A seroepidemiological study of pandemic A/H1N1(2009) influenza in a rural population of Mali.

The swine-origin H1N1 influenza A virus (pH1N1(2009)) started to circulate worldwide in 2009, and cases were notified in a number of sub-Saharan African countries. However, no epidemiological data allowing estimation of the epidemic burden were available in this region, preventing comprehensive comparisons with other parts of the world. The CoPanFlu-Mali programme studied a cohort of 202 individuals living in the rural commune of Dioro (southern central Mali). Pre-pandemic and post-pandemic paired sera (sampled in 2006 and April 2010, respectively) were tested by the haemagglutination inhibition (HI) method. Different estimates of pH1N1(2009) infection during the 2009 first epidemic wave were used (increased prevalence of HI titre of ≥1/40 or ≥1/80, seroconversions) and provided convergent attack rate values (12.4-14.9%), the highest values being observed in the 0-19-year age group (16.0-18.4%). In all age groups, pre-pandemic HI titres of ≥1/40 were associated with complete absence of seroconversion; and geometric mean titres were <15 in individuals who seroconverted and >20 in others. Important variations in seroconversion rate existed among the different villages investigated. Despite limitations resulting from the size and composition of the sample analysed, this study provides strong evidence that the impact of the pH1N1(2009) first wave was more important than previously believed, and that the determinants of the epidemic spread in sub-Saharan populations were quite different from those observed in developed countries.

[Epidemiological, clinical and prognostic aspects of cryptococcal meningitis in hospital area of Bamako, Mali]. / Aspects épidémiologique, clinique et pronostique de la cryptococcose neuroméningée en milieu hospitalier de Bamako, Mali.

The cryptococcosis is a major mycosis of forecast holds during the AIDS. The objective of this study was to determine the frequency of this affection during the AIDS with the service of the infectious diseases of the teaching hospital of the Point G. On the whole 55 patients reached of AIDS were included in this study. They presented all of the evocative signs of meningitis attack. The analysis of the cerebral spinal fluid (CSF) allowed us to detect among this population 17 cases of cryptococcal meningitis means a frequency of 30.9%. The average age was 34 years with the extreme ones going from 18 to 60 years old. The clinical signs were as follows: disorder of the conscious in 4/17 cases (23.6%), fever in 2/17 cases (11.8%), signs of meningitis in 11/17 cases (64.7%). The CSF was clear as water of rock with a lymphocyte at 100% to all the patients. The examination with the Indian ink noted yeasts in capsular identified like the Cryptococcus ones. The treatment was based on amphotericin B intravenous. Lethality rate was 58.8% in 10/17 cas. The crytococcus constitutes a frequent etiology of the meningo-encephalitis demonstrations during the AIDS in this service. We recommend the search for cryptococcus in front of any sign of meningitis occurring during AIDS in Mali.

[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.

[Spatial cluster detection without point source specification: the use of five methods and comparison of their results]. / Détection de clusters spatiaux sans point source prédéfini: utilisation de cinq méthodes et comparaison de leurs résultats.

BACKGROUND: Various statistical methods have been developed to describe spatial heterogeneity, in terms of high risk zones. If no source can be determined, this heterogeneity can be globally or locally described. Global methods test a statistic estimated over the whole studied geographical area, whereas local methods estimate a statistic on each spatial unit (or regrouping unit). This paper aimed to present, and to compare results of an epidemiological application, of five methods of spatial cluster detection. METHODS: The two global detection methods were: 1) Moran's coefficient, a classically used autocorrelation coefficient; 2) Tango's statistic, a spatial generalization of the Chi(2) statistic. The three local methods were: 1) the local application of Moran's coefficient, proposed by Anselin; 2) the scan statistic, which searches for grouping of spatial units; 3) the oblique regression tree, which splits the studied zone into sub-zones of different risks. These five methods were applied to the description of the spatial heterogeneity of the malaria risk over a hyperendemic village, in Mali. RESULTS: All the methods highlighted a significant spatial heterogeneity. Both global methods (Moran's coefficient and Tango's statistic) showed weak spatial correlations. Local Moran's coefficient (with Bonferronis' adjustment) highlighted five spatial units. The scan statistic identified a single high risk cluster. The regression oblique tree split the study area into six sub-zones; the sub-zone with the higher risk was consistent with the cluster identified by the scan statistic. CONCLUSION: These presented methods do not require any previous knowledge of a source. They allow evaluating spatial risk heterogeneity over the entire geographical area under study. It is noteworthy that shape, size, and spatial heterogeneity characteristics (either global or local) of the study area, as well as the definition of the proximity, significantly influence the spatial risk analysis' outcome. Although their results should be cautiously interpreted, these methods are useful for preliminary field studies or epidemiological surveys.

[Blackwater fever in children during cerebral malaria: 3 case reports in Bamako]. / La fièvre bilieuse hémoglobinurique chez l'enfant: à propos de 3 observations à Bamako.

BACKGROUND: Blackwater fever is a rare but serious form of malaria in children. Diagnosis relies on clinical symptoms and on the color of the urines. OBJECTIVES: To describe blackwater fever in children, a disease whose prevalence seems to be increasing. METHOD: We report 3 cases of blackwater fever observed in our institution. RESULTS: In 2 cases, acute renal insufficiency with oligoanuria was observed. In all the 3 cases, treatment with quinine was stopped and replaced by injectable artemether. Evolution was dependent on renal function, and included in 1 patient neurological sequels consisting in aphasia. CONCLUSION: Blackwater fever is a severe affection whose diagnosis should be evoked using the color of urine. Evolution is usually favorable in the pediatric population, when adequate care can be provided.

[Quality of health services in hospital nurseries in commune II of the district of Bamako]. / Qualite des procedures de soins infirmiers dans les formations sanitaires de la commune II du District de Bamako.

Despite the tremendous efforts undertaken by the government of Mali, health indicators for morbidity and mortality are still high. The global mortality rate of 13 per thousand and the low life expectancy are the main enhancing factors for such phenomenon. This study was undertaken in public, private and Para-public and community health structures as well as confessional and faith-based health organizations in commune II of the district of Bamako. Our evaluation was based on the Avedis Donavedian method for health services quality. It was a transversal study based on nursery care in the structures above cited. The procedures for this study consisted of passive observance of nursery care with retrospective collection of data on the technical practices of the health workers in the services offered. The results showed a higher deficit in term of incomplete technical practice, physical and psychic respect of patients in faith-based organizations than in other health structures. There were no written guidelines for preventing nosocomial infections, injections security, management of waste and hazards, prevention and treatment of wounds. There was a lack of adapted sterilization materials in most of the CSCOM and private structures. Most of the injections and treatment of wounds were done by assistant nurses and midwives. Moreover, the utilization rate of nonsterile syringes and pins between 5.3 and 13.6% in the population studied. In conclusion, there is no security in nursery care in most of the health structures of the Commune II in the district of Bamako.

[Role of men in family planning decisions in Mali]. / Implication des hommes dans la prise de decision concernant le planning familial au Mali.

The birth control program was in place and functional since 1970, and it was integrated with maternal and infant health activities in 1978: knowledge about contraception is increasing among women and men respectively 75.6% and 87.6% according to EDSM II, 2001. Nevertheless, only 5.7% of women and 10% of men reported the use of one of the modern contraceptive methods. This is a transversal descriptive and analytic study which included men of 14 years old and above residing in Kayes, Koulikoro, Mopti, Sikasso and Bamako. We used a random choice of 6 out of the 9 regions in Mali (Bamako and the 5 regions supported by partners funding the present study) followed by a non-random choice at different degrees. Data were uniformly collected from One thousand and four men. The mean age was 37.6 +/- 15.6 years, 44.7% of the men were monogamous whereas 23.1% were polygamous and 30.6% were either single or had a fiancé. Most of the men in the study group had more than 2 children compared to 34.2% without children and 19.9% with either one or two children. Among them, 89.1% reported to have heard about birth control program and 70.3% had listed Planned Parenthood as an objective of birth control. The most used methods of birth control the most used are contraceptives (66.7%), condoms (60.5%) and injections (30.8%). However, only 30.6% of men used one birth control method with their partners; among those studied in the cohort, 40.8% used birth control method with their wives. Condom was the main method used by 86% of the men compared to utilization of contraceptive pills and injections respectively 66.7% and 25.6%. Birth control methods were used mainly to protect against sexually transmitted diseases (20.7%), then maternal and infant health respectively 6.0% and 5.8%. 60.7% of men think that the decision to use birth control method should be made by them whereas 25.7% think that the decision should be made by the couples. Many strategies are being proposed to involve men in the wider implementation of birth control program; these strategies will be more efficient when the age group 20-29 and 30-44 are targeted nationwide including rural areas, as well as couples especially those polygamous and illiterate.

Efficacy and safety of artemether in the treatment of severe end complicated malaria in mali.

We compared the efficacy and safety of artemether versus Quinine in 67 children from 3 months to 15 years old hospitalised for severe and complicated in the pediatric service of Gabriel Touré's Hospital Children were randomised to receive artemether or quinine. Artemether was given at 3,2mg/kg in day 1 (two times) and 1; 6mg single dose from day 2 to day5) and quinine was administrated at 20mg/kg (attack dose) followed by 10mg/kg every 8 hours until oral drug administration (10 mg/kg every 8 hours). The treatment for artemether lasted 5 days while quinine treatment lasted 7 day. Thirty tree and 34 children received respectively artemether and quinine. Two groups were comparable with baseline characteristics. Cerebral malaria was most frequent in the two with no statistical difference. Seventy height percent in artemether group compared to 82,4% in quinine group. No statistical difference was found between groups regarding parameters such as : Parasitic clearance, thermal clearances, delay of exit of the coma, upsurge, tolerance, and mortality. Artemether is as efficacious and well safe as quinine for the treatment of sevese and complicated malaria.