Academic journal article Bulletin of the World Health Organization

Recurrence and Emergence of Infectious Diseases in Djibouti City

Academic journal article Bulletin of the World Health Organization

Recurrence and Emergence of Infectious Diseases in Djibouti City

Article excerpt


Recurrence of old infectious diseases and the emergence of new ones, as revealed by unexpected outbreaks or epidemics, are being reported with increasing frequency (l) and could have an adverse impact on health care budgets and disease control strategies. The seriousness of the situation has led to the development of a prevention strategy by the Centers for Disease Control and Prevention (CDC), which addresses emerging infectious disease threats to the United States (2).

This article describes recent changes in the epidemiology of infectious diseases in the capital city of Djibouti, East Africa, which illustrates the problem of emerging diseases in a rapidly growing city of the developing world. The changes are related to poorly documented but significant population movements, including the influx of refugees, in Djibouti following the Ethiopian and Somali political turmoils since the late 1970s and the periodic regional famines.

Findings and discussion

The population of Djibouti city was about 15 000 in 1900, 30000 in 1950, 106 000 in 1970, 156 000 in 1980, 235 000 in 1990, and about 300 000 in 1994 (de Comarmont, Ministry of Urbanism, Djibouti, personal communication, 1994). This increase was primarily due to economic immigrants, high birth rates and the refugees. Although about a third of the national budget has been spent on development since 1977 (de Comarmont, personal communication), the living conditions of Djiboutians remain poor. In an interview to the national newspaper "La Nation" on 7 October 1993, the Djibouti Minister of Urbanism depicted significant difficulties in water supply, sewage system, garbage collection and general housing, and further emphasized the possible adverse consequences on public health. The chronology of the emergence of malaria. HIV/AIDS, multidrug-resistant tuberculosis, dengue fever and cholera in the city of Djibouti is presented in Fig. 1 with the changes in population growth.


In the early 1900s, only two malaria foci were identified, one in Ambouli and the other in Gaanman, two villages located within 4 km of Djibouti city, along the main river valley or wadi (3). Subsequently malaria cases, mostly imported from neighbouring countries, were only infrequently reported until 1973 (4). Recurrence of indigenous malaria was first documented in 1978 in the southern districts, especially Ambouli and Loyada, and then Dikhil and Ali-Sabieh. Malaria. initially unstable with peaks in May-June and November-December, soon became endemic throughout the year, including the dry and torrid summer period. In the following years, cases of malaria occurred for the first time in the northern districts. particularly in Tadjourah. During the 1988-89 winter season, outbreaks of Plasmodium falciparum malaria struck the country, including the capital city and the south-western town of As-Eyla (5). About 3000 malaria cases with significant mortality were reported and the importation of malaria parasites by travellers from adjacent countries was suspected (6). Anopheles arabiensis was identified as the main vector (7). In 1991, Djibouti reported 7338 cases of smear-positive malaria, 98% being falciparum malaria and 80% originating from the Ambouli and airport areas of Djibouti city. Although the figure dropped in 1993 to 4770 (74% from the capital city), malaria had become a permanent public health concern in Djibouti city where the marked seasonal pattern had decreased considerably compared to rural areas. The emergence of urban malaria closely followed the progressive inclusion of the wadi Ambouli, known for its gardens and wells, in the growing agglomeration of Djibouti. Entomological surveys confirmed the Ambouli area as a major source of Anopheles mosquitos (8). In addition, and following the 1985 report of chloroquine-resistant P. falciparum in Ethiopia (9), P. falciparum strains resistant to chloroquine in vivo, including RII/RII resistance. …

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