|
|
 |
[08/04/2005]
 Swaziland | |
|
Author: Dr Francis Louis, Yaoundé, Cameroon
| |
General Statistics
Area: 17,560 km²
Population: 985,335 inhabitants (1999
estimation)
Capital: Mbabane
Currency: lilangeni
Official Languages: English and Siswati
Bordering Countries: South Africa and
Mozambique
Out of 192 countries Swaziland ranks 142nd for life
expectancy, 144th for infant mortality, 105th for GNP, 88th for
daily calorie intake, 133rd for literacy, 63rd for the percentage
of children in full-time education (source: Atlas Encyclopédique
Mondial, Nathan Ed., Paris 1996, pp.562-563).
Swaziland is considered to be a temperate country. It consists
largely of mountains and plateaux. There is a west-east gradient
for temperature and rainfall. The coldest and driest season run
from June to August. In May and September, temperatures hover
between 15°C and 20°C. For the remaining months, that is to say
from October to April, the temperature is often more than 20°C and
monthly rainfall is superior or equal to 200mm: this is the optimal
season for the transmission of malaria. | Epidemiological facies
Plasmodium falciparum is the only malaria
parasite in the Kingdom.
Malaria had all but disappeared from Swaziland in the 70’s
following intense anti-malaria action with the use of insecticides
in the home. This however brought about a fall in fight measures
and 1,473 cases of malaria were counted in 1978. A renewed fight
against the disease meant that in 1982 only 155 cases were
reported. However, in 1984 an epidemic broke out claiming the lives
of 3,373 people (number of reported deaths).
Today, the number of malaria cases is in the order of 1,700 per
year. (4, 3).
| Vectors
Jacques Brunhes et al. (Les anophèles de la région afro-tropicale,
logiciel ORSTOM Ed., 1998) registered only 13 different species of
anopheles in the country, of much varying medical
interest: Anopheles arabiensis, Anopheles coustani,
Anopheles funestus, Anopheles gambiae, Anopheles listeri, Anopheles
marshallii, Anopheles merus, Anopheles parensis, Anopheles
quadriannulatus, Anopheles rhodesiensis rhodesiensis, Anopheles
ruarinus, Anopheles rufipes rufipes and Anopheles theileri.
In 2000, K. Hargreaves et al. brought to light the fact that in
Kwazulu Natal (located on the Swaziland border) Anopheles
funestus has developed resistance to permethrine and, to a
slightly lesser degree, so too had Anopheles rivulorum, (7).
| Chemoresistance
Plasmodium falciparum‘s
resistance to chloroquine was reported in 1987: out of 29 children,
with over 1,000 parasites per microliter of blood, treated with 25
mg/kg of chloroquine over 3 days, 1 had an increased parasite count
on Day 2 and 23 children were still carrying the parasites by day 7
(7).
No other Study has been published.
| The National Anti Malaria Program
Not documented.
Y. Kassankogno describes an Anti-Malaria Program concerned with the
management of cases, spraying with insecticides and the monitoring
of chemosensitivity (6).
| Research
No research on paludism is currently in hand.
| Advices to travelers:
The « Centre National de Surveillance de la Chimiosensibilité
(Français)» (The French National Centre for the Monitoring of
Chemosensitivity) placed Swaziland in Chemoresistance group III .
This means that
"Plasmodium falciparum is
highly Chemoresistant or poly-resistant". According to the B.E.H.
n°24-25 of 14th june 2005, this signifies that a traveler spending
less than 3 months in Swaziland should take Mefloquine or
Atovaquone-Proguanil combined treatment. It is likely that given
the lack of information on malaria in the country, this
recommendation is based upon the recommendations made for the
neighboring countries of South Africa and Mozambique.
The real question is: should a chemoprophylaxis be taken in a
country that only has 1,700 annual cases of malaria for a
population of roughly 1 million inhabitants, in other words, an
annual occurrence rate of 0.17% ?
It seems sensible to bear in mind the conditions of the trip: humid
season Vs dry ? Staying in towns or in the countryside ? Staying at
a hotel or in a traditional dwelling? etc. More often than simple
measures of precaution against mosquito bites might be sufficient.
| Bibliography
1. PACKARD R.M. - Agricultural development, migrant labor and the
resurgence of malaria in Swaziland. Soc. Sci. Med. 1986 ; 22:
861-867.
2. FONTAINE R., HEYNEMAN D., MANBAC C. - Malaria in Swaziland.
Rapport OMS, 1987.
3. RAVIGLIONE M.C. - Appearence of chloroquine-resistant falciparum
malaria in Swaziland. Lancet 1987 ; 11: 44-45.
4. MOUCHET J., MANGUIN S., SIRCOULON J. et Coll. - Evolution of
malaria in Africa for the past 40 years: impact of climatic and
human factors. J. Am. Mosq. Control. Assoc. 1998 ; 14:
121-130.
5. MOUCHET J. - L'origine des épidémies de paludisme sur les
Plateaux de Madagascar et les montagnes d'Afrique de l'Est et du
Sud. Bull. Soc. Path. Exot. 1998 ; 91: 64-67.
6. 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.
7. HARGREAVES K., KOEKEMOER L.L., BROOKE B.D. et Coll. - Anopheles
funestus resistant to pyrethroid insecticides in South Africa. Med.
Vet. Entomol. 2000 ; 14: 181-189.
|
|
|
|
Version française 
