[National reference unit of neonatology: state of play]. / Unit6é de néonatologie de référence nationale du Mali: état des lieux.

BACKGROUND: The neonatal mortality rate in Mali is one of the highest in the world. Only one national reference neonatology unit is available in the country. AIM: To describe the time-course of morbidity, mortality, staff and accommodation facilities from 2008 to 2009 in Mali's unique national reference neonatology unit. METHODS: This descriptive and cross-sectional study was conducted in the neonatology unit of Gabriel Touré Teaching Hospital, Bamako. Data concerning staff number of admissions, sex ratio, diseases, patients outcome, capacity and length-of-stay were compiled for the period from 1st January 2008 to 31 December 2012. RESULTS: Medical staff increased from one to three in 2009 and the number of nurses and midwives decreased from 16 to 14 with an average number of beds of 44. The mean number of hospitalizations per year was 3,900 (range: 3667-4585) with 14% of in-born deliveries and a mean length-of-stay of 3.7 days. Prematurity birth asphyxia and infection represented 80.5% of reasons for admission and 79.5% of deaths. The mortality rate varied from 28.5% to 36.8% with an annual mean of 33.2%. The diseases associated with the highest mortality were tetanus (60.8%), prematurity (42.7%), birth asphyxia (29.4%) and infection (25.7%). CONCLUSION: Neonatal mortality remains very high in Mali. Health authorities should take measures to decentralize the care of sick newborns in order to reduce neonatal mortality in Mali.

[Knowledge and practices of traditionnal birth attendant on birth asphyxia in Kolokani (Mali)]. / Connaissance et pratique des accoucheuses traditionnelles sur l'asphyxie du nouveau-ne dans le district sanitaire de Kolokani.

INTRODUCTION: In Mali, according to the DHS IV in 2006, the neonatal mortality rate is 46 per thousand live births and is higher in rural areas (61‰) than in urban areas (45‰). The proportion of home births is 54%.The aim of our study was to assess the knowledge and practices of traditional birth attendants (TBAs) on pregnancy and newborn asphyxia in the health district of Kolokani. METHODOLOGY: It was a descriptive cross-sectional study conducted in the health district Kolokani 1st September to 04 October 2004. The study population consisted of traditional birth attendants TBAs. Our study covered 10% of the villages is Kolokani 28 villages randomly selected in 22 health areas. A total of 43 TBAs were interviewed. Data were entered with software EPI-Info version 6 and analyzed on SPSS11. RESULTS: TBAs have said that the main pathologies compromising reproductive health were toxoplasmosis (79%), pelvic pain (74.4%), malaria (46.5%). The main diseases were heralds of a difficult delivery were toxoplasmosis (16.2%), pelvic pain (16.2%), polyhydramnios (11.6%), but 67.4% of TBAs unaware of these pathologies.The main actions carried out before and during childbirth were displays of loin cloth (48.8%), floor sweeping (34.8%), display of drawsheet (30.2%), incantations (27.9%), the knotted strings "tafo" (32.5%). Deliveries conducted by TBAs have been estimated at 52% for all areas. CONCLUSION: At the end of our study we recommend TBA training to reduce the risks associated with home births.

INTRODUCTION: Au Mali, selon l'EDSM IV de 2006, le taux de mortalité néonatale est de 46 pour mille naissances vivantes et est plus élevé en zone rurale (61‰)qu'en zone urbaine(45‰).La proportion d'accouchement à domicile est de 54%. L'objectif de notre étude était d'évaluer les connaissances etles pratiques des accoucheuses traditionnelles sur la grossesse et l'asphyxie du nouveau-né dans le district sanitaire de Kolokani. MÉTHODOLOGIE: Il s'agissait d'une étude transversale descriptivemenée dans le district sanitaire de Kolokani du 1er septembre au 04 Octobre 2004. La population d'étude était constituée par les accoucheuses traditionnelles (AT). Notre étude couvrait 10% des villages de Kolokani soit 28 villages sélectionnés de façon aléatoire dans les 22 aires de santé. Au total 43 AT ont étéinterrogées.Les données ont été saisies sur EPI-Info version 6fr, analysé sur SPSS11. RÉSULTATS: Les AT ont déclaré que les principales pathologies compromettant la santé de la reproduction étaient la toxoplasmose (79%), la douleur pelvienne (74,4%), le paludisme (46,5%). Les principales pathologies annonciatrices d'accouchement difficile étaient la toxoplasmose (16,2%), la douleur pelvienne (16,2%), l'hydramnios (11,6%) et par contre 67,4% des AT ignoraient ces pathologies. Les principaux gestes effectués avant et pendant l'accouchement ont été l'étalage de pagne (48,8%), le balayage de sol (34,8%), l'étalage de l'alèze (30,2%), les incantations (27,9%), les cordelettes à nœuds « tafo ¼ (32,5 %).Les accouchements effectués par les AT on été estimés à 52% pour l'ensemble des aires. CONCLUSION: Au terme de notre étude nous recommandons la formation des AT en vue de réduire les risques liés aux accouchements à domicile.

[Retinoblastoma: inventory in Mali and program to develop early diagnosis, treatments and rehabilitation]. / Le rétinoblastome: état des lieux au Mali et programme d'aide au diagnostic précoce, aux traitements et à la réhabilitation.

Retinoblastoma (RB) is a rare embryonic tumour that represents 1/16,000 births in France. In Mali, a study showed the characteristics of a hospital series of cases seen in Bamako in the Pediatric Oncology Unit of Gabriel Touré Teaching Hospital and in the Tropical Ophthalmology Institute of Africa (IOTA) between January 2005 and June 2007. Median age was 4 years versus 2 years in France for unilateral disease. Near two third of children with RB had extra-ocular extension at diagnosis, which is now exceptional in France. Only 11% were bilateral versus 35% in France. Cure rate was around 50%, but it is estimated only on the cases arriving in Bamako and with at least 20% lost of follow-up. Cure rate is over 95% in France within an exhaustive register. RB appears as an exemplary tumor and rapid improvements could be obtained in low-income countries with relatively limited means. This is why, the Alliance mondiale contre le cancer (AMCC), the Institut Curie in Paris, which is the reference center in France for RB, and teams in Bamako were proposing a program to help the development of early diagnosis, treatments, including eye preservation, and rehabilitation of children with RB in sub-Saharan Africa in collaboration with the Groupe franco-africain d'oncologie pédiatrique (GFAOP). The official launching of this program was held in Bamako November 4, 2011 for Mali and the surrounding regions. After this first experience, this program is now implemented in other countries.

[Follow-up of children born to HIV seropositive mothers in Mali]. / Suivi des nourrissons nés de mères séropositives au VIH au Mali.

INTRODUCTION: The rate of mother-to-child transmission without perinatal antiretroviral treatment is 30 to 40%. Antiretroviral treatment of new-borns from HIV infected mother has proved effective in reducing rates of mother-to child transmission. Our aim was to follow newborns of HIV infected mothers for 18 months in three of preventive mother to child transmission (PMTCT) health centres in Bamako and one in Koulikoro. METHODS: This was a longitudinal study with follow-up of a cohort of newborns from HIV-positive mothers over an 18-month period. Follow-up was based on clinical, laboratory and psychosocial parameters for 18 months. A questionnaire was used to collect data. All analyses were performed using ACCESS version 3 software. RESULTS: A total of 157 HIV-infected mothers and 161 children were included. Artificial feeding was performed in 93.2% of children. Antiretroviral prophylaxis was received by 89.8% of children and 100% of mothers. 72.67% (117/161) of the children were followed for 18 months, 3.4% were infected by HIV, 20% were lost to follow-up and 9.31% died. During follow-up, 68.2% of women shared information about their status with their husbands; 83.2% of husbands performed an HIV screening test and 58.4% presented positive HIV serology. CONCLUSION: Clinical, laboratory and psychosocial follow-up can be performed at PMTCT sites and may contribute to a reduction of mother-to-child transmission.

[Training mothers: a strategy to improve the treatment of acute respiratory infections among children in Mali]. / Formation des mères : stratégie pour améliorer le traitement des infections respiratoires aiguës au Mali.

Acute respiratory infections (ARI) are a major public health issue in Mali. The objective of this study was to examine the management of ARI within the community among children aged 2 to 59 months. The study was based on a pilot community intervention over a period of 15 months (June 2008-August 2009) in 4 health districts in Mali. A survey was conducted two weeks before the intervention in order to determine the incidence of ARI. During the intervention phase, 80 community health workers (CHW) and 1,123 mothers were trained, equipped and supervised. 3,532 children aged 2 to 59 months were managed. Two health areas were selected in each district. A "CHW" area (i.e. an area where CHWs were trained and supervised) and a "mother" area (i.e. an area where mothers were trained and supervised) were randomly selected. Among the managed ARI cases, there were more cases of pneumonia in the "mother" areas (29.5%) than in the "CHW" areas (24.9%) (p = 0.003). The study also found that the duration of the prescription period was more appropriate in "CHW" areas (99.5%) than in "mother" areas (97.6%) (p = 0.03). In addition, the reduction in the incidence of complicated cases (before and after intervention) was more significant in "mother" areas (from 69? to 6?, with p = 10?6) than in "CHW" areas (from 24? to 11?, with p = 0.01). The results suggest that mothers with the appropriate training, equipment and supervision are able to manage cases of ARI.

[Community-based intervention to reduce birth asphyxia mortality in Mali]. / Intervention communautaire pour réduire au Mali la mortalité néonatale due à l'asphyxie.

Approximately one million newborn babies die every year as a result of birth asphyxia in developing countries. The objectives of this study are to develop the management of birth asphyxia and to establish a community-based surveillance system of vital events in rural areas of Oueléssébougou, Mali. Traditional birth attendants, female leaders of village associations and village health workers were trained to carry out communication activities designed to change behaviours in the management of birth asphyxia. The study has improved health facility-based delivery (from 80 to 93%) and the identification of birth asphyxia (11 to 12% new born babies have been resuscitated). As a result of training and supervising community actors, the quality of delivery is improved and neonatal mortality is reduced.

[Management of sickle cells disease by households in Bamako]. / Enquete cap des menages sur la prise en charge de l'enfant drepanocytaire a Bamako.

The sickle cell disease constitutes a major problem of public health. We find 5% to 20% of carriers of this disease in West Africa and 40% among some populations in central Africa (Congo, Zaire) and Nigeria (Beguè). In Mali prevalence is estimated to 12% with 3% for the homozygote form. It is a known disease and well documented on the scientific plan and its management is better and better codified nowadays, which contributes to the improvement of life quality. For this reason, Centre for Research and Documentation on Child Survival (CREDOS) lead this study. The aim was to assess the knowledge of the mothers for a best management of sickle cell disease in the households. We conducted a cross-sectional study with single passage realized in the households in 6 communes of Bamako district. We inquired 360 parents of children less than 5 years, according to the method of cluster sampling. The study found that 95.8% of mothers know the sickle cell disease. In addition 63.9% of the mothers didn't know the complications of the sickle cell disease and 58% the causes. In the event of discovered sickle cell disease, 58.3% of the mothers stated to want to resort to a medical structure in first intention, 18.3% with self medication and 13.9% with the traditional practitioner. In front of a sickle cell disease crisis, 56% stated to have recourse to modern medicine against 15.2% with the traditional practitioner. Household's implication in the management of the child sickle cell disease suffers a low knowledge of cause, clinical signs, and complications of this disease by the parents. For a better knowledge of this pathology by the families, information and education of the populations through messages BCC are necessary.

[Management of sickle cell disease by health professional in Bamako]. / Enquete cap des agents de sante sur la prise en charge de l'enfant drepanocytaire a Bamako.

The sickle cell disease is a genotypic affection, suited to the black race, characterized by the presence of an abnormal haemoglobin S (HbS). The purpose of this survey was to assess the knowledge, the attitudes and the practices of the health professionals on management of children with sickle cells diseases. We carried out a cross-sectional survey in the health centres and involved 140 health professional of Community Health Centres (CSCOM) and 6 health districts in Bamako. The study found that 72% of health professionals had between 24 and 39 year old; 39% were physician; 77% didn't know the name of the drugs used in case of non complicate sickle cells diseas. Among the health professionals, 81% knew that the sickle cells disease was a blood illness. Our findings suggest that management of children with sickle cells diseases was not performed better due to the knowledge insufficiency of health professionals. We recommend training the health staff.

Management of malnutrition in rural Mali.

In Mali, according to DHS III (Demographic and Health Survey) in 2001, the global rate of malnutrition (weight for age <2 sd) among under-five children was 38%. The purpose of this study was to assess the management of malnutrition in children (0-59 months old) by the professionals in the intervention areas of 'Strategy for Accelerated Child Survival and Growth', according to IMCI guidelines. We carried out a cross-sectional survey in three randomly selected health districts (Kolokani, Niono and Koro) and involved 27 health centres, 180 children and 180 mothers. We did direct observation of consultations and interrogated the mothers. The study found that the equipement and tools necessary for nutritional status assessment were available but seldom used in practice. Nutrition training was provided only to the health staff of Kolokani where 78% of the staff were trained in IMCI and 55% in IEC (Information Education and Communication). The indicatory weight-for-age was used to assess nutritional status of 64% children in Kolokani vs. 42% in Koro and 4% in Niono. IMCI classification was used only in Kolokani (57% of children). The management of severe malnbutrition in children was more correct in Kolokani (100%) than in Koro (33%) and Niono (0%). Twenty- eight percent of mothers/caretakers knew the appropiate duration of exclusive breastfeeding, but only 5% knew that vitamin A supplementation should be done every 6 months. Our findings suggest that nutritional status assessment is performed better in the health districts where staffs are training in IMCI. We recommend training the health staff in the other health districts and the intensification of behavioural change communication for mothers.

Type 2 Gaucher's disease in a Malian family.

Gaucher's disease is a recessive autosomal disorder caused by an inherited deficiency of betaglucocerebrosidase. We report here the case of an 8 month old child, fourth in a family of four children, who presents the neuropathic form of the disease. The dosages of betaglucosidase activity using C (14 ) techniques have confirmed the diagnosis, and allowed the detection of the disease in the elder brother. Both parents were considered as responsible for the transmission of this disease to their progeny. The type 2 Gaucher's disease is rare in black population, and may be associated with phenotypes heterogeneity.