Evaluation de la séroprévalence des hépatites virales B et C chez les donneurs de sang en milieu urbain dans un hôpital régional au Mali : cas de l'hôpital régional Fousseyni Daou de Kayes

Introduction : La recherche d'agents infectieux transmissibles notamment des virus des hépatites virales B et C chez les donneurs de sang permet de prévenir ces infections chez les receveurs de sang. Le but de cette étude était de déterminer la séroprévalence des virus des hépatites virales B et C chez les donneurs de sang à l'hôpital régional de Kayes et contribuer à la sécurité transfusionnelle.Matériels et méthodes : Il s'agit d'une étude rétrospective et transversale portant sur les donneurs de sang à l'hôpital régional Fousseyni Daou de Kayes, menée du 1er janvier 2011 au 31 décembre 2015. Les données ont été recueillies à partir des registres de don de sang comportant les renseignements pour chaque donneur à savoir l'âge, le sexe, la catégorie du donneur, le résultat de la sérologie des virus des hépatites virales B et C. Les donneurs chez qui ces renseignements n'étaient pas disponibles ont été exclus de l'étude. La recherche d'agents infectieux et le groupage sanguin dans les systèmes ABO et RH (Rhésus) était toujours réalisée au préalable avant le don de sang chez les donneurs familiaux ou occasionnels. Les données ont été traitées au moyen du logiciel Epi info version 6.Résultats : La grande majorité des donneurs étaient des hommes (84%) avec un sex-ratio de 5,2. La tranche d'âge la plus représentée était de 26-35 ans (36%). Il s'agissait d'un don de sang familial ou compensatoire dans 95,6% des cas et d'un don volontaire par des donneurs réguliers ou nouveaux dans 4,4% des cas. La séroprévalence de l'Ag HBs était de 13,1% et celle de l'Ac anti VHC était de 1,4%. Par ailleurs, la séroprévalence de l'Ag HBs et de l'Ac anti VHC était respectivement de 0,13% et de 0,02% chez les donneurs de sang ayant un antécédent transfusionnel.Conclusion : La séroprévalence de l'Ag HBs reste élevée chez les donneurs de sang à Kayes d'une manière générale selon notre étude. Les campagnes de sensibilisation pour la promotion du don volontaire de sang s'imposent pour constituer un stock de sang conséquent pour couvrir les besoins transfusionnels de l'hôpital régional de Kayes

[Using routine information system data to assess maternal and perinatal care services in Mali and Senegal (QUARITE trial)]. / Utilisation des données recueillies en routine pour évaluer l'activité des maternités au Mali et au Sénégal (essai QUARITE).

BACKGROUND: In sub-Saharan Africa, problems of access to relevant and high-quality facility-based statistics hinder the assessment of safe motherhood programs. The objective of this study was to assess the quality of data collected in referral hospitals in Mali and Senegal after the routine information system (RIS) was strengthened. METHODS: This was a multicenter observational study conducted during the pre-intervention period of a randomized controlled trial (trial QUARITE). The RIS was strengthened based on technical, organizational and behavioral factors. We included all women who gave birth in the 46 referral hospitals from October 1, 2007 to October 30, 2008. The completeness, completion and accuracy rates were monitored every 3 months in each hospital. The cost of investment needed to strengthen the existing RIS was also determined. RESULTS: The mean completeness rate ranged from 94 to 97% depending on the study period. The completion and accuracy rates increased during the study period from 72% and 79% to 87% and 93%, respectively (significant differences). The average investment per hospital was less than 1% of state subsidies for public hospitals. CONCLUSION: Strengthening the existing information system has set up an economically and technologically appropriate system for monitoring maternal and perinatal health in Senegal and Mali. We encourage policy makers and researchers from countries with limited resources to invest in RIS to improve and monitor the performance of health systems.

[Prevalence and risk factors of hepatitis C virus infection in chronic hemodialysis patients at the University Hospital of Point G, Bamako, Mali]. / Prevalence et facteurs associes au portage du virus de l'hepatite virale C chez les hemodialyses chroniques au CHU du Point G, Bamako, Mali.

The objective of this prospective study conducted in November 2008, was to determine the prevalence and the factors associated with Hepatitis C Virus (HCV) infection in chronic hemodialysis patients. The study was carried out in the hemodialysis unit of the university teaching hospital of Point G. Serum samples were tested for anti-HCV antibody, anti-HIV antibody and HBs Ag using enzyme immunoassay methods (ELISA) at the laboratory of immunology of the National Blood Transfusion Service of Bamako. The following parameters were assessed: initial nephropathy, duration of the dialysis, history of blood transfusion, number of blood units transfused since the beginning of the dialysis, history of nosocomial exposure. A total of 66 patients were enrolled. The mean age of the patients was 42,27±14, 8 years, with a male to female sex-ratio of 1,44. Anti-HCV antibodies were found in 13 chronic hemodialysis patients, leading to a prevalence of 19,7%. A significant association was found between the bearing of HCV and the duration of the dialysis. These results indicate that hepatitis C is frequent in the chronic hemodialysis patients of the university teaching hospital of Point G, and that the duration of dialysis constitutes the main factor associated with the contamination by the HCV.

Prévalence et facteurs associés au portage du virus de l'hépatite virale C chez les hémodialyses chroniques au CHU du Point G. Bamako, Mali

L'objectif de cette étude prospective conduite en novembre 2008, était de déterminer la prévalence et les facteurs associés au portage du virus de l'hépatite virale C (VHC) chez les hémodialysés chroniques fréquentant l'unité d'hémodialyse du CHU du Point G. La recherche de l'anticorps anti-VHC, de l'AgHBs et de l'anticorps anti-VIH a été effectuée par la méthode immuno-enzymatique (ELISA) aulaboratoire d'immunologie du Centre National de Transfusion Sanguine de Bamako. Les paramètres suivants ont été déterminés chez tous les patients: la néphropathie initiale, l'ancienneté de l'hémodialyse, les antécédents de transfusion sanguine, le nombre d'unités de sang transfusées depuis le début de la dialyse, les antécédents d'exposition nosocomiale. Au total, 66 patients ont été enrôlés. L'âge moyen des malades était de 42,27±14, 8 ans, et on notait une prédominance masculine avec un sexe ratio de 1,44. La recherche d'Ac anti-VHC s'est révélée positive chez 13 hémodialysés chroniques soit une prévalence de 19,7 %. Une association statistiquement significative a été trouvée entre le portage du VHC et l'ancienneté de l'hémodialyse. Ces résultats indiquent que l'hépatite C est fréquente chez les hémodialysés chroniques du CHU du Point G et que l'ancienneté de la dialyse constitue le principal facteur associé à la contamination par le VHC

A qualitative study of clandestine contraceptive use in urban Mali.

This prospective study uses qualitative methods to examine the social and economic impact of family planning on women's lives in the district of Bamako, Mali. Fifty-five first-time users of contraceptives were interviewed in October 1996. Of particular interest is the high proportion (17/55) of those who had hidden their use of a birth-control method from their husbands. Substantial collusion is found to have occurred between sisters-in-law in assisting each other to gain and hide methods of family planning and to keep their use secret from their spouses and older marital relatives. The main reason for discontinuation among the clandestine users was menstrual disruption, which they feared would make their husbands aware of their contraceptive use. By the end of the study, women were aware that their use of contraceptives had increased their mobility and available time, enabling them to enhance the quantity and efficiency of their work activities. Contraception, therefore, appears to be a valuable resource, permitting women to improve their economic and social status. In settings where clandestine use is prevalent, at least in the short term involving men in family planning programs may not always be beneficial, nor may considering the couple as the unit of intervention and analysis always be appropriate. In the long term, however, the underlying causes of men's objections to contraceptive use need to be addressed so as to facilitate communication and joint decisionmaking about family planning.

PIP: This study examines the social and economic impact of family planning on women's lives in the district of Bamako, Mali, Africa. Longitudinal data collected by interview in October 1996 from 55 first-time users of clandestine contraceptives were used in this study. Of particular interest is the high proportion (17/55) of those who had hidden their use of a birth-control method from their husbands. After collecting all the data, it was found out that substantial collusion have occurred between sister-in-law in assisting each other to gain and hide methods of family planning and to keep their use secret from their spouses and older marital relatives. Evidences also suggest that clandestine users have higher rates of discontinuation than overt users. This discontinuation is often associated with the menstrual disruption, which they feared would make their husbands aware of their contraceptive use. At the end of the study, women were aware that their use of contraceptives had increased their mobility and available time, enabling them to enhance the quality and efficiency of their work activities. Therefore, contraception appears to be a valuable resource, permitting women to improve their economic and social status.

[Contraception and protection against STDs. CERPOD measures use of the Protector condom in Mali]. / Contraception et protection contre les MST. Le CERPOD mesure l'utilisation du condom Protector au Mali.

PIP: In April 1993, a technical assistance contract to measure general condom use, particularly use of the brand name Protector, which has been marketed in Mali since March 1992, was made between the Center of Studies and Research on Population for Development (CERPOD) and the Popular Pharmacy of Mali. In June-July 1991, the SOMARC project and the Malian Institute for Applied Research in Development conducted a baseline survey to determine the condom use rate in Mali before Protector was introduced on the Malian market, so the social marketing project for contraception could be evaluated. It examined knowledge, use, and achievable target level and determined the characteristics of users of the Protector condom. It revealed that more than 90% of both men and women believed birth spacing was a good idea. Men approved of birth spacing for cost-saving reasons, while women approved birth spacing because it allowed mothers time to recuperate between births. Another earlier study in 1987 in Bamako found that 78% of the women already favored birth spacing. 90% of the men in the main cities in Mali knew about condoms. 63% of these men had used them in the past, mainly to prevent sexually transmitted diseases. 30% used them consistently. One hoped that this number was going to grow, since 80% of the men said that they would use condoms in the future. The evaluation of the 1991 social marketing campaign will end in August 1993 and will measure whether it was successful or not. In November 1992, CERPOD followed the framework of a recent baseline survey for an IEC (information, education, and communication) family planning program, operated jointly by the Malian Association for the Protection and Promotion of the Family and Population Communication Services, to measure the effect of the brand name Protector. CERPOD's survey results will be compared with those of the 1993 survey.^ieng

[A case study of the interrelations among population, health and development. PSD-Mali]. / Une etude de cas d'interrelations entre population, sante et developpement. Le PSD-Mali.

PIP: The population, health, and development project in Mali (PSD-M) hypothesized that the construction of the Selingue dam would probably improve the income of the populations, cause socio-cultural changes, and degrade the environment. The prevalence of urinary schistosomiasis decreased after construction while the prevalence of intestinal schistosomiasis increased. The prevalence of onchocerciasis fell from 3.6% to 0.2% during 1980-1983. PSD-Mali could not adequately follow up on other parasitic diseases. Information on consumption of fish by the fishermen themselves was unavailable. PSD-Mali did learn, however, that fishing for self-consumption was very much lower than commercial fishing. Fish sales comprised the greatest source of income, so fishing contributed somewhat to improvement of living conditions. Fishing has become a microindustry for the indigenous women, practiced with rudimentary means, with the creation of the artificial lake. The Office for Exploitation of Resources of the Upper Niger lends itself to fishing activities which encourages migration of ethnic fishermen to the Selingue zone. Income-related data were not better available after the dam than before, except for some data related to commercialization of fresh fish. Environmental degradation continues as predicted by PSD-M, which is contradictory to rural practices in the zone. In the past, land was left fallow for several years. 1350 hectares downstream from the dam, 68.7% of which is favorable for growing rice, is not irrigable. Construction of access roads as well as the opening of new tracks allowed deforestation, but the selling of wood for heating, of charcoal, and of bamboo has resulted in a comfortable income. These findings show that there is still need for evaluation of different aspects of life of the population concerned.^ieng

[Adolescent pregnancy. Biological crisis and moral and sociocultural phenomenon]. / La grossesse de l'adolescente. Crise biologique et phenomene moral et socio-culturel.

PIP: In sub-Saharan African, biological adolescence corresponds to a social marriage age. In Burundi, Ghana, Mali, and Senegal, respectively, 5.9%, 17%, 72%, and 42% of women aged 15-19 are married or in a union. Early marriage produced early pregnancy. The valorization of procreation pushes women to prove their fertility as soon as they marry. One adolescent pregnancy in marriage does not translate into immaturity or irresponsible accidental pregnancy. Some specialists exaggerate that adolescent fertility poses a biological catastrophe for the young woman and her infant. Yet, others say that the principal cause of complications related to adolescent pregnancy are a result of inadequate prenatal and obstetric care. Since there are few health facilities and medical personnel in sub-Saharan Africa to provide adequate prenatal and obstetric care, adolescent pregnancy is a major source of problems. Changes in African societies are the reason for the decline in social taboos traditionally regulating fertility. The new understanding of social operation affect the management of fertility, especially in urban areas. Rural areas, which still predominate in sub-Saharan Africa, appear to be much less affected. Early maturity, quasi-universality of marriage, and the notion of marriage being sacred in rural areas remain power regulating elements. Rural adolescents often seasonally migrate to urban centers. Since pregnant adolescents first perceive that society will judge them, they have a poor acceptance of their pregnancy. They experience psycho-tragedies that accompany this perception, especially when the unplanned pregnancy occurs outside of marriage. If society would not disapprove of contraceptive use, contraception would help circumscribe the negative fall-outs of sexuality without real preliminary knowledge. In Mali, only 12% of all women knew when the fertile period of the cycle is. 51% had no knowledge at all. Recognition of the importance of adolescent fertility is a step towards a well-wished balance between population and non-renewable resources.^ieng