Intent to receive flu vaccine and influenza vaccination coverage among health professionals during 2019, 2020 and 2021 campaigns in Côte d'Ivoire.

Vaccination of healthcare workers against influenza is a crucial strategy to reduce transmission amongst vulnerable populations, facilitate patient uptake of vaccination, and bolster pandemic preparedness. Globally, vaccination coverage of health workers varied from 10 % to 88 %. Understanding health workers' knowledge and acceptance of the influenza vaccine, particularly among physicians, is crucial for the fine-tuning and continued success of influenza vaccination campaigns. We conducted a cross-sectional survey of 472 health workers in Abidjan, Côte d'Ivoire, to inform subsequent subnational and national introductions of influenza vaccine and subsequent campaigns targeting health workers in 2019 (14302), 2020 (14872), and 2021 (24473). Using a purposive sample of university hospitals, general hospitals, rural, and urban health facilities, we interviewed a convenience sample of health workers aged 18 years and older. Physicians had the lowest intention to receive the influenza vaccine (58 %), while nurses (78 %) and midwives (76 %) were the most willing. Across all occupations, intention to receive vaccination increased if the vaccine was offered for free or if recommended by the Ministry of Health. 76 % of respondents believed that the influenza vaccine could prevent illness in health workers. Communication strategies, including about the benefits of influenza vaccination, could raise awareness and acceptance among health workers prior to vaccination campaigns. Influenza vaccination coverage rates between 2019 and 2021 were on par with rates of intention to receive vaccination in the 2018 survey; in 2019, 2020, and 2021, coverage among physicians was 73 %, 73 %, and 52 % and coverage among nurses and midwives was 86 %, 86 %, and 74 % respectively. Improving health workers' knowledge and acceptance of the influenza vaccine, particularly among physicians, is crucial for the continued success of influenza vaccination campaigns.

Features of malaria among patients HIV infected in a Department of Infectious Diseases in Bamako

Introduction. We studied malaria in HIV infected subjects hospitalized in the department of infectious diseases at Point G Teaching Hospital in Mali, with the objective to have current data on malaria in patients infected by HIV. Materials and methods. We conducted a prospective study from October, 1st 2016 to September 30th 2018 in patients seropositive for HIV having positive thick smear for Plasmodium and hospitalized in the department of infectious diseases at Point G Teaching Hospital. We collected sociodemographic, clinical and lab data form those patients. Data have been entered and analyzed using SPSS20.0 software. Results. Hospital frequency of malaria among People living with HIV was 24.4% (151/618). This population has a mean-age of 44.1±12.4 y/o and a sex ratio (M/F) of 0.86. Majority of patients were at WHO stage IV of HIV infection (63.4%). Symptoms were by decreasing frequency: fever (98.3%); headache (86.4%); anorexia (72.9%); asthenia (61.0%) and vomiting (42.4%). the mean parasitemia was 172.9±352.1 trophozoite/mm3 . Mean hemoglobin level was 9.1±3.2 g/dl and the mean CD4 count was 9±3 cell/mm3 . Severe malaria was independent from WHO HIV stage and from immunologic deficiency. The malaria treatment when correctly followed conduct to good improvement of the anemia (p = 0.03) and the negativity of the parasitemia (p = 0.00). Death in our HIV patient is linked to association with severe malaria (p = 0,012). Conclusion. Malaria is relatively common and severe among PLWHA in Mali. Prompt treatment is still effective and must be implemented to ensure a good prognosis. Despite cotrimoxazole chemoprophylaxis, a certain number of PLHIV suffer from malaria, raising the hypothesis of plasmodium resistance to antifolates.

[Covid-19 in Côte d'Ivoire (March 2020 - April 2021) a year under the seal of the Coronavirus]. / La Covid-19 en Côte d'Ivoire (mars 2020 - avril 2021) une année sous le sceau du coronavirus.

After a year of coronavirus epidemic, Côte d'Ivoire is completing a third wave of Covid-19. Although the epidemic has been confined mainly to Greater Abidjan, thanks in particular to the isolation measures imposed on the Ivorian economic capital, the impact of the health crisis has nevertheless been marked. Like other West African countries, Côte d'Ivoire did not experience the epidemic tsunami that some predicted in March 2020, but more than 45 000 cases and nearly 300 deaths have been reported, although these figures underestimate the epidemiological reality. With the advent of vaccination, Côte d'Ivoire hopes to control the epidemic, but the possible circulation of variants, particularly South African variants, and the difficulties in obtaining vaccine doses are challenges that the Ivorian health authorities will have to overcome. The resilience of the population has been significant during this crisis, illustrating the ability of Ivorians to withstand the impact of this crisis.

[Factors associated with loss to follow-up in HIV-infected patients, Ségou, Mali]. / Facteurs associes aux perdus de vue chez les patients infectes par le VIH, Segou, Mali.

OBJECTIVE: to study the factors associatedlost to follow-up in People Living with HIV on antiretroviral therapy (ART) at the Ambulatory Treatment Center (ATC). METHODS: This is a retrospective case-control study of two years. It concerned all HIV-infected patients aged 15 and over who were started on ART for at least 4 months. Each case was matched with two controls by sex and age ± 5 years. RESULTS: The proportionlost to follow-up was 21%.The median age lost to follow-up was 36 years (IQR: 30-42 years), sex ratio was 1.4 in favor of women. The median initial CD4 cell count was 151 cells / mm3 (IQR: 51-245) versus 207 (IQR: 67-482) for controls and the median lost to follow-up was 6 months (IQR: 4-9 months): 5-16) for controls. In multivariate analysis, the factors associated lost to follow-up were: unmarried (adjusted OR = 3.84, P = 0.0346); the initial CD4 <200 cells / mm3 (adjusted OR = 3.88, P = 0.0393) and the duration of ARV <= 6 months (adjusted OR = 6.59, P = 0.0047). The protective factors against lost to follow-up were: Body Mass Index of the last visited > = 18.5 kg / m2 (adjusted OR = 0.07, P = 0.0069); (OR adjusted = 0.06, P = 0.0197) and initiation to ART in the rainy season (adjusted OR = 0.21, P = 0.0220). CONCLUSION: These results can be supplemented by quantitative and qualitative studies.

LE BUT: de ce travail était de d'étudier les facteurs associés aux perdues de vue chez les personnes vivant avec le VIH sous traitement antirétroviral (ARV) au Centre de Traitement Ambulatoire. MÉTHODES: Il s'agissaitune étude rétrospective cas-témoins de deux ans. Elle a concerné tous les patients infectés par le VIH âgés de 15 ans et plus initiés au traitement antirétroviral depuis 4 mois. RÉSULTATS: La proportionde perdue de vue était de 21% (31/151). L'âge médian des PDV était de 36 ans (IQR:30-42ans), le sexe ratio était 1.4 en faveur des femmes. Le CD4 initial médian était 151 cellules /mm3 (IQR: 51-245) contre 207 (IQR:67-482) pour les témoins et la durée médiane PDV était de 6 mois (IQR :4-9 mois) contre 9 mois (IQR:5-16) pour les témoins. A l'analyse multivariée, les facteurs associés au PDV étaient : les non mariés (OR ajusté= 3,84, P=0.0346) ; le taux de CD4 initial < 200 cellules /mm3 (OR ajusté= 3.88, P=0.0393) et la durée sous ARV ≤ 6 mois (OR ajusté= 6.59, P=0.0047). Les facteurs associés à une diminution du risque de PDV étaient : IMC de la dernière visitée ≥ 18,5 kg/m2 (OR ajusté=0.07, P=0.0069) ; les activités associatives (OR ajusté = 0.06, P=0.0197) et l'initiation aux ARV en saison de pluie (OR ajusté=0.21, P=0.0220). CONCLUSION: D'autres études quantitatives et qualitatives représentatives de la région de Ségou sont nécessaires afin de mieux comprendre ce phénomène PDV.

[Supporting factors of diarrhoea diseases in the children under 5 years in Commune II of the district of Bamako- Mali]. / Facteurs favorisant les maladies diarrheiques chez les enfants de 0 à 5 ans en Commune II du district de Bamako-Mali.

Diarrhea remains a real public health problem as it is the second leading cause of under-five mortality. In tropical environments, studies show several factors contributing to the frequency and severity of diarrhea. It is in this context that the present study of the factors favoring diarrheal diseases in children from 0 to 5 years old has been carried out. MATERIALS AND METHODS: Cross-sectional cluster survey involving 200 mothers of 0-5 year-old children from November 2015 to October 2016. The Pearson Chi2 test was used with a 95% confidence level. RESULTS: Married women accounted for 85.5% of our sample, 47% of whom had no education. Of the mothers surveyed, 17% of their children had had at least one episode of diarrhea in the two weeks before the survey. Almost all mothers (94%) washed their hands before feeding their children and 13% did not do so after cleaning the children. Regarding the cleanliness of the concession, it was bad in 23.5%. The majority of mothers (51%) did not know the significance of diarrhea, 43% reported the means of transmission, and 28% had inadequate practice in managing diarrhea. Some factors favor the occurrence of diarrhea such as: mixed breastfeeding that was statistically significant (p = 0.014), as well as poor hand hygiene practices (p = 0.027) and concessions (p = 0.000), as well as than the bad knowledge of the subject (p = 0.000). CONCLUSION: Our study shows that diarrhea was a disease of the hands rooms, hence the interest of strengthening the awareness of mothers for best practices for behavior change.

Les diarrhées demeurent un véritable problème de santé publique parce qu'elles constituent la deuxième cause de mortalité des moins de 5 ans. En milieu tropical, des études montrent plusieurs facteurs concourent à la fréquence et à la gravité des diarrhées. C'est dans ce contexte que la présente étude a été réalisée avec objectif de déterminer les facteurs favorisant les maladies diarrhéiques chez les enfants de 0 à 5 ans. MATÉRIEL ET MÉTHODES: Etude transversale par sondage en grappe ayant concerné 200 mères d'enfant de 0-5 ans, de novembre 2015 à octobre 2016. Le test de Chi2 de Pearson a été utilisé avec un niveau de confiance de 95%. Résultats : Les femmes mariées représentaient 85,5% de notre échantillon dont 47% n'avaient reçu aucune instruction. Parmi les mères interrogées, 17% de leurs enfants avaient présenté au moins un épisode de diarrhée dans les deux semaines ayant précédé l'enquête. Presque toutes les mères (94%) se lavaient les mains avant d'alimenter leurs enfants et 13% ne le font pas après le nettoyage des enfants. Concernant la propreté de la concession, elle était mauvaise dans 23,5%. La majorité des mères (51%) ne connaissait pas la signification de la diarrhée, 43% les moyens de sa transmission et 28% avait une pratique inadéquate de la prise en charge de la diarrhée. Certains facteurs favoriseraient la survenue de la diarrhée comme : l'allaitement mixte avec (p = 0,014), de même que les mauvaises pratiques d'hygiène des mains (p =0,027)et des concessions (p = 0,000), ainsi que les mauvaises connaissances du sujet (p = 0,000). CONCLUSION: Notre étude montre que la diarrhée était une maladie des mains salles, d'où l'intérêt de renforcer la sensibilisation des mères pour de meilleures pratiques en faveur du changement de comportement.

Entomological and parasitological parameters of malaria transmission in Douguia, Chad.

Malaria remains a threat for many countries, especially in Chad where it is the leading cause of morbidity and mortality. Few reliable data exist, however, about the entomological and parasitological parameters of malaria transmission. The objective of this study was to investigate the entomological and parasitological parameters of malaria transmission in Douguia, a village located 75 km northeast of Ndjamena (Chad), as part of a training program for participants in Chad's malaria control program. Mosquitoes were collected after morning pyrethroid spraying, with a mouth aspirator. The parasitological data were collected by a rapid diagnosis test or microscopic examination. The study examined 350 subjects aged from 6 months to 80 years. The plasmodic index (PI) of Plasmodium falciparum was 25.4 % (n = 89) and the gametocygenic index (GI) 9.1 % (n = 32); they varied significantly from one age group to another (p = 10- 3). The PI in pregnant women attending antenatal clinics was 18.7 % (n = 12/64). Three Anopheles species were found: Anopheles gambiae s.l, An. arabiensis and An. pharoensis. An. coluzzii accounted for 94.9 % of the An. gambiae s.s. The antigen sporozoite index (SI) was 4.5 %. Our results confirm the endemicity of malaria in Chad (Douguia) and underline the major role of An. gambiae s.l. in its transmission. However, repeated studies using PCR for Plasmodium detection would help to improve our understanding of its epidemiology.

[Maxillary ameloblastoma at the odonto-stomatology University Hospital in Bamako]. / Les ameloblastomes des maxillaires au centre hospitalier universitaire d'odontosmatologie de Bamako.

INTRODUCTION: The aim of this study was to determine the sociodemographic, therapeutic, pathological and clinical aspects of patients with maxillary ameloblastoma at the University Hospital of Odonto-Stomatology (CHU OS) of Bamako. MATERIALS AND METHOD: We performed a retrospective and prospective study over three years (January 2007 - December 2010), examining cases of maxillary ameloblastoma, as confirmed by clinical, associated with radiology or anatomic pathology. Data was collected from medical records, then entered and analyzed using Epiinfo. RESULTS: Tumor lesions were found in 55 men and 43 women with a sex ratio of 1.27. Housewives represented the majority of cases with 35.7%. Maxillary radiography was performed on 96% of patients and biopsy in 66.3% of cases. The most common anatomical location was mandibular in 89.80% of cases, with the preferred area being the mandibular symphysis in 34.7% of cases. Conservative surgery was performed in 50% of patients and radical surgery in 26.5% of cases. CONCLUSION: This study has shown a high frequency of maxillary ameloblastoma, and the fundamental benefits of early treatment, in order to minimize recidivism.

INTRODUCTION: L'objectif de cette étude était, d'évaluer les aspects sociodémographiques, cliniques, anatomopathologiques et thérapeutiques, des patients présentant des améloblastomes des maxillaires, au Centre Hospitalier Universitaire d'Odonto Stomatologie (CHU OS) de Bamako. MATÉRIELS ET MÉTHODE: Nous avons réalisé une étude rétrospective et prospective sur une période de trois ans (de Janvier 2007 à Décembre 2010), sur des cas d'améloblastomes des maxillaires, confirmés par un examen clinique, associé ou à la radiologie, ou à l'anatomopathologie. Les données ont été recueillies à partir des dossiers médicaux, saisies et analysées avec le logiciel Epiinfo. RÉSULTATS: Les lésions tumorales ont concerné 55 hommes et 43 femmes avec un sex-ratio de 1,27. Les femmes au foyer ont été les plus représentées soit 35,7% des cas. La radiographie des maxillaires a été effectuée chez 96% des patients et la biopsie dans 66,3% des cas. La localisation anatomique la plus fréquente a été mandibulaire dans 89,80% des cas, et la zone de prédilection a été la symphyse mandibulaire dans 34,7% des cas. La chirurgie conservatrice a été réalisée chez 50% des patients et la chirurgie radicale dans 26,5% des cas. CONCLUSION: Cette étude montre une fréquence élevée de l'améloblastome des maxillaires, et un intérêt capital pour une prise en charge précoce, dans un souci de minimiser les récidives.

[High prevalence of methicillin-resistant Staphylococcus aureus strains in the Point G teaching hospital in Bamako, Mali]. / Haute prevalence des souches de staphylococcus aureus resistantes a la meticilline au centre hospitalier universitaire du Point G a Bamako (Mali).

Our aim was to study the susceptibility of Staphylococcus aureus to antimicrobial agents and to determine the methicillin-resistant S. aureus (MRSA) prevalence in the Point G teaching hospital in Bamako. METHODS: Columbia blood agar with nalidixic acid and colistin was used for the isolation of S. aureus strains. The diffusion method was used for antimicrobial susceptibility testing. RESULTS: Of 434 non repetitive strains of S. aureus isolated from 2007 to 2009 in the Point G teaching hospital, 297 (68.6%) were from hospital area and 137 (31.4%) were from extra-hospital area. The hospital strains were more resistant to penicillin than the extra-hospital strains (95% versus 88%; p = 0,016). Tetracycline was more active against hospital clinical isolates than extra-hospital clinical isolates (32% versus 21%; p = 0.024). Among 297 S. aureus clinical isolates, 195 (66%) were MRSA and 102 (34%) were methicillin-susceptible S. aureus (MSSA). The MRSA clinical isolates prevalence was higher in hospital area than in extra-hospital area (66% versus 55.5%; p = 0.0418). The MRSA clinical isolates prevalence was higher in the medical wards than in the surgical wards (74.8% vs 34.3%; p < 10-6). Among 251 MRSA clinical isolates, 169 (67.3%) were from urine, 39 (15.5%) from pus, 30 (12%) from blood culture, 7 (2.9%) from vagina and 6 (2.5%) from other sites. The MRSA clinical isolates prevalence was 46% in 2007, 63% in 2008 and 80% in 2009. The MRSA clinical isolates were highly more resistant to penicillin (p < 10-6), to amoxicillin combined with clavulanic acid (p < 10-6), to aminoglycosides (p < 10-6), to macrolides, lincosamides and streptogramins (p < 10-6), to norfloxacin (p < 10-6), to chloramphenicol (p < 10-6), to tetracycline (p = 0,0042), to sulfonamides (p < 10-6), to trimethoprim (p < 10-6), to fusidic acid (p < 10-6), and to fosfomycin (p = 0,0103) than the MSSA strains. The high level resistance to aminoglycosides, fluoroquinolones, macrolides, lincosamides and streptogramins was more frequent in the MRSA strains than in the MSSA strains. CONCLUSION: The MRSA clinical isolates prevalence was very high in the Point G teaching hospital in Bamako, in the medical wards especially. The MRSA strains were drugs multiple resistant.

Notre objectif était d'étudier la sensibilité de Staphylococccus aureus aux antibiotiques et de déterminer la prévalence des souches résistantes à la méticilline au centre hospitalier universitaire du Point G à Bamako. MÉTHODES: L'isolement des souches de S. aureus a été réalisé sur la gélose Columbia additionnée de sang de mouton, d'acide nalidixique et de colistine. L'étude de la sensibilité aux antibiotiques a été faite par la méthode des disques. RÉSULTATS: Sur 434 souches non répétitives de S. aureus isolées de 2007 à 2009 au centre hospitalier universitaire du Point G, 297 (68,6 %) sont d'origine hospitalière et 137 (31,4 %) d'origine extrahospitalière. Les souches hospitalières ont été plus résistantes à la pénicilline G que les souches extrahospitalières (95 % versus 88 %; p = 0,016). La résistance de S. aureus à la méticilline (SARM) a été plus fréquente chez les souches hospitalières que chez les souches extrahospitalières (66 % versus 55,5 %; p = 0,0418). Les plus hautes prévalences de SARM ont été observées dans les services de néphrologie (90 %), de cardiologie (87,5 %) de médecine interne (71 %), d'hématologie-oncologie médicale (66 %) et des maladies infectieuses (65 %). La prévalence des souches de SARM a été de 46 % en 2007, 63 % en 2008 et 80 % en 2009 en milieu hospitalier. Les souches de SARM ont été plus résistantes à la pénicilline G (p < 10−6), à l'association amoxicilline + acide clavulanique (p < 10−6), aux aminosides (p < 10−6), aux macrolides, lincosamides et streptogramines (p < 10−6), à la norfloxacine (p < 10−6), au chloramphénicol (p < 10−6), à la tétracycline (p = 0,0042), aux sulfamides (p < 10−6), au triméthoprime (p < 10−6), à l'acide fusidique (p < 10−6), et à la fosfomycine (p = 0,0103) que les souches de S. aureus sensibles à la méticilline (SASM). Les phénotypes de résistance aux aminosides (KTG, S+ KTG) et aux macrolides, lincosamides et streptogramines (MLSB constitutif) ont été plus fréquents chez les souches de SARM que chez celles de SASM. CONCLUSION: La prévalence des souches de SARM a été très élevée au centre hospitalier universitaire du Point G, dans les services de médecine surtout. Les souches de SARM sont multirésistantes.

Les améloblastomes des maxillaires au centre hopsitalier universitaire d'odontosmatologie de Bamako

Introduction: L'objectif de cette étude était, d'évaluer les aspects sociodémographiques, cliniques, anatomopathologiques et thérapeutiques, des patients présentant des améloblastomes des maxillaires, au Centre Hospitalier Universitaire d'Odonto Stomatologie (CHU OS) de Bamako. Matériels et Méthode : Nous avons réalisé une étude rétrospective et prospective sur une période de trois ans (de Janvier 2007 à Décembre 2010), sur des cas d'améloblastomes des maxillaires, confirmés par un examen clinique, associé ou à la radiologie, ou à l'anatomopathologie. Les données ont été recueillies à partir des dossiers médicaux, saisies et analysées avec le logiciel Epiinfo. Résultats : Les lésions tumorales ont concerné 55 hommes et 43 femmes avec un sex-ratio de 1,27. Les femmes au foyer ont été les plus représentées soit 35,7% des cas. La radiographie des maxillaires a été effectuée chez 96% des patients et la biopsie dans 66,3% des cas. La localisation anatomique la plus fréquente a été mandibulaire dans 89,80% des cas, et la zone de prédilection a été la symphyse mandibulaire dans 34,7% des cas. La chirurgie conservatrice a été réalisée chez 50% des patients et la chirurgie radicale dans 26,5% des cas. Conclusion : Cette étude montre une fréquence élevée de l'améloblastome des maxillaires, et un intérêt capital pour une prise en charge précoce, dans un souci de minimiser les récidives

Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d'Ivoire.

BACKGROUND: In temperate regions, influenza epidemics occur in the winter and correlate with certain climatological parameters. In African tropical regions, the effects of climatological parameters on influenza epidemics are not well defined. This study aims to identify and model the effects of climatological parameters on seasonal influenza activity in Abidjan, Cote d'Ivoire. METHODS: We studied the effects of weekly rainfall, humidity, and temperature on laboratory-confirmed influenza cases in Abidjan from 2007 to 2010. We used the Box-Jenkins method with the autoregressive integrated moving average (ARIMA) process to create models using data from 2007-2010 and to assess the predictive value of best model on data from 2011 to 2012. RESULTS: The weekly number of influenza cases showed significant cross-correlation with certain prior weeks for both rainfall, and relative humidity. The best fitting multivariate model (ARIMAX (2,0,0) _RF) included the number of influenza cases during 1-week and 2-weeks prior, and the rainfall during the current week and 5-weeks prior. The performance of this model showed an increase of >3 % for Akaike Information Criterion (AIC) and 2.5 % for Bayesian Information Criterion (BIC) compared to the reference univariate ARIMA (2,0,0). The prediction of the weekly number of influenza cases during 2011-2012 with the best fitting multivariate model (ARIMAX (2,0,0) _RF), showed that the observed values were within the 95 % confidence interval of the predicted values during 97 of 104 weeks. CONCLUSION: Including rainfall increases the performances of fitted and predicted models. The timing of influenza in Abidjan can be partially explained by rainfall influence, in a setting with little change in temperature throughout the year. These findings can help clinicians to anticipate influenza cases during the rainy season by implementing preventive measures.

[Isolated mandibular fractures study's in the CHU-OS of Bamako: 55 cases]. / Etude des fractures isolees de la mandibule au CHU d'odontostomatologie de Bamako: a propos de 55 cas.

AIMS: The aim of this study was to determine sociodemographics, clinical and therapeutic aspects in patients with isolated mandibular fractures in the Bamako dentistry teaching hospital (CHU-OS). MATERIALS AND METHODS: We carried out restrospective study over a period of four months involving isolated mandibular fracture cases, confirmed by a clinical and radiological examination in 2006. The data were collected from medical records, entered and analyzed using Epiinfo.fr 6.0 software. RESULTS: The lesions involved 42 men and 13 women with a sex ratio of 3.23. The age group of 21-30 was the most affected. The main cause was found to be road traffic accidents with 72.72 % of the total cases. The fractures of the mandible at the level of horizontal branch were the most frequent with 34.54 %. The orthopedic treatment was used in 72.72 % of the cases, with a good and very good results. CONCLUSION: This study shows the high frequency of isolated fractures of the mandible mainly from road traffic accidents, as well as their occurrence among young adults.

OBJECTIF: L'objectif de cette étude était, de déterminer les aspects sociodémographiques, cliniques et thérapeutiques, des patients présentant des fractures mandibulaires isolées, au Centre Hospitalier Universitaire d'Odonto Stomatologie (CHU OS) de Bamako. MATÉRIELS ET MÉTHODE: Nous avons réalisé une étude rétrospective sur une période de quatre mois, des cas successifs de fractures mandibulaires isolées, confirmés par un examen clinique et radiologique en 2006. Les données ont été recueillies à partir des dossiers médicaux, saisies et analysées avec le logiciel Epiinfo.fr 6.0. RÉSULTATS: Les lésions ont concerné 42 hommes et 13 femmes, avec un sex ratio de 3,23. La classe d'âge la plus atteinte a été celle de 21 ­ 30 ans. Les accidents de la voie publique ont été la principale cause, avec 72,72% des cas. Les fractures de la mandibule au niveau de la branche horizontale, ont été les plus fréquentes (34,54%). Le traitement orthopédique a été utilisé dans 72,72% des cas, avec de bons à très bons résultats. CONCLUSION: Cette étude montre la fréquence élevée des fractures de la mandibule isolée lors des accidents de la voie publique, et aussi leur survenue chez l'adulte jeune.

[Epidemiology of cutaneous leishmaniasis in five villages of Dogon country, Mali]. / Épidémiologie clinique et parasitologique de la leishmaniose cutanée dans cinq villages du Pays Dogon, Mali.

The epidemiology of the cutaneous leishmaniasis (CL) with Leishmania major is poorly documented in Mali. Following reports of CL in the tourist areas of the Dogon country (Bandiagara Escarpment), a joint French and Malian bio-clinical team conducted a field study from 16 to 27 January, 2010. The population of 5 villages has been examined by a dermato-infectiologist and cases were selected by visual inspection of skin lesions. Smears and biopsies (from the lesions) and venous blood were obtained from suspected cases of CL. Diagnosis was performed by light microscopy, in vitro cultures, serology and molecular biology. Fifty patients with skin lesions have been examined. Twenty-one have been suspected as CL. At least one sample was obtained from 18 patients. The lesions were predominantly old, more or less scarring and secondary infected. A skin smear was performed for 15 patients, a skin biopsy for 14 patients: smears and cultures were all negative. The PCR (Leishmania spp.) made on 14 biopsies was positive for 12 patients (86%). The low amount of amplified DNA obtained did not allow the sequencing and identification of the species of Leishmania. Western blot (WB) serology was positive in 11 cases out of 12 (92%). This investigation showed the presence of cutaneous leishmaniasis in Bandiagara. A further investigation is required during transmission period (September-October) to confirm the presence of Leishmania major epidemic in Dogon country.

Association of HLA alleles with Plasmodium falciparum severity in Malian children.

Pre-erythrocytic immunity to Plasmodium falciparum malaria is likely to be mediated by T-cell recognition of malaria epitopes presented on infected host cells via class I and II major histocompatibility complex (MHC) antigens. To test for associations of human leukocyte antigen (HLA) alleles with disease severity, we performed high-resolution typing of HLA class I and II loci and compared the distributions of alleles of HLA-A, -B, -C and -DRB1 loci in 359 Malian children of Dogon ethnicity with uncomplicated or severe malaria. We observed that alleles A*30:01 and A*33:01 had higher frequency in the group of patients with cerebral disease compared to patients with uncomplicated disease [A*30:01: gf = 0.2031 vs gf = 0.1064, odds ratio (OR) = 3.17, P = 0.004, confidence interval (CI) (1.94-5.19)] and [A*33:01: gf = 0.0781 vs gf = 0.0266, 4.21, P = 0.005, CI (1.89-9.84)], respectively. The A*30:01 and A*33:01 alleles share some sequence motifs and A*30:01 appears to have a unique peptide binding repertoire compared to other A*30 group alleles. Computer algorithms predicted malaria peptides with strong binding affinity for HLA-A*30:01 and HLA-A*33:01 but not to closely related alleles. In conclusion, we identified A*30:01 and A*33:01 as potential susceptibility factors for cerebral malaria, providing further evidence that polymorphism of MHC genes results in altered malaria susceptibility.

Connaissances, attitudes et pratiques des tradipraticiens de la sante de la ville d'Abidjan sur le paludisme.

INTRODUCTION : An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases. MATERIALS AND METHOD : The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies. RESULTS : Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years.CONCLUSION : A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

[Knowledge, attitude, and practice of traditional healers on the topic of malaria in the city of Abidjan]. / Connaissances, attitudes et pratiques des tradipraticiens de la sante de la ville d'Abidjan sur le paludisme.

INTRODUCTION: An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases. MATERIALS AND METHOD: The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies. RESULTS: Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years. CONCLUSION: A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

Prevalence and predictors of HIV infection amongst Malian students.

The objectives of this cross-sectional study were to assess the prevalence and identify predictors of HIV-1 and HIV-2 infection among students in three cities of Mali. Between January and June 2005, we assessed HIV knowledge, attitudes, associated sexual behaviors and tested HIV serostatus among 950 high school and university students in Sikasso, Bamako, and Koulikoro cities, using a combination of enzyme-linked immunosorbent assay (ELISA) and Western blot testing. Univariate and logistic regression analyses were used to determine predictors of infection among students. Mean HIV prevalence was 3.1%, ranging from 1.8% in Sikasso to 3.6% in Bamako. The results showed the presence of all three HIV subtypes in Bamako, though HIV-1 predominated in all cities. Infection rates were slightly higher among males (3.6%) than among females (2.8%), but the difference was not significant. The single significant predictor of HIV infection was knowledge of HIV routes of transmission (p=0.01). HIV prevalence rates observed in this population were higher than general adult prevalence rates previously reported for Mali. HIV/AIDS education and prevention campaigns should be targeted to students at both the secondary and university levels. Students may represent an informative HIV sentinel population for Mali.

[Five years of cholera surveillance in Ivory Coast during social and political crisis, 2001 to 2005]. / Cinq années de surveillance du choléra en Côte d'Ivoire dans un contexte de crise socio-politique, 2001 à 2005.

For an efficient struggle against infectious diseases with epidemic potential, the Cdte d'Ivoire set up a precocious alert system in 2001 with a main objective: to detect epidemics of cholera, measles, yellow fever and meningitis and to provide necessary information for their control and their prevention. During the 2001 to 2005 period, the country was marked by military and political crisis which occurred in 2002; the country had to face up to a reappearance of cholera. How did it evolve in such a context? The question was to describe the performances of the system and the evolution of cholera from weekly data collected by the centers of epidemiological monitoring in health districts. The cases and declared deaths were compiled and the indicators of morbidity and mortality were then studied according to time site and individual features on the period of 2001 to 2005. From 2001 to 2005, 11,874 cases were notified with 564 deaths and a lethal rate of 4.7%. In 2001, from the initial source of infection, the civil jail, the epidemic of cholera disseminated itself through visitors in the whole city of Abidjan where 3250 cases were notified. Out of city, 20 outbreaks have been declared with a total of 3010 cases. The yearly highest impact, 37 living cases/100,000 inhabitants recorded in 2001, decreased regularly until 2005 with 0.2 living cases/100,000. After 2002, outbreaks were located mainly in the half south of the country which welcomed displaced populations from the north, preferably in transition or settling zones near the front line. The lethal rate in Abidjan (2.3%) was less important than that of other health districts (8.6%). The lethal rate globally increased as the impact decreased. Vibrio cholerae was responsible for the epidemics. The group of 15 years old and over was the most affected (12.69 living cases/100,000) whereas the highest lethal rate appeared in the group under 5 years old (6.6%). The reappearance and constant cholera epidemics in Côte d'Ivoire are due to bad general hygiene conditions, insufficient supply of drinking water from wells or packaged, concentration of populations in the south of the country due to war and uncontrolled development of the poor and unsanitary precarious boroughs. Outburst during the dry season is a warning signal of an important epidemic during the raining season especially in poor urban areas. The precocious alert system has permitted to detect the epidemics, to follow up their evolution and to orientate the struggle against cholera in Côte d'Ivoire.

[Urinary tract infection and pregnancy at the referral health center of the Commune II (CSFEF C.II]. / Infection urinaire et grossesse dan le centre de sante de reference de la Commune II (CSREF C.II).

Prospective study has been conducted with regards to systematic cytological and bacteriological urine examination, including 505 pregnant women examined from April to May 2006. The results have shown that 50 persons have a positive urine cytology representing 9.9% of the population. The age range from 20-34 was mostly represented 66% of cause. Almost 90% of the patients has a history of urinary tract infection. Leukorrhea was present in 94% of examined women. The urine culture has concluded to E. coli infection was asymptomatic, against 50% of Staphylococcus aureus. We have noticed 16% complications related 3 premature deliveries, 4 abortions and 1 death in utero. Early diagnostic of urinary tract infection based on urine analysis on antibiotic selection by any pregnant women is the key of the prevention.

[Persistent neurological sequelae due to cerebral malaria in a cohort of children from Mali]. / Séquelles neurologiques persistantes dues au paludisme cérébral dans une cohorte d'enfants au Mali.

INTRODUCTION: Several neurological complications are associated with cerebral malaria (CM). However, few long-term data from childhood survivors have been published. METHODS: A cross-sectional study was carried out in Mali among children followed from 1999 to 2002 after serious and complicated malaria. Our aim was to evaluate the persistent neurological sequelae associated with CM. RESULTS: This study concerned 101 subjects who had had CM. Mean age was 5.6+/-3.6 years. Twenty-eight children presented persistent neurological sequelae (27.7p.cent). Among them eight (7.9p.cent) children had developed these sequelae just after CM and 20 (19.8p.cent) a few months later: headaches, mental retardation, speech delay, bucco-facial dyspraxia, diplegia and frontal syndrome (one case each), dystonia (two cases), epilepsy (five cases) and behavior and attention disorders (15 cases). CONCLUSIONS: In this study, we show that neurological signs due to CM can persist in the long run. Long-term follow-up and proper management after CM are essential.

Acute intussusception following a pull-through operation for hirschsprung disease

Acute post-operative intussusception is a rare. This is a report of two cases of acute intestinal intussusception were observed in two children aged 14 months and 2.5 years following operation for Hirschsprung's disease. The first signs appeared at the tenth and the fifth post operative day after a satisfactory post-operative period. These signs were not evocative (pains and more or less stopping of the transit). Acute intussusception should be considered in the differential of post -The signs of premature post-operatory occlusion happen in the two weeks of the intervention in hirsch- sprung disease must help to mention the diagnosis of post-operative intestinal invagination. operative intestinal obstruction occurring within two week of pull-through operation forHirschsprung's disease