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PubMed1992

Circadian rhythm of photosensitivity and the adaptation of reproductive function to the environment in two populations of Arvicanthis niloticus from Mali and Burkina Faso.

Previous studies have shown that there is a circadian rhythm of photosensitivity in different rodent species of the Sahel (Burkina Faso) and that, despite the low amplitude of seasonal variations in daylength, the photoperiod may control reproductive function. The present investigation of Arvicanthis niloticus provides additional support for this hypothesis. Populations of Arvicanthis niloticus from two regions at the same latitude 1000 km apart but with different climates were studied. Oursi, Burkina Faso, has an arid climate (annual rainfall 315 mm) and Kamalé, Mali has a wetter climate (annual rainfall 1114 mm). The circadian rhythm of photosensitivity had the same features in both populations, involving inhibition of testicular activity, but the photosensitive phase began 11 h 30 min after dawn in the population from Burkina Faso and 45 min later in that from Mali. Comparison of these results with the annual variation of daylength showed that the photoperiod inhibits the reproductive activity of A. niloticus from April to December in Burkina Faso and only from mid-May to mid-August in Mali. The population of Arvicanthis niloticus living in an environment with a large and seasonally stable food supply (Mali) thus has a longer reproductive period. This corroborates results from field studies on annual variations of population density.

Adaptation, Physiological↗
PubMed2002

Growth and development of adolescent girls from the Segou Region of Mali (West Africa).

In Mali, adolescent girls face many physical stresses which, with a history of poor nutrition, can result in delayed growth and development. Despite the fact that adolescent girls encounter nutritional demands, most research in Mali has focused only on young children. This study examines anthropometric and reproductive data on 1,056 adolescent girls (aged 10-17 years) from the Segou Region of Mali. When compared to the reference population, the Malian girls exhibited poorer indicators of growth and development. Z-scores for height-for-age and weight-for-age were below 0 at all ages. Urban girls had better indicators of growth than rural girls. The body composition data show that the Malian girls have lower body fat than reference girls. Menarche was delayed by about 1.5 years compared to girls from the United States and Europe. Delayed growth and development may be due to many factors, including a history of undernutrition, poor socioeconomic status, and increased energy demands.

Adolescent↗
PubMed2006

Ethnopharmacological survey of plants used for the treatment of schistosomiasis in Niono District, Mali.

In Mali the use of traditional medicine is a wide spread phenomenon, not only because of its cultural importance, but also as the majority of people cannot afford the western drugs or medicines. In Mali, the Office du Niger area constitutes the main zone of schistosomiasis transmission where both Schistosoma mansoni and Schistosoma haematobium are encountered. An ethnopharmacological survey, using questionnaire, was conducted in the Office du Niger area of the Niono District to determine the plants used against schistosomiasis amongst traditional healers. Forty healers from 21 villages of six different health areas were interviewed. All interviewed healers knew about urinary schistosomiasis, while only six knew about the intestinal form. The presence of blood in urine was reported as the main symptom of urinary schistosomiasis. Fifty-five plants belonging to 30 families were reported to be used alone for treating urinary and intestinal schistosomiasis, while nine combinations of plants were used against the urinary form of the disease. Cissus quadrangularis and Stylosanthes erecta were the plants most frequently used and were reported for the first time, to be used against schistosomiasis in Mali.

Humans↗
PubMed2003

The pyrethroid knock-down resistance gene in the Anopheles gambiae complex in Mali and further indication of incipient speciation within An. gambiae s.s.

In Mali the Anopheles gambiae complex consists of An. arabiensis and Mopti, Savanna and Bamako chromosomal forms of An. gambiae s.s. Previous chromosomal data suggests a complete reproductive isolation among these forms. Sequence analysis of rDNA regions led to the characterization of two molecular forms of An. gambiae, named M-form and S-form, which in Mali correspond to Mopti and to Savanna/Bamako, respectively, while it has failed so far to show any molecular difference between Savanna and Bamako. The population structure of An. gambiae s.l. was analysed in three villages in the Bamako and Sikasso areas of Mali and the frequency of pyrethroid resistance of the knock-down resistance (kdr) type was calculated. The results show that the kdr allele is associated only with the Savanna form populations and absent in sympatric and synchronous populations of Bamako, Mopti and An. arabiensis. This is the first molecular indication of barriers to gene flow between the Bamako and Savanna chromosomal forms. Moreover, analyses of specimens collected in the Bamako area in 1987 show that the kdr allele was already present in the Savanna population at that time, and that the frequency of this allele has gradually increased since then.

Animals↗
PubMed1998

Epidemiologic aspects of scabies in Mali, Malawi, and Cambodia.

BACKGROUND: The prevalence rates of scabies are compared in Bamako, Mali, Karonga District, Malawi, and Battambang Province, Cambodia. METHODS: In Mali, children attending three different urban schools catering for different socio-economic levels were examined specifically for scabies. In Malawi, data were collected during a total population survey for leprosy. In Cambodia, a sample survey was carried out in a rural area to determine the prevalence of leprosy and other skin diseases. RESULTS: In Mali, the prevalence rate of scabies among all the children examined was 4% (44/1103), but only 1.8% (7/388) in the higher socio-economic group. In Malawi, the overall prevalence rate of scabies was 0.7% (408/61,735). The highest rate (1.1%) was found among children 0-9 years of age. In Cambodia, the overall prevalence in the 13 villages screened was 4.3% (645/14,843). The highest rate (6.5%) was found among children 0-9 years of age. CONCLUSIONS: Scabies was most prevalent among children in Cambodia and Malawi, but there were considerable differences in the overall rates between the two areas studied. The data from all three countries indicate that poor socio-economic conditions, in particular crowding and public water supplies, are risk factors for scabies.

Adult↗
PubMed2000

Traditional couching is not an effective alternative procedure for cataract surgery in Mali.

INTRODUCTION: In Mali, more cataract patients receive sight-restoring surgery using a traditional "couching" procedure (the lens inside the vitreous body) than by modern cataract surgery. In order to evaluate the relative effectiveness and other outcomes of the traditional procedure compared to the modern surgical intervention, we conducted a population-based survey in a rural district of Mali in 1996. METHOD: A total of 99,800 persons from 160 villages were eligible to be included in the sample. All individuals operated for cataract by a modern procedure were checked for visual acuity and questioned regarding their clinical history, the cost of the surgery and their satisfaction with the surgery immediately following the operation and presently. Each patient was paired with one person operated by a traditional cataract surgical procedure. RESULTS: From a total population of 99,800 we found 85 individuals (0.085%) who had been operated by intracapsular extraction (ICCE) without lens implantation and we paired these with 82 individuals operated by the traditional method and by a local healer. In both groups, males were predominant (74.4% in the modern group and 61.3% in the traditional) and the median age was 65 and 68 years, respectively. Men with a higher social status (defined as administrative or religious authority) were slightly more common among those operated by ICCE (18.9%) than among those operated by the traditional healer (4.4%). Nearly half (47.6%) of the patients operated by couching did not know that a modern alternative existed. The mean cost to the patient of the two procedures was similar; with traditional couching costing on average US$ 42.10 and modern surgery (including transport and drugs) costing US$ 52.40. The traditional healer was often paid partially in kind and the price paid varied according to the patient's ability to pay. The clinical results differed greatly between the two methods. After aphakic correction of eyes operated by ICCE, 5.3% had good vision (33/18), 76.8% had low vision (33/60 and <3/18) and 17.9% were still blind (<3/60). Of eyes operated by traditional couching, none had good vision, 29.1% had low vision and 70.9% were blind. The level of satisfaction was high (89.7%) among persons operated in an ophthalmic center by the modern method, and relatively low (22.6%) among persons operated traditionally. DISCUSSION: In Mali, two types of providers offer two different interventions to treat cataract-blind persons. This study suggests that the couching method used by traditional healers is relatively expensive and ineffective. It is also potentially dangerous although this study did not address this question specifically. It is important that health policy makers and medical authorities do what they can to prevent traditional healers from performing the couching procedure, as well as informing the population about the existence of a more-effective and safer alternative. However, while more effective and safer, the results obtained by ICCE are not excellent either. Further, it is important to improve the quality of ophthalmic services in order to provide cataract patients with the best, most accessible and least expensive services possible.

Aged↗
PubMed2002

From visual function deficiency to handicap: measuring visual handicap in Mali.

BACKGROUND/AIMS: Blindness is a major public health problem in developing countries, even though most could be prevented by relatively simple hygienic and medical interventions. Relatively few patients use the quality health care services available, despite their low cost, due to problems of access or socio-cultural barriers. This health services research project stressed the need for measurement of subjective self-perceived health. The objectives of this study were twofold: a) To translate, adapt and integrate the cultural context found in Mali and validate two instruments for measuring, respectively, perceived vision and quality of life. b) To study the relationship between these variables and visual deficiencies by gender. METHODS: The perceived vision and quality of life questionnaires were based on a translation of the Aravind questionnaire, adapted to Mali. The resulting perceived vision questionnaire comprises 13 questions, grouped according to five subscales (global vision, visual perception, sensory adaptation, visual field and depth perception). Furthermore, the 13 questions on quality of life were grouped into four subscales (personal care, mobility, social life and psychological). For both questionnaires, a global score could be computed. These two questionnaires were administered to a representative sample of 203 subjects with impaired vision, aged over 40, in a rural area in Mali. RESULTS: The acceptability of the questionnaires was good (1% missing data). The convergent validity was adequate for all but one subscale (psychological). The discriminate validity is acceptable for three of the six subscales where measurement can be made (visual perception, personal care, mobility). The Cronbach alpha coefficients indicate good reliability for the global scores. CONCLUSIONS: Analysis of mean results confirms the validity of the International Classification of Disease (ICD) definition of blindness (seeing less than 0.05 results in a steep decrease in quality of life). Moreover, blindness affects the quality of life of women more severely than that of men; this may be related to the availability of social support.

Adult↗
PubMed2005

Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali.

BACKGROUND: In Mali, an estimated 73% of pregnant women are anaemic largely due to iron deficiency. National policy recommends women to take iron and folic acid supplements daily from first prenatal contact until 3 months postpartum. However, many pregnant women in Mali could benefit from multiple micronutrient supplements. OBJECTIVE: To assess pregnant women's acceptability of and adherence to a daily multiple micronutrient supplementation scheme compared with the current daily iron and folic acid supplementation scheme. DESIGN: Seventy pregnant women were allocated to either the daily multiple micronutrient or daily iron and folic acid supplementation scheme. Women started receiving supplements at the end of the first trimester of pregnancy until delivery and throughout the first 3 months postpartum. RESULTS: No significant differences were observed between comparison groups with respect to women's perceptions about supplement size, colour, taste or flavour. Adherence to the multiple micronutrient supplementation scheme was better (257.5+/-20.9 tablets; average adherence 95.4%) than that to the iron and folic acid supplementation scheme (238.5+/-32.7 tablets; average adherence 92.2%; P=0.008) although both were very good, as were women's perceptions about the benefits of micronutrient supplements to their health and that of their newborns. CONCLUSION: Malian women adhere to prenatal/postpartum micronutrient supplementation - no matter what supplement is chosen - when access to supplements is guaranteed and when they are provided with minimum, consistent and easily understandable information and counselling, indicating that these are key elements to ensure effective programmes. These findings, together with those of the global research agenda on the efficacy of multiple micronutrient supplements for pregnant women, will inform policy development in Mali for the effective control of iron deficiency and iron-deficiency anaemia in pregnant women.

Adolescent↗
PubMed2004

Spatial patterns of infant mortality in Mali: the effect of malaria endemicity.

A spatial analysis was carried out to identify factors related to geographic differences in infant mortality risk in Mali by linking data from two spatially structured databases: the Demographic and Health Surveys of 1995-1996 and the Mapping Malaria Risk in Africa database for Mali. Socioeconomic factors measured directly at the individual level and site-specific malaria prevalence predicted for the Demographic and Health Surveys' locations by a spatial model fitted to the Mapping Malaria Risk in Africa database were examined as possible risk factors. The analysis was carried out by fitting a Bayesian hierarchical geostatistical logistic model to infant mortality risk, by Markov chain Monte Carlo simulation. It confirmed that mother's education, birth order and interval, infant's sex, residence, and mother's age at infant's birth had a strong impact on infant mortality risk in Mali. The residual spatial pattern of infant mortality showed a clear relation to well-known foci of malaria transmission, especially the inland delta of the Niger River. No effect of estimated parasite prevalence could be demonstrated. Possible explanations include confounding by unmeasured covariates and sparsity of the source malaria data. Spatial statistical models of malaria prevalence are useful for indicating approximate levels of endemicity over wide areas and, hence, for guiding intervention strategies. However, at points very remote from those sampled, it is important to consider prediction error.

Adult↗
PubMed2002

Risk factors for trachoma in Mali.

OBJECTIVES: Prior to commencing a campaign to eliminate blinding trachoma in Mali, a national disease prevalence survey was conducted from March 1996 to June 1997. The prevalence of trachoma was estimated and potential risk factors were studied. METHODS: In each of Mali's seven regions (excluding the capital Bamako), a sample of 30 clusters was taken from the general population, in accordance with the principle of probability proportional to the size of the community. All children under 10 years of age were examined. The simplified clinical coding system proposed by the World Health Organization was used. The position of each village was established and subsequently related to the nearest meteorological station. Socioeconomic and environmental information was collected at both village and household level. The mother or caretaker of each child was questioned about availability and use of water for washing the child. At the time of examination, facial cleanliness and the presence of flies on the face were noted. RESULTS: A total of 15,187 children under 10 years of age were examined. The prevalence of active trachoma (follicular [TF] or intense trachoma [TI]) was 34.9% (95% CI : 32.3-37.6) and the prevalence of TI was 4.2% (95% CI : 3.5-5.0). Aridity/environmental dryness appears to be a risk factor influencing the current geographical distribution of trachoma. Small villages had considerably higher trachoma prevalence than their larger neighbours. The proximity of a medical centre and the existence of social organizations such as a women's association were associated with lower levels of trachoma. Crowded living conditions increased the risk. Using a monetary marker of wealth, we observed a linear inverse relation between wealth and trachoma prevalence. The presence of a dirty face was strongly associated with trachoma (odds ratio [OR] = 3.67) as was the presence of flies on the child's face (OR = 3.62). Trachoma prevalence increased with distance to a water source. Disease prevalence decreased with a higher frequency of both face washing and bathing. CONCLUSIONS: Of all the risk factors examined, facial cleanliness had the strongest association with the prevalence of trachoma. This was followed by the presence of flies on the child's face. Both face washing and bathing showed beneficial effects. Socioeconomic factors such as wealth were significantly explanatory. It is likely that hygiene education and fly control by environmental improvement could have a very significant impact on the prevalence of trachoma in Mali.

Baths↗
PubMed1998

Midgut bacteria in Anopheles gambiae and An. funestus (Diptera: Culicidae) from Kenya and Mali.

Field studies in Kenya and Mali investigated the prevalence of bacteria in the midguts of malaria vectors, and the potential relationship between gram-negative bacteria species and Plasmodium falciparum sporozoites. Midguts were dissected from 2,430 mosquitoes: 863 Anopheles funestus Giles and 1,037 An. gambiae s.l. Giles from Kenya, and 530 An. gambiae s.l. from Mali. An. funestus had a higher prevalence of gram-negative bacteria (28.5%) compared with An. gambiae collected in Kenya and Mali (15.4 and 12.5%, respectively). Twenty different genera of bacteria were identified by gas chromatography from 73 bacterial isolates from mosquito midguts. Pantoea agglomerans (Enterobacter agglomerans) was the most common species identified. There was no association between gram-negative bacteria in the midgut and P. falciparum sporozoites in field-collected An. gambiae s.l. and An. funestus. However, An. funestus females that harbored gram positive bacteria were more likely to be infected with sporozoites compared with those with no cultivable bacteria or gram negative bacteria in their midguts. Habitat-related variation in the prevalence of diverse types of bacteria in mosquitoes could influence malaria parasite development in mosquitoes and corresponding sporozoite prevalence.

Animals↗
PubMed2005

Seroprevalence of Q-fever in febrile individuals in Mali.

OBJECTIVES: We conducted a serological survey for Q-fever among febrile patients in Bamako and Mopti (Mali) and investigated the main risk factors for seroconversion. METHODS: Blood samples from 156 febrile patients were collected in healthcare facilities of Bamako and Mopti and examined with the microimmunofluorescence test. RESULTS: Forty per cent (n = 63) were seropositive for Q-fever, 28% in Bamako and 51% in Mopti. A more recent infection was suspected in 9.5% (n = 6) of all seropositive patients. This is the first time that Q-fever seropositivity is reported in febrile individuals in Mali. The patients' symptoms and diagnoses spanned a wide range of conditions; none had been diagnosed with Q fever by their treating physician. No risk factors for seropositivity could be identified with the exception of the city of residence and none could be identified with a logistic regression model with 'city' taken as random effect. CONCLUSION: A high rate of seropositivity to C. burnetii was found among febrile urban patients in Mali but no risk factors for seropositivity could be identified in this study.

Adolescent↗
PubMed1999

Female genital cutting practices in Burkina Faso and Mali and their negative health outcomes.

Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.

Adolescent↗
PubMed2006

Determinants of anemia among pregnant women in Mali.

BACKGROUND: Anemia in pregnancy remains a major problem in nearly all developing and many industrialized countries. In Mali, the subpopulation prevalence and etiology of anemia during pregnancy are largely unknown. OBJECTIVE: To examine the prevalence and likely etiologies of anemia in pregnancy in a poor urban population in Bamako, Mali. METHODS: Pregnant women (n = 190) were selected randomly. Hemoglobin, serum iron, and total iron-binding capacity were measured; blood smears were examined for Plasmodium falciparum malaria; and single stool and urine samples were examined for Schistosoma haematobium and hookworm. Gynecologic examinations were performed and interviews conducted to qualitatively assess food consumption and other socioeconomic characteristics. Associations among mild, moderate, and severe anemia; iron and parasite status; erythrocyte sedimentation rates; and the presence of abnormal vaginal discharge were evaluated. Differences in hemoglobin and serum iron concentrations, total iron-binding capacity, and anemia were compared according to trimester of pregnancy and between infected and noninfected women. The relative and attributable risks of anemia were calculated, and adjusted odds ratios for anemia and low serum iron were estimated by multivariate logistic regression. RESULTS: Of the 131 women for whom complete data were available, 47% had hemoglobin concentrations below 110 g/L; 13% had serum iron concentrations below 12 micromol/L; none had transferrin saturation values below 16%; 11%, 23%, and 8% harbored P. falciparum, S. haematobium, and hookworm, respectively; and 82% had an abnormal vaginal discharge. Food restrictions were reported by 45% of the women. Abnormal vaginal discharge correlated significantly with anemia (Pearson chi2 = 62.4; p < .01). Univariate and multivariate analyses found that infections were strongly associated with and predictive of anemia. CONCLUSIONS: Our data suggest that infections and food accessibility contribute to the high rates of anemia during pregnancy in Mali.

Adolescent↗
PubMed2005

First biologic and genetic characterization of Toxoplasma gondii isolates from chickens from Africa (Democratic Republic of Congo, Mali, Burkina Faso, and Kenya).

The prevalence of Toxoplasma gondii in free-ranging chickens (Gallus domesticus) is a good indicator of the prevalence of T. gondii oocysts in the soil because chickens feed from the ground. In the present study, prevalence of T. gondii in chickens from Democratic Republic of Congo, Mali, Burkina Faso, and Kenya is reported. The prevalence of T. gondii antibodies in sera of 50 free-range chickens from Congo was 50% based on the modified agglutination test (MAT); antibody titers were 1:5 in 7, 1:10 in 7, 1:20 in 6, 1:40 in 1, and 1:160 or more in 4 chickens. Hearts, pectoral muscles, and brains of 11 chickens with titers of 1:20 or more were bioassayed individually in mice; T. gondii was isolated from 9, from the hearts of 9, brains of 3, and muscles of 3 chickens. Tissues of each of the 14 chickens with titers of 1:5 or 1:10 were pooled and bioassayed in mice; T. gondii was isolated from 1 chicken with a titer of 1:10. Tissues from the remaining 25 seronegative chickens were pooled and fed to 1 T. gondii-free cat. Feces of the cat were examined for oocysts, but none was seen. The results indicate that T. gondii localizes in the hearts more often than in other tissues of naturally infected chickens. Genotyping of these 10 isolates using the SAG2 locus indicated that 8 were isolates were type III, 1 was type II, and 1 was type I. Two isolates (1 type I and 1 type III) were virulent for mice. Toxoplasma gondii was isolated by mouse bioassay from a pool of brains and hearts of 5 of 48 chickens from Mali and 1 of 40 chickens from Burkina Faso; all 6 isolates were avirulent for mice. Genetically, 4 isolates were type III and 2 were type II. Sera were not available from chickens from Mali and Burkina Faso. Toxoplasma gondii antibodies (MAT 100 or more) were found in 4 of 30 chickens from Kenya, and T. gondii was isolated from the brain of 1 of 4 seropositive chickens; this strain was avirulent for mice and was type II. This is the first report on isolation and genotyping of T. gondii from any source from these 4 countries in Africa.

Agglutination Tests↗
PubMed2004

Foot and mouth disease in Mali: the current situation and proposed control strategies.

Two main reasons prompted the authors to write this paper. First, outbreaks of foot and mouth disease (FMD) have occurred repeatedly in Mali and neighbouring countries during the last decade. Secondly, there is a pressing need for control strategies, since the first molecular epidemiological studies of FMD virus in West Africa have demonstrated that FMD transmission across national boundaries is common in this region. The authors discuss the FMD outbreaks that occurred during the period of 1980 to 1996, which were reported to the Central Livestock Office in Mali by field veterinarians. The outbreaks in 1980 and 1982 were confined to the regions of Kayes and Gao, respectively. Between 1991 and 1992, outbreaks occurred in Segou, Sikasso and Bamako. In 1996, FMD outbreaks were reported in cattle populations throughout Mali, except in Kidal in the Sahara desert, where temperatures reach 45 degrees C. High mortality was reported in young animals, while morbidity approached 100% in adult cattle.

Animals↗
PubMed1997

Failure of mebendazole in treatment of human hookworm infections in the southern region of Mali.

Preliminary studies indicated that single-dose (500 mg) mebendazole gave disappointing results in the treatment of hookworm infections (Necator americanus) in Mali. A placebo-controlled, randomized trial conducted with the participation of 103 infected subjects (background hookworm prevalence > 50%) confirmed that mebendazole (Vermox) did not reduce parasite burdens significantly, as assessed through fecal egg counts. In contrast, a group of subjects treated with pyrantel (Combantrin) experienced a significant reduction in fecal worm egg counts (overall, both sexes combined showed a 75% reduction). Male subjects carried significantly more intense infections compared with females, but there was no gender difference in response to treatment. A standard egg hatch assay showed that N. americanus from our subjects in Mali was more resistant to benzimidazoles compared with a laboratory-maintained strain that had not been exposed to anthelmintics in more than 100 generations (50% effective dose = 0.12 and 0.07 microg/ml of thiabendazole, respectively), suggesting that, among other possibilities, the development of resistance to the benzimidazoles by N. americanus may have contributed to the drug failure. Whatever the underlying explanation, our results indicate that single-dose treatment with mebendazole is an ineffective treatment for hookworm infections and despite its relatively cheap cost and wide availability, mebendazole should not be considered a drug of choice in the mass treatment of hookworm infections in this region of Mali.

Adolescent↗
PubMed2002

Impact of preseason treatment on incidence of falciparum malaria and parasite density at a site for testing malaria vaccines in Bandiagara, Mali.

Treating malaria before immunizing has been standard in malaria vaccine field trials. To assess the impact of this practice on subsequent infection and disease incidence, we conducted a randomized cohort study in Bandiagara, Mali. Subjects received a treatment dose of sulfadoxine-pyrimethamine (SP) or no treatment at the beginning of the transmission season. Cumulative and age-specific incidence of clinical episodes was similar between the 2 groups, but SP treatment delayed the median time to first clinical episode from 38.5 to 68 days, and after this initial period of protection, disease incidence in the SP group quickly surpassed the incidence in the untreated group. Parasite densities during disease episodes were lower in the SP group. SP was chosen as the drug for initial parasite clearance for the following reasons: 1) it has been used in previous vaccine trials; 2) our studies have found it to have >99% efficacy in treating uncomplicated malaria in Mali compared to 85-90% efficacy for chloroquine in this area; 3) SP is the approved second-line antimalarial agent in Mali; and 4) its single-dose regimen ensures compliance when treatment is directly observed.

Adolescent↗