[Perception of the population in the fourth municipality of Bamako-Mali, on the COVID-19 vaccine]. / Perception de la population de la commune iv de Bamako-Mali, sur le vaccin contre la COVID-19.

INTRODUCTION: In response to the COVID-19 pandemic, various candidate vaccines has been approved to be used by WHO. However, there is low adherence to the vaccination campaign, especially in Mali. The goal was to study the perception of fourth municipality's population of the district of Bamako, about the COVID-19 vaccine. METHODS: It was a cross-sectional descriptive and analytic study conducted from May to August 2021. A rational selection of two wards of the fourth municipality of Bamako was carried out. The Chi-square test of Pearson was used to test association between variables. RESULTS: In total 179 people from two wards were surveyed. The average age was 37.73 years (SD=13.67), 34.6% (n=62) we'renot in school, and 7.8% (n=62) had received at least the first dose of a COVID-19 vaccine. 37.4% (n=67) did not believe in the existence of COVID-19; while 84.9% (n=152) didn't know at least the name of the vaccine in use in Mali. 65.4% (n=117) didn't trust the vaccine, while 78.1% (n=25) would have preferred other vaccines from AstraZeneca. Knowledge of the vaccine was associated with education level (OR=18.86; 95% CI [7.16-49.64]; p=0.00). CONCLUSION: The population of the fourth municipality of Bamako have a few knowledge about the vaccine in use in Mali. So it's necessary to strengthen awareness campaigns.

INTRODUCTION: Face à la pandémie de la COVID-19, plusieurs vaccins candidats ont reçu l'accord de l'OMS d'être utilisés. Cependant on assiste à une faible adhésion à la campagne de vaccination, surtout au Mali. L'objectif était d'étudier la perception de la population de la commune IV du district de Bamako sur le vaccin contre la COVID-19. MÉTHODE: Il s'agissait d'une étude transversale descriptive et analytique, réalisée du mois de Mai au mois d'Août 2021. Un choix raisonné de deux quartiersde la commune IVa été réalisé. Le test de Khi-deux de Pearson a été utilisé pour vérifier l'association entre les variables. RÉSULTATS: Au total179 personnes de deux quartiers de la commune IV ont été enquêtées. L'âge moyen était 37,73 ans (SD=13,67), 34,6% (n=62) n'étaient pas scolarisées, et 7,8% (n=62) avaient reçu au moins la première dose d'un vaccin contre la COVID-19.37,4% (n=67) ne croyaient pas à l'existence de la COVID-19 ; pendant que 84,9% (n=152)ne connaissaient,ne seraitce que le nom du vaccin en usage au Mali. 65,4% (n=117) ne faisaient pas confiance au vaccin, pendant que 78,1% des enquêtés (n=25) auraient préféré autres vaccins différents d'AstraZeneca. On pouvait voir que La connaissance du vaccin étaitassociée au niveau d'étude (OR=18,86 ; 95% IC [7,16-49,64] ; p=0,00). CONCLUSION: La population de la commune IV du district de Bamako a très peu de connaissance sur le vaccin utilisé au Mali, d'où la nécessité de renforcer les campagnes de sensibilisation.

[Evaluation of the care of the severe acute malnutrition in the service of pediatrics of the CHU Gabriel TOURE, Bamako, Mali]. / Evaluation de la prise en charge de la malnutrition aigue severe dans le service de pediatrie du Centre Hospitalier Universitaire (CHU) Gabriel TOURE, Bamako, Mali.

OBJECTIVE: To study the care of children suffering from severe acute malnutrition with complications at the URENI of the pediatrics of the CHU (University Hospital) Gabriel TOURE. PATIENTS AND METHOD: it was a comprehensive cross-sectional study with a retrospective collection of data on children monitored for the treatment of severe acute malnutrition from January 1st till December 31st, 2014. We, also, conducted a qualitative survey of staff and carers of children under treatment during the survey period. RESULTS: 490 patients were admitted directly to URENI. The 12-23 month age group was predominant (46.5%). The sex ratio was 1.09 in favor of the male sex. The success rate of treatment at the URENI was 51.40%. At the URENAS, the dropout rate was 27.50%. At the URENAM, the dropout rate was 72.70%. Almost all the carers interviewed during the individual interviews and focus groups were satisfied with nutritional care. CONCLUSION: The lack of autonomous hospitalization rooms at the URENI and the inadequacies noticed at the level of performance indicators have to motivate the creation of an URENI answering the standards at the level of the pediatrics of the CHU (University Hospital) Gabriel TOURE.

OBJECTIF: Etudier la prise en charge des enfants souffrant de malnutrition aiguë sévère avec complications au niveau de l'URENI de la Pédiatrie du CHU Gabriel TOURE. PATIENTS ET MÉTHODE: Il s'agissait d'une étude transversale exhaustive avec un recueil rétrospectif des données sur les enfants suivis pour le traitement de la malnutrition aiguë sévère du 1er janvier au 31 décembre 2014. Nous avons, aussi, procédé à une enquête qualitative auprès du personnel et des accompagnants des enfants sous traitement pendant la période de l'enquête. RÉSULTATS: Il y avait 490 patients admis directement à l'URENI . La tranche d'âge de 12-23 mois était prédominante (46,5%). Le sex-ratio était de 1,09 en faveur du sexe masculin. Le taux de succès au traitement à l'URENI était de 51,40%. A l'URENAS, le taux d'abandon était de 27,50%. A l'URENAM, le taux d'abandon était de 72,70%. La quasi-totalité des accompagnantes interviewées, en entretien individuel et en focus groupe, étaient satisfaites de la prise en charge nutritionnelle. CONCLUSION: L'absence de salles d'hospitalisation autonome à l'URENI et les insuffisances constatées au niveau des indicateurs de performance doivent motiver la création d'une URENI répondant aux normes au niveau de la pédiatrie du CHU Gabriel TOURE.

Evaluation de la prise en charge de la malnutrition aigue severe dans le Service de pediatrie du centre hospitalier universitaire (CHU)Gabriel toure, Bamako, Mali

Objectif: Etudier la prise en charge des enfants souffrant de malnutrition aiguë sévère avec complications au niveau de l'URENI de la Pédiatrie du CHU Gabriel TOURE.Patients et méthode:Ils'agissait d'une étude transversale exhaustive avec un recueil rétrospectif des données sur les enfants suivis pour le traitement de la malnutrition Aiguë sévère du 1erjanvier au 31 décembre 2014. Nous avons, aussi, procédé à une enquête qualitative auprès du personnel et des accompagnants des enfants sous traitement pendant la période de l'enquête.Résultats:Il y avait 490 patients admis directement à l'URENI.La tranche d'âge de 12-23 mois était prédominante (46,5%). Le sexratio était de 1,09 en faveur du sexe masculin. Le taux de succès au traitement à l'URENI était de 51,40%. A l'URENAS, le taux d'abandon était de 27,50%. A l'URENAM, le taux d'abandon était de 72,70%. La quasi totalité des accompagnantes interviewées, en entretien individuel et en focus groupe, étaient satisfaites delpriseenchargenutritionnelle.Conclusion:L'absence de salles d'hospitalisation autonome à l'URENI et les insuffisances constatées au niveau des indicateurs de performance doivent motiver la création d'une URENI répondant aux normes au niveau de la pédiatrie du CHU GabrielTOURE

Place du paludisme en saison de haute transmission dans les urgences fébriles au Centre Hospitalier Universitaire Gabriel Touré de Bamako

Le but de cette étude est d'évaluer la fréquence du paludisme parmi les causes de fièvres chez les patients admis au Service d'Accueil des Urgences (SAU) du CHU ­Gabriel Touré de Bamako. Il s'agissait d'une étude transversale allant du 1er août au 30 novembre 2015. Tous les patients admis au Service d'Accueil des Urgences étaient inclus dans notre étude. La goutte épaisse ou le Test de Diagnostic rapide étaient utilisés pour la confirmation biologique des cas de paludisme. Nous avions enregistré 6 641 patients parmi lesquels 5,07 % étaient fébriles. L'âge moyen des patients était de 21 ans avec une prédominance de la tranche d'âge de 18-40 ans soit 52 %. Le sex-ratio était de 1,5 en faveur des hommes. Les élèves-étudiants représentaient 34,85 % des cas suivis des ménagères avec 20,71 %. Le diagnostic clinique réalisé par des médecins avait donné un taux de 74,5 % de paludisme contre 58,8 % selon la GE/TDr. L'incidence du paludisme comme cause de la fièvre était de 58,8 %. Tous les cas de paludisme simple ont été traités avec les CTA et les cas graves avec des formes injectables de l'artesunate dans 68,38 %, l'artemether dans 17,65 % et la quinine dans 13,17 %. Le paludisme est fréquent parmi les urgences fébriles au SAU du CHU-GT. Les dispositions doivent être renforcées pour une confirmation biologique systématique de tous les cas suspects de paludisme pour éviter les erreurs diagnostics

Effet de la formation sur la qualité de la prise en charge des cas de paludisme dans les centres de santé de premier contact de la commune V de Bamako

Le programme national de lutte contre le paludisme avec ses partenaires a entrepris des formations des prestataires sur les nouvelles directives de prise en charge des cas de paludisme dans les formations sanitaires du pays. Cette étude visait à mesurer l'effet desdites formations sur les pratiques des prestataires formés. Elle s'est déroulée dans les structures de premier contact de la commune V du district de Bamako. Il s'agissait d'une étude transversale portant sur les données de 3 mois avant et après la formation à partir des registres de consultation. La fièvre était le symptôme le plus fréquent avec 34,7 % avant la formation et 33,6 % après la formation. La majorité des patients a bénéficié d'un examen biologique soit 57,9 % avant la formation et 60,5 % après la formation. Le paludisme simple a représenté 35,4% avant la formation et 37,9 % après la formation contre respectivement 34,8 % et 34,3 % pour le paludisme grave. Cependant, 29,8 % des patients avant la formation et 27,8 % après la formation n'ont pas été classés conformément aux normes nationales. Parmi les cas de paludisme simple, 45,3 % ont été traités correctement avant la formation contre 57,6 % après la formation. Pour le paludisme grave, les taux de traitement correct étaient de 75,5 % avant la formation contre 72,1 % après la formation. La formation des prestataires a eu un effet modéré sur la qualité de la prise en charge des cas de paludisme dans les structures concernées. La supervision postformation ou la formations des prestataires à la tâche pourrait améliorer la situation

The delegation of tasks in the era of e-health to support community interventions in maternal and child health: lessons learned from the PACT-Denbaya project.

The PACT-Denbaya project (Program for community access to telemedicine for families) aimed to help improve the health of mothers and child in rural communities through the delegation of obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This operational research took place in 6 community health centers in the Dioïla health district in Mali. Our method was based of the delegation of tasks, supported by teleconsultations. Experts in pediatrics and obstetrics/gynecology provided a week-long training program to general practitioners and midwives, in the management of the most common problems in the field and in the use of the "Bogou" teleconsultation and "Dudal" tele-education platforms to ensure exchanges and follow-up. Overall, 17 healthcare providers, that is, general practitioners, nurse-obstetricians, and midwives participated in sessions to strengthen gynecology-obstetric and pediatric capacity in the field. The evaluation of knowledge and of the indicators compared with the baseline of 8359 pregnancies and 1991 documented deliveries and of user satisfaction showed that this type of service resulted in decreased maternal and child mortality. In view of these results, we can deduce that the delegation of tasks, when it is supported by telehealth, encounters no resistance from the specialists and contributes to the significant improvement of maternal and infant health in remote areas. A long-term impact study is necessary to reinforce these results.

[Fatal poisoning in Mali]. / Les intoxications mortelles au Mali.

AIMS: The aim of this study was to determine the epidemiological characteristics of the cases of fatal poisoning in Mali. METHODS: This retrospective study examined the cases of fatal poisoning recorded between 2000 and 2010 in six Health Reference centers, six regional hospitals and three university hospitals in the district of Bamako. RESULTS: During the study period, 146 cases of fatal poisoning were recorded, accounting for 4.6% of all poisoning cases during this period. The average age of patients who died was 24 ± 17.7 years with a female-male ratio of 1.05. Nearly half (43%) were younger than 20 years. The ingestion was intentional in 66.4% of cases, mainly suicide attempts (47%) and therapeutic errors (19%). The median time until arrival at hospital was 8 hours after poisoning with multiple and varied clinical signs. CONCLUSIONS: Decreasing the mortality rate from poison ingestion requires increasing public awareness about poisons and improving emergency service equipment and health personnel training.

[Coverage rate and satisfaction of populations after mass treatment with praziquantel and albendazole in Mali]. / Taux de couverture et satisfaction des populations apres traitement de masse au praziquantel et a l'albendazole au Mali.

In Mali, schistosomiasis always remains a major public health problem. In 2005, mass treatment campaigns with praziquantel and albendazole have been organized in all endemic regions. The present study aimed to assess the impact of these mass treatment campaigns and the recipient's satisfaction in two endemic areas (Mopti and Ségou). It was a cross-sectional study with one passage from February to March 2006. The study carried out on political authorities (n=142), teachers and school administers (n=70), health workers (n=46), community distributors (n=33), community members (n=2170) and pupils (n=2480). We used Lot Quality Assurance Sample (LQAS) to determine treatment coverage and recipient's satisfaction. Two types of lots were considered, villages and schools. Questionnaires were used for investigation. In Ségou, the treatment rates varied from 100% at school level and in community in Bla district to 97.2% in the community of Ségou town. In Mopti, a treatment rate of 100% was observed in Bankass and Douentza both at school and in the community. The proportion of happiest individuals (to feel well) after the mass treatment campaign was 72.3% among pupils and 76.6% in the community. The results of this study suggest that the high treatment coverage rates observed during these campaigns should be sustained by a yearly chemotherapy strategy preceded by a community's health education programmes.

[Anti-tetanus vaccine coverage of mothers of infants under 23 months of age in the Bamako District]. / Couverture vaccinale anti-tetanique des meres d'enfants de moins de 23 mois dans le District de Bamako.

Mali makes left of the 26 important countries in the world of which 18 in Africa for the elimination of tetanus neonatal. The plan of action conceived to this effect doesn't keep the District of Bamako like zone of intervention, had consideration to the sanitary conditions judged among best in the country. However, the district of Bamako arranges today of a number important of peripheral districts whose isolated sanitary realities can generate some indicators different of the middle indicators of the District. It is for this reason that we undertook this work, while using the LQAS method separately in each of the six communes of the district of Bamako, for i) to determine the percentage of mothers of children of 15 at 49 years having received at least two doses of antitetanus vaccine at the time of their last pregnancy in each of the six communes of the district, ii) to identify the non effective zones of the district concerning vaccination of mothers of children of less than 23 months. It was about an investigation of antitetanus vaccinal coverage of mothers of children of less than 23 months by gone residents since at least 3 months in the six communes of the district of Bamako in April 2004. The vaccinal status of targets of the survey was established from the card of vaccination or the notebook of health delivered at the time of the prenatal consultations. In the first five communes, for topics not having card or notebook of health us established the vaccinal status also by cross-examination, what has been qualified of determination of the statute by " history ", Of the survey it comes out again that the rates of cover in at least two doses of antitetanus antigen of mothers of children of less than 23 months vary from 17.6 ± 7.2% (Commune V ) to 78.4 ± 7.0% (Commune II) according to the card. In the first five townships these rates go from 46.3 ± 9.5 % (commune V) to 94.01 ± 3.4% (commune IV) according to the card and history. According to the card, the communes I, IV and V, didn't record any zone of cover of the CSCOMS concerning vaccinations where the rate of mothers having received the VAT2 reaches 80%, in reference to the value of decision (6) either vaccinated at least 13 topics (68,4%) by lot. The assessment of the coverage according to the card and history improves this weak performance noted in certain zones of cover (communes I, III, IV). Results of this survey put as it was always the case the problem of data compilation concerning assessment of the vaccinal coverage. And for reasons of efficiency, an approach associating the backing of the routine's vaccination, of countries of mass magazines and a highly efficient surveillance of tetanus neonatal is to consider.

Enquete CAP des menages sur la prise en charge de l'enfant drepanocytaire a Bamako

La drepanocytose constitue de nos jours un probleme majeur de sante publique. On trouve 5 a 20 de porteurs de cette maladie en Afrique de l'Ouest et jusqu'a 40chez certaines ethnies d'Afrique Centrale (Congo; Zaire) et du Nigeria (Begue). Au Mali sa prevalence est estimee a 12 avec 3pour la forme homozygote. C'est une maladie connue et bien documentee sur le plan scientifique et sa prise en charge est de mieux en mieux codifiee de nos jours; ce qui contribue a l'amelioration de la qualite de la vie. Face a cette situation; le CREDOS a initie cette etude dans l'objectif d'evaluer les connaissances des meres pour une meilleure prise en charge de la drepano- cytose dans les menages. Il s'agit d'une etude transversale a passage unique realisee au niveau des menages dans 6 communes du district de Bamako. Nous avons enquete 360 parents d'enfants ages de 0 a 5 ans; qui ont ete interroges selon la methode de sondage en grappes. L'etude a permis de montrer que 95;8des meres enquetees connaissent la drepanocytose. Par ailleurs 63;9des meres ne connaissent pas les complications de la drepanocytose et 58les causes. En cas de decouverte de la drepanocytose; 58;3des meres ont declare vouloir recourir a une structure sanitaire en premiere intention; 18;3a l'automedication et 13;9aux guerisseurs traditionnels. Devant une crise drepanocytaire 56ont declare avoir recours a la medecine moderne contre 15;2aux traditherapeutes. L'implication des menages dans la prise en charge de l'enfant drepanocytose souffre d'une connaissance limitee de la cause; des signes cliniques; des complications de cette maladie par les parents. Pour une meilleure connaissance de cette pathologie par les familles; l'information; l'education des populations a travers des messages IEC sont necessaires

Taux de couverture et satisfaction des populations apres traitement de masse au praziquantel et a l'albendazole au Mali

Au Mali; les schistosomes demeurent toujours un probleme majeur de sante. En 2005; des campagnes de traitement de masse au praziquantel et a l'albendazole ont ete organisees dans toutes les regions endemiques du pays. La presente etude avait pour but d'evaluer les taux de couverture et de satisfaction de ces campagnes de traitement dans deux regions d'endemie (Segou et Mopti). Nous avons procede a une etude transversale a un seul passage qui s'etalait de fevrier a mars 2006. L'enquete a porte sur les responsables politiques (n=142); administratifs (n=70) et sanitaires (n=36); les distributeurs communautaires (n=33); les eleves (n=2480) et les membres de la communaute (n=2170). Nous avons utilise la technique de controle de la qualite des lots (LQAS) pour determiner la couverture de traitement et de satisfaction. Deux types de lots ont ete considere; les villages et les ecoles. La technique d'entretien par questionnaires a permis de mesurer le taux de satisfaction. Dans la region de Segou; les taux de couverture variaient de 100en milieu scolaire et dans la communaute (cercle de Bla) a 97;2a Segou-ville. Dans la region de Mopti; des taux de couverture therapeutique de 100etaient observes a Bankass et a Douentza a la fois en milieu scolaire et dans la communaute. La proportion d'individus satisfaits (se sentir bien) apres traitement etait de 72;3et 76;6respectivement parmi les eleves et dans la communaute. Les resultats de cette etude montrent les taux de couverture eleves au cours de ces campagnes de traitement pourraient etre soutenus par une strategie de traitement annuelle precedee par des programmes d'education pour la sante

[Haemophilus influenzae b among bacterial meningitis in Bamako (2002-2004)]. / Haemophilus influenzae b parmi les méningites bactériennes a Bamako (2002-2004).

In Mali little study exist on the meningitis with Haemophilus influenzae b (Hib). This weak data availability on Hib meningitis, didn't permit to introduce the immunization against this pathology in the Expanded Program Immunization (EPI) of Mali. The present survey aims to improve the availability of the data on Hib meningitis and to advocate for the introduction of immunization against Hib in EPI in Mali. The survey consisted to the exploitation of spinal fluid examination data for the suspected cases of meningitis, sent by the different health centers to National Institute for Public Health Research (INRSP) on the period going from October 1st, 2002 to September 30, 2004. According to the survey, on 230 cases of meningitis whose germs have been identified to the latex and the culture, Hib occupies the 3rd place with 21.3% among the bacterial meningitises. In Bamako Hib occupies the 2nd place (27.4%) according to the source. The persons less than 1 year (59.6%) were the more affected (p < 0.001) and the diseases distribution has been observed during the dry seasons (51.0%) and rainy (49.0%) without meaningful impact of temperature and rainfall (p > 0.05) (p = 0.8249). The cases of Hib identified were more sensitive to ciprofloxacine (100%) and to ceftriaxone (100%). Taken into consideration the cost raised of quinolones and cephalosporines, and in reference to the high mortality and frequent complications known of Hib meningitis, the introduction of immunization against Haemophilus influenzae in the Expanded Program Immunization should contribute to a better control of this disease.

[Utilisation of community health centres in Koulikoro region, Mali]. / Frequentation des centres de sante communautaires dans la region de Koulikoro, Mali.

In Mali since the adoption of community health center (CSCOM) politics, their number knew a progression remarkable: 370 in 1998 and 660 in the end of 2003. Concerning the health staff, the ratio always remained per capita weak in relation to the international norms. In 2001 for the first level of health center, the quantum was: 1 physician for 14,612 inhabitants (norm being of 1/10,000); 1 nurse for 13,989 inhabitants (WHO norm being of 1/10,000). In spite of the well stocked efforts, the foreseen objectives are far from being reached. For example, the used rate of curative consultation was of 0.19 new contact/year/inhabitant. The foreseen objective is of 0.50. Our survey had as objectives to study the reasons of CSCOM's under frequenting, to identify the reasons and to propose some recommendations to improve the situation. We conducted a cross-sectional study that had taken place in Banamba and Dioïla in the Koulikoro's region in April 19 to May 8, 2004. Interview have been performed with the head of CSCOM, the CSCOM's staff, the persons responsible of community health association (ASACO), the mothers residing in the areas at least six months and having a child less than 5 years and the community leaders. We found that women in Banamba (89%) frequented the CSCOM more that those of Dioïla (60%). The reasons of the CSCOM's under frequenting are especially bound to the staff's instability, the geographical accessibility, to poverty and to the insufficiency of information. We recommend to the different actors to inform and to sensitize the population on the importance of the CSCOM's activities, to the state to take the staff's part in charge to improve their stability, in the ASACO to establish the contracts of work with the staff.

[Morbidity and mortality in the pediatric service at Gabriel Toure's University Hospital in Mali]. / Morbidite et Mortalite dans le Service de Pediatrie du Chu Gabriel Toure au Mali.

The aim of this work was to study morbidity and mortality before implementing the setting up of the pediatric service of Bamako. Involved in the study were all the children hospitalized during 12 months that is a total of 2000 cases among which 57.3% boys and 42.8% girls. Our study indicated that only 25% of children (509/2000) were referred. The most encountered pathologies were : malaria 898 (44.9%), ARI 528 (26.4%), diarrhea 224 (11.2%), malnutrition 269 (13.4%) and anemia 239 (11.9%). Mortality rate in hospital was 7.1 % and the main causes of deaths were : malaria (23.9% of death cases), diarrhea (20.4%) and malnutrition (31.7%). Thus we have recorded 8.3% of deaths for a period of resort beyond 3 days, compare to 3.3 % for a resort of less than 24 hours. (x² = 8.10, p= 0.017 ). The pediatric service operated as a center for first contact. In the framework of the establishment of this project, organizational efforts should allow to receive only referred cases.

Enquete CAP des agents de sante sur la prise en charge de l'enfant drepanocytaire a Bamako

La drepanocytose est une affection genotypique; propre a la race noire; caracterisee par la presence d'une hemoglobine anormale S ( HbS ). Le but de notre etude etait d'etudier les connaissances; les attitudes et les pratiques des prestataires de sante de Bamako sur la prise en charge des enfants drepanocytaires. Nous avons realise une etude transversale a passage unique realisee au niveau des centres de sante; de 140 agents de sante des Centres de Sante Communautaire (CSCOM) fonctionnels et des Centres de Sante de Reference(CSRef) des 6 communes de Bamako prenant en charge des enfants malades. Notre etude a revele qu'environ 72des agents de sante avaient un age compris entre 24 et 39 ans ; 39des agents etaient des Medecins; 77des prestataires ne savaient pas le nom des solutes utilises en cas de crise non compliquee de la drepanocytose. Parmi les prestataires; 81savaient que la drepanocytose etait une maladie du sang. La prise en charge de l'enfant drepanocytaire souffre de l'insuffisance de connaissance des agents de sante et justifie une formation du personnel

Haemophilus influenzae b parmi les meningites bacteriennes a Bamako (2002-2004)

Au Mali il existe peu d'etudes sur la meningite a Hib. Cette faible disponibilite des donnees relatives a la meningite a Hib; n'a jusqu'ici; pas permis d'introduire la vaccination contre cette pathologie dans le programme elargi de vaccination (PEV) du Mali. La presente etude est une contribution a la reponse au besoin d'ameliora-tion de la disponibilite des donnees sur la meningite a Hib et au plaidoyer en faveur de l'introduction de la vaccination anti-Hib dans le PEV de routine au Mali. L'etude a consiste a l'exploitation des donnees des examens des liquides cephalo-rachidiens (LCR) des cas suspects de meningite; envoyes par les differentes structures socio sanitaires du pays a l'INRSP sur la periode allant du 1er octobre 2002 au 30 septembre 2004. Selon l'etude; sur 230 cas de meningite dont les germes ont ete identifies au latex et a la culture; Hib occupe la 3eme place avec 21;3parmi les meningites bacteriennes. Au niveau du District de Bamako il occupe la 2eme place (27;4) suivant l'analyse en fonction de la provenance. Les sujets de moins de 1 an (59;6) etaient les plus atteints (p0;001) et la distribution de la maladie a ete observee pendant les saisons seche (51;0) et pluvieuse (49;0) sans impact significatif de la temperature et de la pluviometrie (p0;05) (p=0;8249). Les cas de Hib identifies ont ete plus sensibles a la ciprofloxacine (100) et a la ceftriaxone (100). Eu egard au cout eleve des quinolones et des cephalosporines d'une part; et d'autre part en reference a la forte mortalite et aux sequelles frequentes connues de ce type de meningite; l'introduction de la vaccination contre Haemophilus influenzae dans le programme elargi de vaccination contribuerait a mieux controler cette maladie

[Randomized clinical trial of two malaria prophylaxis regimens for pregnant women in Faladie, Mali]. / Essai clinique randomisé de deux schémas de prévention contre le paludisme au cours de la grossesse à Faladiè (Mali).

From June 2003 to May 2004 we carried out a comparative study of two malaria prophylaxis regimens for pregnant women. The purpose was to compare the efficacy of two regimens using chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) during pregnancy and delivery in a village located in an endemic area of Mali. The study was carried out in Faladié (District of Kati) located 80 km from Bamako. Prophylaxis was administered during the second and third trimesters of pregnancy (except the 9th month for SP). A total of 301 pregnant women were enrolled including 150 in the CQ group and 151 in the SP group. At the onset of the study, the two groups were comparable with regard to socio-demographic and malaria factors. At the time of delivery, malaria infection was reduced by 43.3% in the CQ group (P < 10-6), and by 79.1% in the SP group (p < 10-6). The anemia rate was reduced by 57.5% in the CQ group (Ch2 of McNemar = 0.017), and by 74.8% in the SP group (Ch2 of McNeamar = 0.025). The incidence of placental infection was 20.6 % in the CQ group versus 8.3 % in the SP group (p = 4.10-3). Overall 16.7% of newborns presented low birth weight at delivery including 70.4% in the CQ group. The findings of this study suggest that intermittent presumptive treatment using SP is more effective than intermittent presumptive treatment using CQ in protecting both the mother and newborn against intra-uterine malaria transmission and its consequences.

[Knowledge, attitude and practices (KAP) of community health center staff on birth asphyxia in Kolokani (Mali)]. / Enquete cap du personnel des Centres de Sante Communautaire de Kolokani (Mali) sur l'asphyxie du nouveau ne.

Most newborn deaths are associated with birth asphyxia (40%), low birth weigt and prematurity (25%) and infections (20%). In Mali, in the Community Health Centers (CSCOM) exercises a staff composed of the nurse chief of health centers (ICPM) assuring the supervision of the matrons that is charged in pregnancy and the newborn. An investigation KAP (Knowledge, Attitudes and Practises) initiated in order to assess the knowledge and the practices of the community health centers agents on birth asphyxia. The survey was cross-sectional and that took place in September 2004. Have been included in the study the matrons, the nurse chief available at the time of the survey. The multiplicity of the names mentioned among which Ninakili dégou (27,3%) and Niominè (15,2%) are the most frequent and show the necessity of a qualitative investigation to find a name. Prolonged labor more than 12 hours (73,3%) and the stained amniotic liquid (63,3%) are the most recognized signs during labor making fear the birth asphyxia. In our survey the prolonged labor (63,7%), the infection/malaria of mother (60,7%) and the Dystocic delivery (45,5%) were the mostly reported causes of birth asphyxia. The pale or bluish coloration (69,7%), the irregular or lack of breath (69,7%), the lack of cry (63,6%) were known as the main signs of birth asphyxia. We noted some good practices as aspirating with a bulb (69,7%) and clearing upper ways with a finger covered with gauze (30,3% ); doing the mouth to mouth (51,5%); stimulating the newborn (66,7%). The improvement of the neontatal mortality requires the training of the staff and the equipment of the centers in small simple materials of resuscitation.

[Prescribing and drug utilization at community health centers]. / Pratiques de prescription dans les centres de sante communautaires (CSCOM) et utilisation des midicaments par les populations.

The rationalization of the prescription and the good use of the drugs generally constitute a major problem in the health facilities. The present survey led in November 2002 in Mali assessed the practices of prescription and the use of the drugs by the populations. The indicators of drugs use rational have been measured from 600 drawn prescriptions randomly select at the level of 20 community health center (CSCOM) retained at random in the regions of Ségou, Sikasso, Mopti and the District of Bamako. The means of drugs by order (2.8), the percentages of prescription with antibiotic (61.6%) and injectable drugs (35%) are raised in relation to the normative values of WHO (Wold Health Organization). The rate of conformity to the treatments standardized estimated on exploitation of consultations registers in the centers is estimated to 0.5% for the simple diarrhoea, 13.5% for the acute respiratory infections (ARI) without pneumonia and 60.5% for the pneumonia. On 293 patients in the households our survey permitted to estimate to 84.6% the observance of the treatment by the persons having bought the prescribed drugs totality. The percentage of antibiotics prescription and injectable drugs, and the big insufficiency in the non respect of the treatment standard constitutes some practices potentially to high risk justifying the necessity of an urgent training to the rational prescription.