Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study.

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The disorder is common in type 2 diabetics (T2D) and is linked with T2D comorbidities, particularly cardiovascular disease. Dyslipidemia in T2D is typically characterized by elevated plasma triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels. There is a significant gap in the literature regarding dyslipidemia in rural parts of Africa, where lipid profiles may not be captured through routine surveillance. This study aimed to characterize the prevalence and demo-graphic profile of dyslipidemia in T2D in the rural community of Ganadougou, Mali. We performed a cross-sectional study of 104 subjects with T2D in Ganadougou between November 2021 and March 2022. Demographic and lipid profiles were collected through cross-sectional surveys and serological analyses. The overall prevalence of dyslipidemia in T2D patients was 87.5% (91/104), which did not differ by sex (P = .368). High low-density lipoprotein cholesterol (LDL-C) was the most common lipid abnormality (78.9%, [82/104]). Dyslipidemia was associated with age and hypertension status (P = .013 and.036, respectively). High total and high LDL-C parameters were significantly associated with hypertension (P = .029 and .006, respectively). In low-resource settings such as rural Mali, there is a critical need to improve infrastructure for routine dyslipidemia screening to guide its prevention and intervention approaches. The high rates of dyslipidemia observed in Gandadougou, consistent with concomitant increases in cardiovascular diseases in Africa suggest that lipid profile assessments should be incorporated into routine medical care for T2D patients in African rural settings.

Causal effect of severe and non-severe malaria on dyslipidemia in African Ancestry individuals: A Mendelian randomization study.

BACKGROUND: Dyslipidemia is becoming prevalent in Africa, where malaria is endemic. Observational studies have documented the long-term protective effect of malaria on dyslipidemia; however, these study designs are prone to confounding. Therefore, we used Mendelian randomization (MR, a method robust to confounders and reverse causation) to determine the causal effect of severe malaria (SM) and the recurrence of non-severe malaria (RNM) on lipid traits. METHOD: We performed two-sample MR using genome wide association study (GWAS) summary statistics for recurrent non-severe malaria (RNM) from a Benin cohort (N = 775) and severe malaria from the MalariaGEN dataset (N = 17,000) and lipid traits from summary-level data of a meta-analyzed African lipid GWAS (MALG, N = 24,215) from the African Partnership for Chronic Disease Research (APCDR) (N = 13,612) and the Africa Wits-IN-DEPTH partnership for genomics studies (AWI-Gen) dataset (N = 10,603). RESULT: No evidence of significant causal association was obtained between RNM and high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol and triglycerides. However, a notable association emerged between severe malarial anaemia (SMA) which is a subtype of severe malaria and reduced HDL-C levels, suggesting a potential subtype-specific effect. Nonetheless, we strongly believe that the small sample size likely affects our estimates, warranting cautious interpretation of these results. CONCLUSION: Our findings challenge the hypothesis of a broad causal relationship between malaria (both severe and recurrent non-severe forms) and dyslipidemia. The isolated association with SMA highlights an intriguing area for future research. However, we believe that conducting larger studies to investigate the connection between malaria and dyslipidemia in Africa will enhance our ability to better address the burden posed by both diseases.

[Causes Of Death In The Medicine Department Of The Regional Hospital Of Sikasso]. / Causes De Décès Au Service De Médecine De l'Hôpital Régional De Sikasso.

The causes of death are of great importance in assessing the health status of the population and care'squality. Their study could guide health policies aimed at increasing life expectancy. OBJECTIVES: It was to determine the causes of death; to study the socio-demographic characteristics of deceased. MATERIALS AND METHODS: This was a retrospective and descriptive study of all deaths that occurred in the Medical Department of Sikasso Hospital from January 2018 to December 2020. RESULTS: Among 265 deaths recorded, the mean age was 45.12 ± 17.5 years. The sex ratio was 1.59. They were mostly city dwellers and 51.64% lived in Sikasso city. The mean length of hospitalization was 7.09 ± 6.38 days. Kidney failure was the first reason for hospitalization. HIV infection was the leading cause of death (29.8%), followed by renal failure (24.2%). The male sex was predominant in all causes of death except HIV infection and anemia. Deaths linked to kidney failure have increased fivefold from 2018 to 2020. CONCLUSION: Deaths related to HIV/AIDS remain in the lead despite their strong reduction; those related to kidney failure have increased fivefold.

Les causes de décès revêtent une grande importance dans l'évaluation de l'état de santé de la population et de la qualité des soins. Leur étude pourrait orienter les politiques de santé visant à accroître l'espérance de vie. OBJECTIFS: C'était de déterminer les causes de mort ; d'étudier les caractéristiques sociodémographiques des défunts. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude rétrospective et descriptive portant sur tous les décès survenus dans le service de Médecine de l'hôpital de Sikasso de Janvier 2018 à Décembre 2020. RÉSULTATS: Parmi 265 décès recensés, l'âge moyen était de 45,12±17,5 ans. Le sex-ratio était de 1,59. Il s'agissait en majorité de citadins et 51,64% résidaient à Sikasso ville. La durée moyenne d'hospitalisation était 7,09 ± 6,38 jours. L'insuffisance rénale constituait le 1er motif d'hospitalisation. L'infection à VIH était la 1ère cause de décès (29,8%), suivie de l'insuffisance rénale (24,2%). Le sexe masculin était majoritaire dans toutes les causes de décès hormis l'infection à VIH et l'anémie. Les décès liés à l'insuffisance rénale ont quintuplé de 2018 à 2020. CONCLUSION: Les décès liés au VIH/SIDA reste en tête malgré leur forte réduction ; ceux liés à l'insuffisance rénale ont quintuplé.

[Epidemio-clinical features of retinoblastoma at the Yalgado Ouedraogo University Hospital Center in Burkina Faso: about 32 cases]. / Caractéristiques épidémio-cliniques du rétino blastome au Centre Hospitalier Universitaire Yalgado Ouedraogo du Burkina Faso: à propos de 32 cas.

Retinoblastoma is the most common intraocular cancer of childhood. Its estimated incidence is 1 case per 15 000 to 18 000 births. The purpose of this study is to highlight the epidemiological and clinical features of this disease as well as its management in Burkina Faso. We conducted a retrospective study over a period of 5 years at the Yalgado Ouedraogo University Hospital Center. The average age of patients was 33 months, with predominance of male sex (68.75%). Exophthalmia was the most frequent reason for consultation (59.37%). The predominant pattern was unilateral (75%) associated with eye protrusion (59.38%). Chemotherapy associated with surgery was the treatment of choice, with a 5-year survival rate of 34.37%. Retinoblastoma is one of the most common cancers in children younger than 5 years. In our low-income country this disease is diagnosed late. Patients´ management is complex and is commonly associated with poor prognosis. Mortality and morbidity from this disease are disproportionate in our country facing a shortage of technical equipment. In our low-income country, patient´s management should be based on early detection of the disease as well as on adequate treatment.

Revenue-raising potential for universal health coverage in Benin, Mali, Mozambique and Togo.

Increasing overall fiscal space is important for the health sector due to the centrality of public financing to make progress towards universal health coverage. One strategy is to mobilize additional government revenues through new taxes or increased tax rates on goods and services. We illustrate how countries can assess the feasibility and quantitative potential of different revenue-raising mechanisms. We review and synthesize the processes and results from country assessments in Benin, Mali, Mozambique and Togo. The studies analysed new taxes or increased taxes on airplane tickets, phone calls, alcoholic drinks, tourism services, financial transactions, lottery tickets, vehicles and the extractive industries. Study teams in each country assessed the feasibility of new revenue-raising mechanisms using six qualitative criteria. The quantitative potential of these mechanisms was estimated by defining different scenarios and setting assumptions. Consultations with stakeholders at the start of the process served to select the revenue-raising mechanisms to study and later to discuss findings and options. Exploring feasibility was essential, as this helped rule out options that appeared promising from the quantitative assessment. Stakeholders rated stability and sustainability positive for most mechanisms, but political feasibility was a key issue throughout. The estimated additional revenues through new revenue-raising mechanisms ranged from 0.47-1.62% as a share of general government expenditure in the four countries. Overall, the revenue raised through these mechanisms was small. Countries are advised to consider multiple strategies to expand fiscal space for health.

Il est important d'accroître l'espace budgétaire global alloué à la santé en raison du caractère crucial du financement public pour accomplir des progrès en faveur de la couverture sanitaire universelle. Une stratégie consiste à mobiliser des fonds publics supplémentaires par le biais de nouvelles taxes ou d'une augmentation des taux d'imposition applicables aux biens et aux services. Nous expliquons comment les pays peuvent évaluer la faisabilité et le potentiel quantitatif de différents mécanismes de mobilisation de fonds. Nous examinons et synthétisons les processus et les résultats d'évaluations nationales menées au Bénin, au Mali, au Mozambique et au Togo. Ces études ont analysé la mise en place de nouvelles taxes ou la hausse de taxes sur les billets d'avion, les appels téléphoniques, les boissons alcoolisées, les services touristiques, les transactions financières, les billets de loterie, les véhicules et les industries extractives. Les équipes chargées des études au sein de chaque pays ont évalué la faisabilité des nouveaux mécanismes de mobilisation de fonds à l'aide de six critères qualitatifs. Le potentiel quantitatif de ces mécanismes a été estimé en définissant différents scénarios et en formulant des hypothèses. Des consultations ont été menées auprès des parties prenantes au début du processus afin de sélectionner les mécanismes de mobilisation de fonds à étudier et de discuter des résultats et des options à un stade ultérieur. Il était essentiel d'étudier la faisabilité, car cela a permis d'écarter les options qui semblaient prometteuses à partir de l'évaluation quantitative. Les parties prenantes ont jugé la stabilité et la durabilité positives pour la plupart des mécanismes, mais la faisabilité politique a été une question clef tout au long du processus. Nous avons estimé que la part des fonds supplémentaires générés par les nouveaux mécanismes de mobilisation de fonds dans les dépenses générales de l'État allait de 0,47 à 1,67% dans les quatre pays. Dans l'ensemble, les fonds générés par ces mécanismes étaient de faible ampleur. Il est conseillé aux pays d'envisager plusieurs stratégies pour augmenter l'espace budgétaire alloué à la santé.

El aumento del espacio fiscal general es importante para el sector de la salud debido al carácter central de la financiación pública para avanzar hacia una cobertura sanitaria universal. Una estrategia consiste en movilizar fondos públicos adicionales mediante nuevos impuestos o aumentar los tipos impositivos sobre los bienes y servicios. A continuación se ilustra cómo los países pueden evaluar la viabilidad y el potencial cuantitativo de los diferentes mecanismos de recaudación de fondos. Se han revisado y sintetizado los procesos y los resultados de las evaluaciones nacionales en Benin, Malí, Mozambique y Togo. Los estudios analizaron nuevos impuestos o la subida de los impuestos sobre los billetes de avión, las llamadas telefónicas, las bebidas alcohólicas, los servicios turísticos, las transacciones financieras, los billetes de lotería, los vehículos y las industrias de extracción. Los equipos de estudio de cada país evaluaron la viabilidad de nuevos mecanismos de recaudación de fondos mediante seis criterios cualitativos. El potencial cuantitativo de estos mecanismos se estimó mediante la definición de diferentes escenarios y el establecimiento de supuestos. Las consultas con las partes interesadas al comienzo del proceso sirvieron para seleccionar los mecanismos de recaudación de fondos que se estudiarían y posteriormente examinar las conclusiones y las opciones. Era esencial explorar la viabilidad, ya que ayudaba a descartar opciones que parecían prometedoras de la evaluación cuantitativa. Las partes interesadas calificaron la estabilidad y la sostenibilidad como positivas para la mayoría de los mecanismos, pero la viabilidad política fue una cuestión clave en todo momento. Los fondos adicionales estimados por medio de los nuevos mecanismos de recaudación oscilaron entre el 0,47 % y el 1,62 % de los gastos de las administraciones públicas de los cuatro países. En general, los fondos recaudados mediante estos mecanismos fueron reducidos. Se aconseja a los países que consideren múltiples estrategias para ampliar el espacio fiscal para la salud.

Using the Lives Saved Tool to aid country planning in meeting mortality targets: a case study from Mali.

BACKGROUND: Mali is one of four countries implementing a National Evaluation Platform (NEP) to build local capacity to answer evaluation questions for maternal, newborn, child health and nutrition (MNCH&N). In 2014-15, NEP-Mali addressed questions about the potential impact of Mali's MNCH&N plans and strategies, and identified priority interventions to achieve targeted mortality reductions. METHODS: The NEP-Mali team modeled the potential impact of three intervention packages in the Lives Saved Tool (LiST) from 2014 to 2023. One projection included the interventions and targets from Mali's ten-year health strategy (PDDSS) for 2014-2023, and two others modeled intervention packages that included scale up of antenatal, intrapartum, and curative interventions, as well as reductions in stunting and wasting. We modeled the change in maternal, newborn and under-five mortality rates under these three projections, as well as the number of lives saved, overall and by intervention. RESULTS: If Mali were to achieve the MNCH&N coverage targets from its health strategy, under-5 mortality would be reduced from 121 per 1000 live births to 93 per 1000, far from the target of 69 deaths per 1000. Projections 1 and 2 produced estimated mortality reductions from 121 deaths per 1000 to 70 and 68 deaths per 1000, respectively. With respect to neonatal mortality, the mortality rate would be reduced from 39 to 32 deaths per 1000 live births under the current health strategy, and to 25 per 1000 under projections 1 and 2. CONCLUSIONS: This study revealed that achieving the coverage targets for the MNCH&N interventions in the 2014-23 PDDSS would likely not allow Mali to achieve its mortality targets. The NEP-Mali team was able to identify two packages of MNCH&N interventions (and targets) that achieved under-5 and neonatal mortality rates at, or very near, the PDDSS targets. The Malian Ministry of Health and Public Hygiene is using these results to revise its plans and strategies.

Aza-amino acid scanning of chromobox homolog 7 (CBX7) ligands.

An aza-amino acid scan of peptide inhibitors of the chromobox homolog 7 (CBX7) was performed to study the conformational requirements for affinity to the methyllysine reader protein. Twelve azapeptide analogues were prepared using three different approaches employing respectively N-(Fmoc)aza-amino acid chlorides and submonomer azapeptide synthesis to install systematically aza-residues at the first four residues of the peptide, as well as to provide aza-lysine residues possessing saturated and unsaturated side chains. The aza-peptide ligands were evaluated in a chromobox homolog 7 binding assay, providing useful insight into structural requirements for affinity. Copyright © 2017 European Peptide Society and John Wiley & Sons, Ltd.

Strengthening Community Networks for Vital Event Reporting: Community-Based Reporting of Vital Events in Rural Mali.

BACKGROUND: Like many developing countries, Mali has few sources of mortality data. High quality mortality estimates are available from household surveys, such as the demographic and health surveys (DHS), approximately every five years, making it difficult to track progress in reducing mortality. The Rapid Mortality Monitoring (RMM) project in Mali aimed to address this issue by testing a community-based approach to measuring under-five mortality on a yearly basis. METHODS AND FINDINGS: Seventy-eight community-based workers (relais) were identified in 20 villages comprising approximately 5,300 households. The relais reported pregnancies, births, and under-five deaths from July, 2012 to November, 2013. Data were double-entered, reconciled, cleaned, and analyzed monthly. In November-December 2013, we administered a full pregnancy history (FPH) to women of reproductive age in a census of the households in the project villages. We assessed the completeness of the counts of births and deaths, and the validity of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FPH for two rolling twelve-month periods. Monthly reporting by relais was high, with reports on pregnancies, births, and deaths consistently provided from all 78 relais catchment areas. Relais reported 1,660 live births and 276 under-five deaths from July, 2012 to November, 2013. The under-five mortality rate calculated from the relais data was similar to that estimated using the validation survey, where the overall ratios of the community-based to FPH-based mortality rates for the reporting periods were 100.4 (95% CI: 80.4, 120.5) and 100.8 (95% CI: 79.5, 122.0). CONCLUSIONS: On a small scale, the community-based method in Mali produced estimates of annualized under-five mortality rates that were consistent with those obtained from a FPH. The community-based method should be considered for scale-up in Mali, with appropriate measures to ensure community engagement, data quality, and cross-validation with comparable FPHs.

Solid-phase synthesis of C-terminal azapeptides.

The solid-phase synthesis of azapeptides possessing a C-terminal aza-residue has been accomplished by a protocol featuring regioselective alkylation of benzhydrylidene-aza-glycinamide and illustrated by the syntheses of [aza-Lys(6)] growth-hormone-releasing peptide-6 analogs.

[Formative research on community-based vital events registration in Mali]. / Recherche formative sur l’enregistrement d’évènements vitaux en milieu communautaire au Mali.

OBJECTIVES: The under-five mortality rate in Mali is high, with most deaths occurring in the community where there is no reliable vital events registration. The objective of this study was to collect data on community-based vital events registration in the Niono and Baroueli districts of the Segou region, in order to improve the community-based vital events registration system. METHODS: Data collection for this cross-sectional, descriptive, and qualitative study was conducted in May 2010. Participants included health and administrative workers, community members, women's associations, and non-governmental organizations. Data collection methods included individual interviews and focus groups, as well as document review. Data were entered and codified with Modalisa version 5.1. RESULTS: Pregnancy registration was performed exclusively by health workers in health facilities and was not performed before the third month of pregnancy due to concerns about losing the pregnancy (due to sorcery or spells). Birth registration was performed in administrative and health structures and at the community level, but after an interval of about 7 days. Childhood deaths were rarely registered because the community did not understand the importance of this registration, and because of problems accessing the structures in which deaths are registered. Community opinions were favourable to the implementation of an improved system involving relays (community-based volunteers). CONCLUSION: Improvements to vital events registration in this setting should make use of relays by increasing the awareness and involvement of the population.

Diversity-oriented synthesis of azapeptides with basic amino acid residues: aza-lysine, aza-ornithine, and aza-arginine.

Aza-peptides with basic amino acid residues (lysine, ornithine, arginine) and derivatives were synthesized by an effective approach featuring alkylation of a hydrazone-protected aza-glycine residue with α-bromo ω-chloro propane and butane to provide the corresponding alkyl chloride side chains. Displacement of the chloride with azide and various amines gave entry to azaOrn, azaLys, and azaArg containing peptides as demonstrated by the solution and solid-phase syntheses of 29 examples, including an aza-library of Growth Hormone Releasing Peptide-6 analogs.

Flexible synthesis and evaluation of diverse anti-Apicomplexa cyclic peptides.

A modular approach to synthesize anti-Apicomplexa parasite inhibitors was developed that takes advantage of a pluripotent cyclic tetrapeptide scaffold capable of adjusting appendage and skeletal diversities in only a few steps (one to three steps). The diversification processes make use of selective radical coupling reactions and involve a new example of a reductive carbon-nitrogen cleavage reaction with SmI2. The resulting bioactive cyclic peptides have revealed new insights into structural factors that govern selectivity between Apicomplexa parasites such as Toxoplasma and Plasmodium and human cells.

HIV status disclosure and retention in care in HIV-infected adolescents on antiretroviral therapy (ART) in West Africa.

OBJECTIVE: We assessed the effect of HIV status disclosure on retention in care from initiation of antiretroviral therapy (ART) among HIV-infected children aged 10 years or more in Cote d'Ivoire, Mali and Sénégal. METHODS: Multi-centre cohort study within five paediatric clinics participating in the IeDEA West Africa collaboration. HIV-infected patients were included in this study if they met the following inclusion criteria: aged 10-21 years while on ART; having initiated ART ≥ 200 days before the closure date of the clinic database; followed ≥ 15 days from ART initiation in clinics with ≥ 10 adolescents enrolled. Routine follow-up data were merged with those collected through a standardized ad hoc questionnaire on awareness of HIV status. Probability of retention (no death or loss-to-follow-up) was estimated with Kaplan-Meier method. Cox proportional hazard model with date of ART initiation as origin and a delayed entry at date of 10th birthday was used to identify factors associated with death or loss-to-follow-up. RESULTS: 650 adolescents were available for this analysis. Characteristics at ART initiation were: median age of 10.4 years; median CD4 count of 224 cells/mm³ (47% with severe immunosuppression), 48% CDC stage C/WHO stage 3/4. The median follow-up on ART after the age of 10 was 23.3 months; 187 adolescents (28.8%) knew their HIV status. The overall probability of retention at 36 months after ART initiation was 74.6% (95% confidence interval [CI]: 70.5-79.0) and was higher for those disclosed compared to those not: adjusted hazard ratio for the risk of being death or loss-to-follow-up = 0.23 (95% CI: 0.13-0.39). CONCLUSION: About 2/3 of HIV-infected adolescents on ART were not aware of their HIV status in these ART clinics in West Africa but disclosed HIV status improved retention in care. The disclosure process should be thus systematically encouraged and organized in adolescent populations.

Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: results from a cluster randomized control trial.

BACKGROUND: Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived. METHODS: To assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007. RESULTS: At baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001).The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%). CONCLUSION: This study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali.

Forming spirocyclohexadienone-oxocarbenium cation species in the biomimetic synthesis of amomols.

The oxidation of appropriate 2-(4-hydroxyphenyl)ethyl ketones gives direct access to amomols by means of the formation of a transient spirocyclohexadienone-oxocarbenium ion that is intermolecularly intercepted by an alcohol. Furthermore, homochiral amomols and other new analogues were synthesized for the first time and were biologically evaluated on Plasmodium falciparum.

Molecular markers of resistance to sulphadoxine-pyrimethamine one year after implementation of intermittent preventive treatment of malaria in infants in Mali.

BACKGROUND: Intermittent preventive treatment in infants (IPTi) with sulphadoxine-pyrimethamine (SP) given during routine vaccinations is efficacious in preventing malaria disease and shows no interaction with the vaccines. However, there is a fear that IPTi may result in a rapid increase of parasite resistance to SP. METHODS: To evaluate the impact of IPTi on SP-resistance point mutations, the 22 health sub-districts in the district of Kolokani, Mali, were randomized in a 1:1 ratio and starting in December 2006, IPTi with SP was implemented in 11 health sub-districts (intervention zone), while the other 11 health sub-districts served as the control (non-intervention zone). Blood smears and blood dots on filter paper were obtained from children aged 0-5 years, randomly selected in each of heath sub-districts during two cross-sectional surveys. The first survey was conducted in May 2007 before the start of the transmission season to collect baseline prevalence of the molecular markers of resistance to SP and the second in December 2007 after the end of the transmission season and one year after implementation of IPTi. A total of 427 and 923 randomly selected blood samples from the first and second surveys respectively were analysed by PCR for dhfr and dhps mutations. RESULTS: Each of the three dhfr mutations at codons 51, 59 and 108 was present in 35% and 57% of the samples during the two surveys with no significant differences between the two zones. Dhps mutations at codons 437 and 540 were present respectively in about 20% and 1% of the children during the two surveys in both zones at similar proportion. The prevalence of quadruple mutants (triple dhfr-mutants + dhps-437G) associated with in-vivo resistance to SP in Mali after one year implementation of IPTi was also similar between the two zones (11.6% versus 11.2%, p = 0.90) and to those obtained at baseline survey (10.3% versus 8.1%). CONCLUSION: This study shows no increase in the frequency of molecular markers of SP resistance in areas where IPTi with SP was implemented for one year.

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.

Revenue-raising potential for universal health coverage in Benin, Mali, Mozambique and Togo

Increasing overall fiscal space is important for the health sector due to the centrality of public financing to make progress towards universal health coverage. One strategy is to mobilize additional government revenues through new taxes or increased tax rates on goods and services. We illustrate how countries can assess the feasibility and quantitative potential of different revenue-raising mechanisms. We review and synthesize the processes and results from country assessments in Benin, Mali, Mozambique and Togo. The studies analysed new taxes or increased taxes on airplane tickets, phone calls, alcoholic drinks, tourism services, financial transactions, lottery tickets, vehicles and the extractive industries. Study teams in each country assessed the feasibility of new revenue-raising mechanisms using six qualitative criteria. The quantitative potential of these mechanisms was estimated by defining different scenarios and setting assumptions. Consultations with stakeholders at the start of the process served to select the revenue-raising mechanisms to study and later to discuss findings and options. Exploring feasibility was essential, as this helped rule out options that appeared promising from the quantitative assessment. Stakeholders rated stability and sustainability positive for most mechanisms, but political feasibility was a key issue throughout. The estimated additional revenues through new revenue-raising mechanisms ranged from 0.47­1.62% as a share of general government expenditure in the four countries. Overall, the revenue raised through these mechanisms was small. Countries are advised to consider multiple strategies to expand fiscal space for health