[Trachoma in the health district of Douentza, 10 years later the investigation in 1997]. / Le trachome dans le cercle de douentza, 10 ans apres l'enquete de 1997.

In Mali one of the options of the fight against blindness is to implement the "CHANCE" strategy. The antibiotherapy is one of the strategy which has always a question who should be treated by which process (mass treatment focused treatment) and when we should treat for both mass treatment or targeted treatment, that is why this study has been initiated to evaluate the level of active trachoma (TI/TI) and the trichiasis in the district of Douentza and undertake the appropriate actions to fight for its reduction. It was a cross sectional survey done in may 2005 following a methodology based on the random size described by WHO (world health Organization) in the evaluation of the health coverage. The study targets 1450 ten years old children, less than 1564 of fifteen years old children and respectively for the estimation of the trachoma prevalence and trichiasis. The families chiefs have been asked or interviewed for the risk factor and the happening of trachoma, mothers were interviewed about their attitude and practices in hygiene. The active trachoma prevalence rate among children is estimated at 13.2 ± 2.7% in the district. Kids from 0 to 4 are more affected than those from 5 to 10 years old with p < 0.001. The trichiasis rate is 0.6% The pumps (30.3%), the communicative wells (23.8%) the traditional wells not maintained (19.4%), and the maintained wells (15.7%), faucets (9.7%) are the essential sources of water which is not sufficient. The presence of animals in 40.40 to 76.1% families, the low percentage of families with latrines (toilets) 41.40%, the presence of waste water and garbage in 25.3% families, 42.9% outside the families or 31.8% anywhere were observed during the study. Based on all these results, the antibiotic mass treatment to reduce the active trachoma is a necessity; this mass treatment combined with an efficient IEC to improve body and environmental hygiene will have an impact on the trachoma in the district of Douentza.

[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.

[Geographic distribution and epidemiology of urinary schistosomiasis in Mali: implications for a control program]. / La diversité écoclimatique et l'épidémiologie des schistosomiases au Mali: implications pour un programme de contrôle.

A national survey was conducted in Mali between 1986 and 1990 to determine the geographical distribution of urinary schistosomiasis in order to define an ecologically based national schistosomiasis control programme. Fifty six thousand two hundreds and sixty five individuals randomly selected from 323 villages in the nine ecologically defined areas of the whole country were submitted to urine examination using Filtration Technique. In villages along the Niger and Senegal rivers, in the Dogon Plateau and Office du Niger areas, the prevalence of Schistosoma haematobium infection was the highest, respectively 41.8%, 53.1%, 59.4% et 62.9%. In these areas, more 70% of children aged 7 to 14 years were infected. In the Soudanian and North-Soudanian areas, the prevalence were below 10% and respectively only 5.3% and 11.5% of children aged 7 to 14 years were infected. It is concluded that Schistosoma haematobium infection is of public health importance in dam and irrigation areas and in areas along the Niger and Senegal rivers namely in Kayes, Koulikoro, Segou, Mopti regions and in Bamako district. These areas should be considered as priority areas for active control interventions. The interventions should include community-based mass chemotherapy with praziquantel after community diagnostic using urine examination in school aged children and a good monitoring system.

[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.

[Morbidity and mortality of infectious diseases determined mass vaccination in children under 5 ans in Bamako District]. / Morbidite et mortalite liees aux maladies cibles du programme elargi de vaccination chez les enfants de moins de cinq ans dans le District de Bamako.

Available facts on morbidity and mortality due to PEV diseases for children under 5 years come from routine facts in Bamako District. The Present study through population investigation proposed to evaluate indicators. It was about a transversal investigation realised about 1014 children less than 5 year living in Bamako (on October 2000). The selection of children has been made by boring after stratification of the district based on socio-economic level and stabilization of population of different sectors. According to study, the global incidence rate of target patients of PEV is about 4.93% +- 1.33%. These rate were about 4.14% +- 1.22% for measles which is the 1st cause of morbidity among target patients of PEV, 0.69% +- 0.50% for whooping cough, 0.903% +- 0.19 for poliomyelitis and 0% for neo natal tetanus. For tuberculosis of which evolution have been appreciated trough counting of antituberculosis clinic register (DAT) during 10 years (1990-1999), its tendency was increasing. The death rate registered during investigation was related to measles with an estimated rate of 4.93% +- 4.31%. Results analysis, global incidence of PEV target patients was in decrease at Bamako district. At vaccinated patients against measles (64.3%) and whooping cough (57.14%) is in favour for an investigation about effective vaccinal.

Prevalence of antibodies against respiratory viruses in children of Koulikoro (Mali).

The prevalence of antibodies to viruses associated with respiratory illnesses (influenza, corona, R.S., adeno, parainfluenza Mycoplasma pneumoniae) has been investigated in 119 children under 3 years of age (Koulikoro region Mali) and 50 persons 15-19 years of age (Bamako/Mali). In the surveillance period (March 1982-September 1982) an outbreak of respiratory disease in association with RS virus took place. A rise of CF titer has been found in 90.8% of the children; 59.1% of them presented a fourfold or greater increase of titer. The GMT values rose from 1:7 to 1:48. Concerning influenza viruses a higher incidence of positive reactions has been observed only for H3N2 viruses. A fourfold CF rise of titer has been observed for adenovirus and mycoplasma pneumoniae in 3 cases each, for parainfluenza type I and III in 2 cases each, and for parainfluenza II in 1 case. In persons 15-19 years of age the incidence of positive CF reactions was relatively high (68%-98%), but the GMT values were moderate (1:12-1:25). These data confirm that the frequency of viral respiratory diseases is the same in tropical countries as in countries with a temperate climate.

[Serum conversion rate following oral poliomyelitis immunization in Mali, Africa 1982]. / Serokonversionsrate nach Polioschluckimpfung in Mali/Afrika 1982.

118 infants under 3 years of age were thrice orally immunised against poliomyelitis at 2 months interval. Before the vaccination 26% were triple negative and 24% triple positive. 44% had neutralising polio antibodies type 1, 53% type 2 and 52% type 3. At the end of the vaccinations 59% of the vaccinees were triple positive and only 3.4% triple negative. 82% had polio antibodies type 1, 85% antibodies type 2 and 76% antibodies type 3. At the start of the trial 54% of the vaccinees excreted enteroviruses. Only in 12% young infants had enterovirus in anal swabs and seroconverted well. In view of the prevalence of paralytic poliomyelitis in tiny babies an early oral polio immunisation in the tropics is highly recommended.

[Naturally acquired tetanus antitoxin in the serum of children and adults in Mali]. / Uber natürlich erworbene Tetanusantitoxine im Serum von Kindern und Erwachsenen in Mali.

Among 48 adults without a history of tetanus immunization, we found with the aid of indirect hemagglutination test 20 individuals with protective tetanus antibody titers, 23 with low levels of antitoxin (under 0,1 I.U./ml) and 5 devoid of tetanus antitoxin. In two blood samples of 99 unvaccinated children under 3 years of age (taken at 7 months intervall) 12,1% showed tetanus antitoxin in the first serum sample and 16,2% in the second sample. Protective antibody titers could be found only in 4 children in each of the first and second serum sample. The data suggest a silent oral immunization by tetanus bacilli thus boosting under unhygienic conditions the tetanus immunity with advancing age.

[Cerebrospinal meningitis in Bamako from 1969 to 1978 strategic modifications]. / Méningite cérébro-spinale à bamako de 1969 a 1978, modifications stratégiques.

The observation of cerebrospinal meningitidis at Bamako from 1969 to 1978 show that the incidence of morbidity and the lethality of meningitidis are raised specially. Because there epidemiologic factors, the reflection beared on the measures of wrestling antimicrobial and vaccinal prepossession to propose for control this situation.

[A focus of human and animal anthrax in the area surrounding Kati (Republic of Mali)]. / Un foyer de charbon human et animal dans le cercle de Kati (République du Mali).

Followed of one human and animal anthrax in the circle of Kati (Republic of Mali), 1978. This localized affection interested 84 men and 38 domesticated animals. The preventive dispositions of infection and damming in of transmission are considered.