The changing pattern
of Plasmodium falciparum
susceptibility to chloroquine but not to mefloquine in a
mesoendemic area of Somalia. Trans. R. Soc. Trop. Med. Hyg. 1991 ;
85: 200-203.
10. SIDRAK W. et Coll. - Déficience dissimilaire de la
glucose-6-phosphate deshydrogénase (G-6-PD) chez les Afars et les
Somalis de Djibouti. Med. Trop. 1991 ; 51: 211-214.
11. LAUGHLIN L.W. et Coll. - Disease threats in Somalia. Am. J.
Trop. Med. Hyg. 1993 ; 48: vi-x.
12. BONE W.D. et Coll. - Imported malaria from Somalia. N. Engl. J.
Med. 1993 ; 328: 1046-1047.
13. SANCHEZ J.L. et Coll. - Mefloquine or doxycycline prophylaxis
in US troops in Somalia. Lancet 1993 ; 341: 1021-1022.
14. GUNBY P. - Extraordinary epidemiologic, environmental health
experience emerges fromoperation restore hope. JAMA 1993 ; 269:
2833-2838.
15. GUNBY P. - Will civilian physicians see post-Somalia malaria ?
JAMA 1993 ; 269: 3091.
16. ANONYME - Malaria among U.S. military personnel returning from
Somalia, 1993. MMWR 1993 ; 42: 524-526.
17. WALLACE M.R. et Coll. - Malaria in Mogadishu, Somalia. Clin.
Infect. Dis. 1993 ; 17: 510-511.
18. SMART R. - Infectious diseases in Somalia. N. Engl. J. Med.
1993 ; 329: 889-890.
19. MAGILL A.L. et Coll. - Failure of mefloquine chemoprophylaxis
for malaria in Somalia. N. Engl. J. Med. 1993 ; 329:
1206.
20. CRUTCHER J.M. et Coll. - Malaria (part 1). Lessons from Somalia
and General Slim. Navy Med. 1994 ; 85: 16-19.
21. SIGHINOLFI L. et Coll. - A double malarial infection in a
soldier returning from Somalia. Eur. J. Epidemiol. 1994 ; 10:
445-
446.22. NEWTON J.A. Jr et Coll. - Malaria in US Marines returning
from Somalia. JAMA 1994 ; 272: 397-399.
23. WAESAME M. et Coll. - An epidemic
of Plasmodium falciparum malaria in
Balcad, Somalia, and its causation. Trans. R.
Soc. Trop. Med. Hyg. 1995 ; 89: 142-145.24. LEDBETTER E. et Coll. -
Malaria in Somalia: lessons in prevention. JAMA 1995 ; 273:
774-775.
25. PERAGALLO M.S. et Coll. - Prevention of malaria among Italian
troops in Somalia and Mozambique. Trans. R. Soc. Trop. Med. Hyg.
1995 ; 89: 302.
26. SHANKS G.D. et Coll. - Doxycycline for malaria prophylaxis in
Australian soldiers deployed to United Nations missions in Somalia
and Cambodia. Mil. Med. 1995 ; 160: 443-445.
27. WALLACE M.R. et Coll. - Malaria among United States troops in
Somalia. Am. J. Med. 1996 ; 100: 49-55.
28. IBRAHIM M.M. et Coll. - Child mortality in a collapsing African
society. Bull. OMS 1996 ; 74: 547-552.
29. CALI G. - The Italian Army Medical Corps in the United Nations
"peace keeping" operations: Somalia and Mozambique, December
1992-December 1994. Med. Trop. 1996 ; 56: 400-403.
30. SMOAK B.L. et Coll. - Plasmodium
vivax infections in U.S. Army troops: failure of primaquine to
prevent relapse in studies from Somalia. Am. J. Trop. Med. Hyg.
1997 ; 56: 231-234.
31. PERAGALLO M.S. et Coll. - Prevention and morbidity of malaria
in non-immune subjects: a case-control study among Italian troops
in Somalia and Mozambique, 1992-1994. Trans. R. Soc. Trop. Med.
Hyg. 1997 ; 91: 343-346.
32. SMOAK B.L. et Coll. - The effects of inadvertent exposure of
mefloquine chemoprophylaxis on pregnancy outcomes and infants of US
Army servicewomen. J. Infect. Dis. 1997 ; 176: 831-833.
33. KACHUR S.P. et Coll. - Malaria surveillance - United States,
1994. MMWR 1997 ; 46: 1-18.
34. ANONYME - Enhanced medical assessment strategy for Barawan
Somali refugees - Kenya, 1997. MMWR 1998 ; 46:
1250-1254.
35. ANOMYME - From the Centers for Disease Control and Prevention.
Enhanced medical assessment strategy for Barawan Somali refugees -
Kenya, 1997. JAMA 1998 ; 279: 904-905.
36. FRITZ M.J. et Coll. - Somali refugee health screening in
Hennepin County. Minn. Med. 1998 ; 81: 43-47.
37. WEINA P.J. - From atabrine in World War II to mefloquine in
Somalia: the role of education in preventive medicine. Mil. Med.
1998 ; 163: 635-639.
38. PERAGALLO M.S. et Coll. - Compliance and tolerability of
mefloquine and chloroquine plus proguanil for long-term malaria
chemoprophylaxis in groups at particular risk (the military).
Trans. R. Soc. Trop. Med. Hyg. 1999 ; 93: 73-77.
39. SKEIK-MOHAMED A. et Coll. - Where health care has no access:
the nomadic populations of sub-Saharan Africa. Trop. Med. Int.
Health 1999 ; 4: 695-707.
40. MILLER J.M. et Coll. - Malaria, intestinal parasites, and
schistosomiasis among Barawan Somali refugees resettling to the
United States: a strategy to reduce morbidity and decrease the risk
of imported infections. Am. J. Trop. Med. Hyg. 2000 ; 62: 115-121.
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