Area: 56,731 km² 
Population: 4,356,800 inhabitants (1993 estimation ) 
Capital: Lome 
Currency: CFA Franc 
Official Language: French 
Bordering Countries: Benin, Burkina Faso, Ghana 

Out of 192 countries, Togo ranks 153rd for life expectancy, 151st for infant mortality, 169th for GNP, 148th for daily calorie intake, 165th for literacy, 104th for the percentage of children in full-time education (source: Atlas Encyclopédique Mondial, Nathan Ed., Paris 1996, pp.562-563). 

Concerning climatology, the country is divided in half by a line that passes through Blitta: 

The North, from 8° to 11° latitude north, is characterized by a rainy season from April to September and a dry season from October to March. Temperature varies between 25°C in April and 37°C In February. Vegetation is like that found in the savannah. 

The South, from 6°to 8° latitude north, is characterized by two rainy seasons from March to July and from the 15th September to the 15th December, and two dry seasons from August to the 15th September and from the 15th December to the end of February. Temperatures vary from 25°C to 28°C. Vegetation is of the tropical humid variety.

According to A. Gayibor, Plasmodium  falciparum represents 99.48% of parasites and Plasmodium  malariae 0.52% (24). Plasmodium  ovale is also said to be present, but remains anecdotal (22). 

In a 1987 study conducted in Sokodé (in the centre of Togo) out of 707 children in the 2 to 9 year old age category, A.R. Gbary et al. found 263 to be parasite carriers (37.2%). The species of parasites found were divided between Plasmodium  falciparum (88.9%), Plasmodium  malariae (8.3%) and Plasmodium  ovale (2.8%) (6). 

It is normal to consider that there is stable equatorial malaria present in the country. However, variations in climate all year round also lead to variations in the intensity of the transmission of the disease. Thus, a 1996 study showed a variation of parasite prevalence from 37.7% in January to 61.1% in August for an average monthly rainfall of 49.7% (#1).

The principal malaria vector is Anopheles gambiae, and is present in all the country

Anopheles funestus and Anopheles nili are also present countrywide.

Anopheles melas is present along the coast, Anopheles rufipes and Anopheles wellcomei wellcomei being present only in the extreme north of the country. 

Amongst the other species recorded there is also: Anopheles hargreavesi, Anopheles pharoensis, Anopheles coustani, Anopheles squamosus, Anopheles flavicosta, Anopheles brohieri, Anopheles pretoriensis, Anopheles rhodesiensis rhodesiensis and Anopheles rivulorum (#1).

Jacques Brunhes et Coll. do not confirm the presence of Anopheles rufipes, Anopheles squamosus, Anopheles brohieri and Anopheles rivulorum, but on the otherhand, do cite the presence of Anopheles arabiensis, Anopheles smithii and Anopheles ziemanni (#2).

1. Resistance to chloroquine: 

The first case of in vivo chloroquine-resistance was reported by P. Bourée in 1987 in a French woman who had gone on holiday to South Togo (Lome, Atakpame and Palime) (4). 

In 1987 in Sokode, A.R. Gbary et al. found 30.4% resistance (7/ 23) to chloroquine dosed at 10 mg/kg, but only 4.5% (2/ 44) when dosed at 25 mg/kg (6). It is interesting to note that at that time the 10 mg / kg dose was recommended in Togo for the precautionary treatment of feverish attacks. 

The other statistics on in vivo chloroquine-resistance are given in table I below. 

Table I - in vivo chloroquine-resistance in Togo

* Subjects ill

There have been no published reports on in vitro chloroquine-resistance. 

2. Resistance to other antimalarial drugs: 

Resistance to amodiaquine:

In vivo resistance is shown in table II below. There have been no published reports on in vitro resistance.. 

Table II - In vivo resistance to amodiaquine in Togo

Resistance to quinine:

One case of relapse after a treatment with quinine was reported by C. Longuet et al., but it isn’t possible to tell if contamination occurred in Benin, Ghana or Togo (21). 

Resistance to mefloquine:

D. Gizolme et al. published 3 cases of failed chemoprophylaxis by mefloquine (22).The reality of this resistance is questioned by J. Chandenier et al. (25). 

Resistance to cycloguanil (active metabolite of proguanil):R. Durand et al. reported the state of resistance to proguanil in 1995 (81 isolates), 1996 (161 isolates) and 1997 (259 isolates).Out of the 501 isolates, 21 came from Togo, but the authors did not give the details of the analysis (26). 

Resistance to the sulfadoxine-pyrimethamine combination: 

In 1996, not one of the 32 patients treated with the sulfadoxine-pyrimethamine combination suffered from resistance to the drug (23).

From 1981 to 1987, a public awareness campaign in Lome was run concerning Vector control and brought about a 68% reduction in domestic and paradomestic larvae sites (#1). However, after the campaign was abandoned in 1987, it took only eight years for the situation to return to how it was in 1981. 

In 1996 a program was run promoting the use of insecticide treated mosquito nets for which 90 people were trained in treating techniques, in addition to the training of 90 advanced health and hygiene officers, coming from 30 counties in the country (#1). There is no feedback from the outcome of these training schemes. 

The National Anti-Malaria Program employs a full time doctor (Dr Adjogblé), 6 coordination officers, 5 administrative staff, 4 laboratory technicians and 12 part-time members of staff (#1). The government pays the salaries of the staff and a WHO donation (300 000 $US in 1997) allows the program to operate. Their equipment consists of 2 lightweight vehicles, a coach, 6 microscopes and an equipped office. 

Aims of the 1995-1998 plan were to (#1): 

Provide the correct care and treatment for 90% of malaria cases; 

Promote the use of insecticide treated mosquito nets in at least 30% of homes; 

Provide the correct chemoprophylaxis for 80% of pregnant women. 

Even if these goals were not attained, the National program did achieve other important results: 

Useful training guide (1995) ; 

Creation of 34 mosquito net treating centres across the country (1995-1996); 

A doctor’s guide book for the care and treatment of serious cases of malaria (1997) ; 

A nurse’s guide book for the care and treatment of serious cases of malaria (1997); 

Organization of a National Public Awareness Day supporting anti-malaria action (30/05/1996: Lomé ; 08/07/1997: Tsévié) ; 

Training of health officers in the correct care and treatment of malaria victims, in 5 regions of the country. 

In 1997, Togo was integrated with the 21 countries selected by the WHO for the “Harare declaration for the prevention of and the fight against malaria, within the context of African Economic Recovery and Development” (27). From 1997 to 1999, the strategy of the National Anti Malaria Program was based upon the management of cases and the use of mosquito nets. The training of the Health workers is shown in table III below 

Table III - Distribution of trained personnel (27)

Care and treatment of severe cases

Training to become an instructor

The table shows ideal results: Togo has more trained personnel that was planned for by the program and it would be interesting to see what kind of results these trained personnel can achieve in the field of action.

There are many researchers working on malaria in Togo (#1):

Professeur Kossivi AGBO (20), Département de Parasitologie, C.H.U. Tokoin, Faculté mixte de médecine et de pharmacie, Lome, Togo. Research theme: monitoring of failed drugs trials. 

Professeur Messanvi GBEASSOR, Faculté des sciences Lome, Togo. Research theme: Use of medicinal plants in the treatment of malaria (8). Most recent publication: MacKinnon S. et al. – Anti-malarial activity of tropical Meliaceae extracts and gedunin derivatives. J. Nat. Prod. 1997 ; 60: 336-341. 

Docteur Kodjo DOGBA, Ecole supérieure des technologies biologiques et alimentaires de l'Université du Bénin, Lomé, Togo. Research theme: in vivo and in vitro chemosensitivity of Plasmodium falciparum. No publications.

The ‘Centre National Français de Surveillance de la Chimiosensibilité’ (“ French National Cente for the Monitoring of Chemosensivity “) placed Togo in group III, which includes countries where "Plasmodium  falciparum is highly Chemoresistant, even poly resistant"

According to the B.E.H. n°24-25 of 14th june 2005, this signifies that at traveler spending less than 3 months in Togo should take Mefloquine or Atovaquone-Proguanil combined treatment.

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 not simple measures of precaution against mosquito bites are largely sufficient

(only the first author is mentioned)

1. BIENZLE U. - Haemoglobin and glucose-6-phosphate dehydrogenase variants: distribution in relation to malaria endemicity in a Togolese population. Z. Tropenmed. Parasitol. 1972 ; 23: 56-62.

2. TROJAN HJ - Complications oculaires dans le traitement au long cours par chloroquine. Etude au Togo. Rev. Int. Trach. Pathol. Ocul. Trop. Subtrop. 1975 ; 52: 129-137.

3. BREMAN J.G. - Single-dose chloroquine therapy for Plasmodium  falciparum in children in Togo, West Africa. Am. J. Trop. Med. Hyg. 1987 ; 36: 469-473.

4. BOUREE P. - Plasmodium  falciparum chloroquinorésistant au Togo. Une observation. Presse Med. 1987 ; 16: 1760.

5. MORAN J.S. - Failure of chloroquine treatment to prevent malaria in Americans in West Africa. JAMA 1987 ; 258: 2376-2377.

6. GBARY A.R. - Emergence Emergence du paludisme chloroquinorésistant en Afrique de l'Ouest: cas de Sokode (Togo). Trop. Med. Parasitol. 1988 ; 39: 142-144.

7. DREMING M.S. - Home treatment of febrile children with antimalarial drugs in Togo. Bull. WHO 1989 ; 67: 695-700.

8. GBEASSOR M. - Antimalaria effects of eight African medicinal plants. J. Ethnopharmacol. 1989 ; 25: 115-118.

9. BOUKARI B.S. - Le paludisme congénital: considérations cliniques, parasitologiques et histologiques. A propos de 200 observations colligées au CHU de Lomé et à l'hôpital de Kpalimé. Bull. Soc. Path. Exot. 1991 ; 84: 448-457.

 10. AGBERE A.D. - Profil infectieux du nouveau-né dans un service de pédiatrie d'un CHR au Togo. Bull. Soc. Path. Exot. 1991 ; 84: 751-760.

11. ASSIMADI K. - Itinéraires et soins de santé des enfants au Togo. Bull. Soc. Path. Exot. 1991 ; 84: 794-803.

12. CHIPPAUX J-P. - Effets de la supplémentation en fer sur l'infection palustre. Bull. Soc. Path. Exot. 1991 ; 84: 54-62.

13. BRINKMANN U. - Malaria and health in Africa: the present situation and epidemiological trends. Trop. Med. Parasitol. 1991 ; 42: 204-213.

14. GUIGUEMDE T.R. - Point actuel sur la chimiorésistance du paludisme des sujets autochtones dans les états de l'O.C.C.G.E. (Afrique de l'Ouest). Ann. Soc. belge Med. trop. 1991 ; 71: 199-207.

15. ROMAND S. - Paludisme congénital. Un cas survenu chez des jumeaux de mère asymptomatique. Presse Med. 1994 ; 23: 797-800.

16. SCHNEIDER D. - Evaluation de l'impact d'un traitement martial. Interférence du paludisme. Bull. Soc. Path. Exot. 1995 ; 88: 260-264.

17. AGBO K. - Surveillance de la chimioprophylaxie antipalustre chez la femme enceinte en milieu urbain et rural au Togo. Mal. Inf. Dis. Afr. 1995 ; n°2: 16-17.

18. GAYIBOR A. - Traitement du paludisme: pratique des agents des pharmacies de Lomé. Mal. Inf. Dis. Afr. 1995 ; n°3: 13-15. 

19. BALO K.P. - Maculopathie liée à la chloroquine et prévention du paludisme. J. Fr. Ophtalmol. 1996 ; 19: 770-776.

20. AGBO K. - Diagnostic biologique de l'infection à Plasmodium  falciparum par système ParaSight-F®, un outil efficace au lit du malade. Tunis. Med. 1997 ; 75: 860-864.

21. LONGUET C. - Paludisme à Plasmodium  falciparum: résistance de type R1 à la quinine en Afrique de l'ouest. Presse Med. 1998 ; 27: 522.

22. GIZOLME D. - Echec relatif de chimioprophylaxie par méfloquine à l'occasion d'un voyage au Togo. Trois cas au sein d'une même famille. Presse Med. 1998 ; 27: 1575-1576.

23. ASSIMADI J.K; - Paludisme grave chez les enfants au Togo. Arch. Pediatr. 1998 ; 5: 1310-1315.

24. GAYIBOR A. - République Togolaise, Ministère de la Santé, Direction Générale de la Santé, Service des Maladies transmissibles, Programme National de Lutte contre le Paludisme. Mal. Inf. Dis. Afr. 1998 ; n°8: 44-54.

25. CHANDENIER J. - Chimioprophylaxie et impaludation. Presse Med. 1999 ; 28: 399.

26. DURAND R. - increased incidence of cycloguanil resistance in malaria cases entering France from Africa, determined as point mutations in the parasites' dihydrofolate-reductase genes. Ann. Trop. Med. Parasitol. 1999 ; 93: 25-30.

27. KASSANKOGNO Y. - Aperçu sur le programme de lutte contre le paludisme africain pour la période 1996-1997. Mal. Inf. Dis. Afr. 1999 ; n°9bis: 52-61. 

Autres sources documentaires:

#1. GAYIBOR A., D'ALMEIDA A.E., AGBO K. - Situation du paludisme au Togo. Doc. Ministère de la Santé 1997 ; 12 p., non publié.

#2. HERVY J-P., LE GOFF G., GEOFFROY B., HERVE J-P., MANGA L., BRUNHES J. - Les anophèles de la région afro-tropicale, logiciel ORSTOM Ed., 1998.

#3. ADJOGBLE L.L. - Guide pratique de formation du personnel de santé sur la lutte contre le paludisme. PNLP, Ministère de la Santé Publique, Lomé, Togo, 1995.