Extravenereal treponematosis ('dichuchwa') in the Bakwena Reserve of the Bechuanaland Protectorate: a study of a common childhood infection from the social, epidemiological, clinical, therapeutic and control aspects.

Abstract

1. There is a form of extravenereal treponematosis in the Bakwena Reserve of the Bechuanaland Protectorate known by the local word of "dichuchwa". This disease is similar to bejel, njovera aid the endemic syphilis reported from Bosnia and other parts of the world.2. It is probable that syphilis .:eras introduced to the Batswana people in the late 18th century soon after their first contacts with Europeans, Coloureds and Hottentots. This venereal syphilis, on account of the epidemiological factors present in Bechuanaland soon became non -venereal in its form of spread. Large numbers of the population were then affected.3. Today the disease is well known throughout all parts of the Bechuanaland Protectorate. It is known by different names by the different tribes. Reports suggest that throughout the whole of the Bechuanaland Protectorate there is a seropositive rate of about 30%. In the Bakwena Reserve as a whole the rate is 37%.4. The essential characteristics of the disease are, that it is a childhood and family disease spread usually, non- venereally, although venereal spread can occur. It affects mainly the more primitive and unhygienic members of the tribe, amongst whom it spreads through the common use of domestic utensils and through direct contact. The early lesions are similar to the secondary lesions of sporadic venereal syphilis and these lesions are followed in a number of cases by tertiary lesions. The tertiary lesions mainly affect the skin, causing gummatous ulceration; the nasopharynx and the long bones.5. Primary lesions are rare. 'They, occur only if the size of the inoculum is large enough and if the epidemiological conditions are satisfactory. These conditions are present when a mother develops primary sores on the nipples through feeding an infected infant.6. Lesions of the cardio -vascular system and central nervous sytem, althoughrare, do occur.7. Congenital syphilis is also very rare but congenital spread is possible. The rarity is probably accounted for by the fact that many years usually elapse from time of the attack of dichuchwa to the birth of the child.8. Superinfection of an already infected and allergic host is probably the chief reason for the frequency of tertiary lesions. When the number of infectious cases decrease in an area so also does the number of tertiary cases.9. The highest infection r te was found amongst the Makgalagadi people lifiTing in the western part of the Reserve in the Kalahari desert. It is emphasisei that it is in this area that the mass treatment campaign in the rest of Bechuanaland will have to be concentrated.10. Treatment of the disease with PAM is very effective. Mass treatment of cases and contacts combined with improved standards of hygiene could eradicate the disease. It is important after a mass treatment of a village to return fairly soon to search out cases which escaped the first visit and which constitute a reservoir for the infection.11. The World Health Organisation team worked in the Bakwena Reserve from November 1953 until February 1955 and the methods adopted in this field campaign are described