Malaria in the Republic of Djibouti, 1998–2009

Ollivier, Lénaïck; Nevin, Remington L.; Darar, Houssein Youssouf; Bougère, Jacques; Saleh, M.Ridha; Gidenne, T.; Maslin, J.; Anders, Dietmar; Decam, C.; Todesco, Alain; Khaireh, Bouh Abdi; Ahmed, Ammar Abdo

doi:10.4269/ajtmh.2011.11-0122

Cited by 10 publications

(11 citation statements)

References 19 publications

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“…Its climate is semi-arid, with a mean annual rainfall of 147 mm [38]. Over the past 12 years, malaria incidence, as well as recurrence of epidemics, has decreased [44]. The epidemiologic strata have been illustrated by few micro-epidemics [32], with the exception of a major malaria outbreak that occurred in 1999 [45].…”

Section: Introductionmentioning

confidence: 99%

Population genetics analysis during the elimination process of Plasmodium falciparum in Djibouti

Khaireh

Assefa

Guessod³

et al. 2013

Malar J

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BackgroundCase management of imported malaria within the context of malaria pre-elimination is increasingly considered to be relevant because of the risk of resurgence. The assessment of malaria importation would provide key data i) to select countries with propitious conditions for pre-elimination phase and ii) to predict its feasibility. Recently, a sero-prevalence study in Djibouti indicated low malaria prevalence, which is propitious for the implementation of pre-elimination, but data on the extent of malaria importation remain unknown.MethodsDjiboutian plasmodial populations were analysed over an eleven-year period (1998, 1999, 2002 and 2009). The risk of malaria importation was indirectly assessed by using plasmodial population parameters. Based on 5 microsatellite markers, expected heterozygosity (H.e.), multiplicity of infection, pairwise Fst index, multiple correspondence analysis and individual genetic relationship were determined. The prevalence of single nucleotide polymorphisms associated with pyrimethamine resistance was also determined.ResultsData indicated a significant decline in genetic diversity (0.51, 0.59, 0.51 and 0 in 1998, 1999, 2002 and 2009, respectively) over the study period, which is inconsistent with the level of malaria importation described in a previous study. This suggested that Djiboutian malaria situation may have benefited from the decline of malaria prevalence that occurred in neighbouring countries, in particular in Ethiopia. The high Fst indices derived from plasmodial populations from one study period to another (0.12 between 1999 and 2002, and 0.43 between 2002 and 2009) suggested a random sampling of parasites, probably imported from neighbouring countries, leading to oligo-clonal expansion of few different strains during each transmission season. Nevertheless, similar genotypes observed during the study period suggested recurrent migrations and imported malaria.ConclusionIn the present study, the extent of genetic diversity was used to assess the risk of malaria importation in the low malaria transmission setting of Djibouti. The molecular approach highlights i) the evolution of Djiboutian plasmodial population profiles that are consistent and compatible with Djiboutian pre-elimination goals and ii) the necessity to implement the monitoring of plasmodial populations and interventions at the regional scale in the Horn of Africa to ensure higher efficiency of malaria control and elimination.

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Section: Introductionmentioning

confidence: 99%

Population genetics analysis during the elimination process of Plasmodium falciparum in Djibouti

Khaireh

Assefa

Guessod³

et al. 2013

Malar J

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“…Over the last 14 years, the transmission and the malaria cases number remained low. As a result, foreign armies present in the Republic of Djibouti have recently considered stopping their malaria chemoprophylaxis [12], as the French army did last year.…”

Section: Introductionmentioning

confidence: 99%

Plasmodium vivax and Plasmodium falciparum infections in the Republic of Djibouti: evaluation of their prevalence and potential determinants

Khaireh

Briolant

Pascual

et al. 2012

Malar J

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BackgroundFormerly known as a hypoendemic malaria country, the Republic of Djibouti declared the goal of pre-eliminating malaria in 2006. The aim of the present study was to evaluate the prevalence of Plasmodium falciparum, Plasmodium vivax and mixed infections in the Djiboutian population by using serological tools and to identify potential determinants of the disease and hotspots of malaria transmission within the country.MethodsThe prevalence of P. falciparum and P. vivax within the districts of the capital city and the rest of the Republic of Djibouti were assessed using 13 and 2 serological markers, respectively. The relationship between the immune humeral response to P. falciparum and P. vivax and variables such as age, gender, wealth status, urbanism, educational level, distance to rivers/lakes, living area, having fever in the last month, and staying in a malaria-endemic country more than one year was estimated and analysed by questionnaires administered to 1910 Djiboutians. Multivariate ordinal logistic regression models of the immune humeral response were obtained for P. falciparum and P. vivax.ResultsThe P. falciparum and P. vivax seroprevalence rates were 31.5%, CI95% [29.4-33.7] and 17.5%, CI95% [15.8-19.3], respectively. Protective effects against P. falciparum and P. vivax were female gender, educational level, and never having visited a malaria-endemic area for more than one year. For P. falciparum only, a protective effect was observed for not having a fever in the last month, living more than 1.5 km away from lakes and rivers, and younger ages.ConclusionsThis is the first study that assessed the seroprevalence of P. vivax in the Republic of Djibouti. It is necessary to improve knowledge of this pathogen in order to create an effective elimination programme. As supported by recent observations on the subject, the Republic of Djibouti has probably demonstrated a real decrease in the transmission of P. falciparum in the past seven years, which should encourage authorities to improve efforts toward elimination.

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“…The antimalarial drug mefloquine (commonly marketed as Lariam) had until recently enjoyed a long history of preferred use in certain military settings in the prophylaxis of chloroquine-resistant P. falciparum malaria. Originally developed by the US military in a Vietnam War-era drug development program and subsequently licensed for prophylactic use in the US in 1989 [ 1 ], mefloquine has, in the over quarter century since, been widely used by the US military and by various international militaries during deployments in malaria-endemic areas, including the Horn of Africa [ 2 – 4 ], sub-Saharan Africa [ 5 ], Australasia [ 6 , 7 ], Southeast Asia [ 8 ], and the Middle East—particularly during recent large-scale operations in Iraq and Afghanistan [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Owing to slight international differences in such costs and indications, as well as to differences in risk-benefit decision-making, international military antimalarial policies have varied, even between deployments posing similar risks to military forces. For example, for military deployments to Djibouti (a nation located in the Horn of Africa) French military forces discontinued the widespread use of mefloquine in 2002 in favor of preferred use of the broad-spectrum antibiotic and antimalarial doxycycline [ 2 ]. In contrast, US forces, which had been prescribing mefloquine to its personnel there at a dose of 250 mg weekly, delayed preferred use of doxycycline until 2009 [ 2 ], before next substituting the combination drug atovaquone/proguanil (commonly marketed as Malarone) in 2011 [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

“…For example, for military deployments to Djibouti (a nation located in the Horn of Africa) French military forces discontinued the widespread use of mefloquine in 2002 in favor of preferred use of the broad-spectrum antibiotic and antimalarial doxycycline [ 2 ]. In contrast, US forces, which had been prescribing mefloquine to its personnel there at a dose of 250 mg weekly, delayed preferred use of doxycycline until 2009 [ 2 ], before next substituting the combination drug atovaquone/proguanil (commonly marketed as Malarone) in 2011 [ 46 ]. In contrast, German forces have always preferentially used atovaquone/proguanil for the duration of their deployments there [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Rational Risk-Benefit Decision-Making in the Setting of Military Mefloquine Policy

Nevin

2015

Journal of Parasitology Research

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Mefloquine is an antimalarial drug that has been commonly used in military settings since its development by the US military in the late 1980s. Owing to the drug's neuropsychiatric contraindications and its high rate of inducing neuropsychiatric symptoms, which are contraindications to the drug's continued use, the routine prescribing of mefloquine in military settings may be problematic. Due to these considerations and to recent concerns of chronic and potentially permanent psychiatric and neurological sequelae arising from drug toxicity, military prescribing of mefloquine has recently decreased. In settings where mefloquine remains available, policies governing prescribing should reflect risk-benefit decision-making informed by the drug's perceived benefits and by consideration both of the risks identified in the drug's labeling and of specific military risks associated with its use. In this review, these risks are identified and recommendations are made for the rational prescribing of the drug in light of current evidence.

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Malaria in the Republic of Djibouti, 1998–2009

Cited by 10 publications

References 19 publications

Population genetics analysis during the elimination process of Plasmodium falciparum in Djibouti

Population genetics analysis during the elimination process of Plasmodium falciparum in Djibouti

Plasmodium vivax and Plasmodium falciparum infections in the Republic of Djibouti: evaluation of their prevalence and potential determinants

Rational Risk-Benefit Decision-Making in the Setting of Military Mefloquine Policy

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