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PubMed1999

Genetic variability of blood and saliva antigens and serum proteins among subtribes of Mali from Andhra Pradesh, India.

The subtribes of Mali viz. Manzai Mali and Bod Mali of Andhra Pradesh, India, were screened for A1A2B0, Rhesus (CcDEe) and MN blood groups, ABH saliva secretion and plasma proteins, namely haptoglobin, transferrin, caeruloplasmin and albumin. The genetic differences between the two subtribes are marginal and not significant except for ABH saliva secretion and plasma haptoglobin. Our observations suggest that the isolation of these two subtribes cannot date long back.

ABO Blood-Group System↗
PubMed2000

[Acanthamoeba keratitis: search for a healthy carrier in Mali].

The first cases of Acanthamoeba keratitis in Africa were reported in 1990 at the Institute of African Tropical Ophthalmology (IOTA) in Bamako, Mali. From 1990 to 1995, a total of 22 cases of corneal ulcers involving Acanthamoeba sp. were diagnosed at the IOTA. To improve our understanding of the epidemiological characteristics of these lesions in tropical areas, we attempted to identify healthy carriers of Acanthamoeba sp. by studying the normal eye flora of 149 patients examined at the IOTA in February 1996. Acanthamoeba sp. was not detected in any sample. Fungi were detected in 22.15 p. 100 of the samples. Thus, it would appear that, unlike fungi, Acanthamoeba sp. is not present in normal eye flora in Mali. This findings suggests that the occurrence of Acanthamoeba in corneal ulcers is not an accident. Our results also emphasize the need for screening to detect Acanthamoeba in developing countries such as Mali. However, further study will be needed to confirm these findings in a larger group of subjects more closely matched with the patients presenting the corneal ulcers diagnosed at the IOTA, especially with regard to geographical origin.

Acanthamoeba↗
PubMed2000

[Sociocultural dimension of epilepsy (kirikirimasien) in a Bambara rural area (Mali)].

The anthropological study of kirikirimasien (epilepsy) in Mali constitutes an integral part of a research programme devoted to the epidemiology of epilepsy and onchocerciasis in Mali. This programme is run jointly by scientists of the Ecole Nationale de Médecine et de Pharmacie (National School of Medicine and Pharmacy) of Bamako, Mali, and the Faculté de Médecine (Faculty of Medicine) of Marseilles, France. Preliminary results of the anthropological study are presented, based on the qualitative analysis of 132 interviews, conducted over 6 months. Those interviewed were mainly persons affected by kirikirimasien, but included members of the family circle, traditional healers, and outsiders as well. Participatory interview techniques used the national language bambara. The interviews were unstructured and semi-structured so as to identify themes in the bambara language concerning kirikirimasien. Two dominant trends were identified, concerning the aetiology and nosography of the disease, and the social dimension of kirikirimasien, respectively. In terms of aetiology and nosography, diagnosis, contamination and appelation are--in order of priority--the most important aspects of the disease. Yet the social dimension of kirikirimasien appears largely to surpass its aetiological and nosographic aspects. The social dimension is crucial to the anthropological understanding of kirikirimasien. This was amply illustrated by various references which arose during the interviews. First, how is the notion of contamination represented and which practices are associated with it? Second, invalidity and handicap appear to play an essential role in the way people deal with the disease. The notion of tolerance in the bambara environment is also addressed, mainly through a spatial study of the adherence of the person affected by the disease (family, village and outsiders). The third part of the study deals with the social understanding of kirikirimasien and looks at how those affected are cared for, both within their social setting and in terms of seeking treatment.

Anthropology, Cultural↗
PubMed1994

Studies on transmission and schistosome interactions in Senegal, Mali and Zambia.

The transmission and interaction of schistosomes in the Senegal River Basin in Mali and Zambia are reviewed and some preliminary field data are presented. In the Senegal River Basin four species of schistosomes are prevalent: Schistosoma mansoni, S. haematobium, S. bovis and S. curassoni as well as the following potential intermediate hosts: Biomphalaria pfeifferi, Bulinus globosus, B. umbilicatus, B. truncatus, B. senegalensis and B. forskalii. The role of each of these species in the transmission of schistosomes in man and domestic stock is discussed. Recent ecological changes caused by the construction of dams at Diama and Mananatali on the Senegal River, such as reduction in salinity, more stable water flow, creation of irrigation canals and development and extension of rice culture, have contributed towards the occurrence of new outbreaks of both intestinal and urinary schistosomiasis in the Senegal River Basin. In Mali, the four main areas of high prevalence of S. haematobium are Office du Niger (irrigation areas), Bandiagara (small dams), Selingué (dam areas) and Baguineda (irrigation areas). Apart from the Office du Niger, S. mansoni infections are rare. Surveys were carried out in the Dogon Country (Bandiagara District) in an attempt to confirm the recent independent reports of the presence of S. intercalatum. Data based on egg morphology and Ziehl Neelsen staining of egg shells suggested the possible occurrence of S. haematobium x S. intercalatum hybrids. Potential factors affecting the focal endemicity of S. haematobium in Mali are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Pemphigus in Mali: a study of 30 cases.

Pemphigus has been largely studied in developed countries (North America and Europe) and in Brazil. In these geographical settings, pemphigus presents two very different epidemiological and clinical patterns. Little is known about pemphigus in other regions of the world, particularly in Africa. We report here a study of 30 cases of pemphigus observed in Bamako, Mali. Our data suggest that pemphigus in this area presents a distinctive pattern. Our cases of pemphigus were diagnosed on the basis of clinical, histological and direct immunofluorescence studies. We estimated the annual incidence in the Bamako region to be 0.29 cases per 100,000 inhabitants. There was no endemic focus in Mali. The disease was observed mainly in women (24 of 30; 80%), especially those older than 40 years (mean age, 46.7 years), and in the Fulani ethnic group (10 of 30; 33%). Our study group was composed of 25 cases of pemphigus foliaceus (PF) (83%), four cases of pemphigus vulgaris and one case of pemphigus vegetans. Pustules with hypopyon were observed in 11 patients (37%). A diffuse verrucous change in the skin was noted in four cases of erythrodermic PF. In 16 patients with PF, localized verrucous lesions mimicking seborrhoeic keratoses were observed when oral corticosteroid treatment was decreased. Histopathological examination demonstrated eosinophilic spongiosis in 50% of patients. These data suggest that pemphigus in Mali differs from the two main known patterns of the disease: the North American/European one, and the Brazilian pattern, with which it shares the predominance of superficial forms but otherwise differs in many features.

Adult↗
PubMedDate not supplied

[Leprosy as a cause of physical disability in rural and urban areas of Mali].

We performed a cross-sectional study of populations from two areas of Mali, in May and June 1996. The aim of the study was to assess the extent to which leprosy causes physical disability in Mali. One area was rural (Circle of Bougouni), the other urban (Bamako District). We used a cluster sampling method, with 500 households selected for study in each of the two areas. All members of the households randomly selected were included in the study. For all survey sites, the number of households was proportional to the number of inhabitants. The total study population was 8,175, including 172 cases of physical handicap, 76 in Bamako and 96 in Bougouni. The prevalence of physical handicap was 21 per 1,000 inhabitants (25.3 per 1,000 in rural areas and 17.3 per 1,000 in the city). The difference in the prevalence of physical handicap between the two areas was statistically significant (p = 0.01). Ten per cent of the disabilities were caused by leprosy. The most common causes of disability other than leprosy were trauma and poliomyelitis. Leprosy mostly caused disabilities in rural areas. In both areas, leprosy caused more disabilities in men and boys (64% of cases) than in women and girls. The frequency of disabilities caused by leprosy increased with age, whereas the frequency of handicaps with other causes decreased with age. This study shows that leprosy is still a major cause of disability in countries in which it is endemic, such as Mali. Disability prevention measures and physical rehabilitation programs should be incorporated into the national program for the elimination of epilepsy.

Adult↗
PubMed2005

Folding pathway of the pyridoxal 5'-phosphate C-S lyase MalY from Escherichia coli.

MalY from Escherichia coli is a bifunctional dimeric PLP (pyridoxal 5'-phosphate) enzyme acting as a beta-cystathionase and as a repressor of the maltose system. The spectroscopic and molecular properties of the holoenzyme, in the untreated and NaBH4-treated forms, and of the apoenzyme have been elucidated. A systematic study of the urea-induced unfolding of MalY has been monitored by gel filtration, cross-linking, ANS (8-anilino-1-naphthalenesulphonic acid) binding and by visible, near- and far-UV CD, fluorescence and NMR spectroscopies under equilibrium conditions. Unfolding proceeds in at least three stages. The first transition, occurring between 0 and 1 M urea, gives rise to a partially active dimeric species that binds PLP. The second equilibrium transition involving dimer dissociation, release of PLP and loss of lyase activity leads to the formation of a monomeric equilibrium intermediate. It is a partially unfolded molecule that retains most of the native-state secondary structure, binds significant amounts of ANS (a probe for exposed hydrophobic surfaces) and tends to self-associate. The self-associated aggregates predominate at urea concentrations of 2-4 M for holoMalY. The third step represents the complete unfolding of the enzyme. These results when compared with the urea-induced unfolding profiles of apoMalY and NaBH4-reduced holoenzyme suggest that the coenzyme group attached to the active-site lysine residue increases the stability of the dimeric enzyme. Both holo- and apo-MalY could be successfully refolded into the active enzyme with an 85% yield. Further refolding studies suggest that large misfolded soluble aggregates that cannot be refolded could be responsible for the incomplete re-activation.

Binding Sites↗
PubMed2006

The match between motivation and performance management of health sector workers in Mali.

UNLABELLED: Human resources for health (HRH) play a central role in improving accessibility to services and quality of care. Their motivation influences this. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. OBJECTIVES: To describe the factors motivating and demotivating health workers in Mali and match the motivators with the implementation of performance management. METHODS: First an exploratory qualitative study was conducted: 28 interviews and eight group discussions were held. This was followed by a cross-sectional survey, during which 370 health workers were interviewed. The study population consisted of health workers of eight professional groups. The following issues were investigated: motivating and demotivating factors; experiences with performance management, including: job descriptions, continuous education, supervision, performance appraisal and career development. FINDINGS: The study showed that the main motivators of health workers were related to responsibility, training and recognition, next to salary. These can be influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal). Performance management is not optimally implemented in Mali, as job descriptions were not present or were inappropriate; only 13% of interviewees received 4x per year supervision, and training needs were not analysed. Some 48% of the interviewees knew their performance had been appraised in the last two years; the appraisals were perceived as subjective. No other methods were in place to show recognition. The results enabled the research team to propose adaptations or improvements upon existing performance management. CONCLUSION: The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation. This can be done by matching performance management activities to motivators identified by operational research.

Journal Article↗
PubMed2001

Chromosome banding in Cacopsylla mali (Schmidberger) and Cacopsylla sorbi (Linnaeus) (Homoptera, Psyllidae) with polymorphic sex chromosomes.

C-banding and Ag staining were applied to Cacopsylla sorbi and C. mali. The aim was to discover some additional cytological markers to follow the pathways of the sex determination system transformation in the evolution of the species. Of three karyotype patterns so far described in the literature for these species--a type A (XO), B (neoXY) and C (neoX1X2Y), only the last two types (B and C) were found. All 6 studied Cacopsylla sorbi from Finland had a karyotype of type B (2n = 20 + XY), while C. mali had both types. Type B (2n = 22 + XY) was observed in 31 males, whereas type C (2n = 20 + neoX1X2Y) in the remaining four. The karyotype of C. sorbi was found to be characterized by a very small amount of C-positive material, localized in a telomere of the Y chromosome. The karyotype of C. mali was also characterized by a very small amount of C-banded material. Both the sex chromosomes and the autosomes displayed a marked polymorphism of C-positive bands within different individuals and even the same individual. In both species the nucleolus was located in the telomere of a middle sized autosomal till diplotene inclusive. The C-banding and Ag staining in the studied Cacopsylla species did not provide any additional cytological markers for an understanding of the pathways of sex determination system transformation in the evolution of the species.

Animals↗
PubMedDate not supplied

[Apropos of the Mali syndrome].

The authors report two original cases of profuse pigmentation associated with proliferative lesions of the lower limbs, in patients with venous incompetence, suggestive if the syndrome described by Mali and al. in 1963. One case was in fact of Kaposi's disease associated with severe thrombocytopenia which was the cause of death, despite the use of Chloraminophene-Cortancyl. The other case was a woman with profuse pigmentation of the lower limbs associated with multiple disseminated lesions of allergic vasculitis, probably of drug origin. Suppression of the drug and rest led to a marked improvement in the lesions. Although very different from each other, both of these cases are suggestive of Mali's syndrome, but their treatment was totally opposite. The first case, a real vascular neoplasia, required the combination of antimitotic-steroid ; the second case, on the contrary, resolved with rest and a simple elastic bandage, like allcutaneous venous lesions, in particular Mali's syndrome.

Aged↗
PubMed1992

Nutritional status of adults in rural Mali.

An anthropometric assessment was conducted of 441 adults from six rural villages in southern Mali. As is typical for human populations, females are shorter and lighter than males. Both females (N = 320) and males (N = 121) are shorter and lighter than their U.S. counterparts. Mean weight in the sample is 53.4 +/- 8.5 kilos for females and 58.8 +/- 6.5 kilos for males. Mean height is 160.4 +/- 5.7 cm for females and 171.3 +/- 6.6 cm for males. The data for height in males are very similar to those reported from other surveys in Mali, and show no evidence for a positive secular trend in height. Mean body mass index (BMI) is 20.8 for females and 20.0 for males. These are lower than U.S. averages, but well above suggested cutoff points for malnutrition in adults. Average arm circumference is 26.5 cm for females and 26.4 cm for males. Females have relatively large arm circumferences due, in part, to the heavy manual labor they perform. Average head circumference is 53.0 cm for females and 54.8 cm for males. For both sexes, these values are more than 1 standard deviation (SD) below the U.S. means. Adult values for anthropometric measurements reflect childhood stresses of malnutrition and disease, and a lifetime of accommodation to a high-carbohydrate, low-protein diet, and hard physical labor. Females are significantly closer to the U.S. standards than males for weight, height, BMI, and arm circumference; these findings support the idea that females are buffered from environmental stresses relative to males. In addition, females exhibit significantly more variability than males for weight, arm circumference, and head circumference, but not for height, suggesting that variability in adult height does not reflect the presence or absence of female buffering or the level of environmental adversity.

Adult↗
PubMedDate not supplied

The impact of self-assessment on provider performance in Mali.

Improving the quality of clinical care in developing country settings is a difficult task, both in public sector settings where supervision is infrequent and in private sector settings where supervision and certification are non-existent. This study tested a low-cost method, self-assessment, for improving the quality of care that providers offer in a peri-urban area in Mali. The study was a cross-sectional, case-control study on the impact of self-assessment on compliance with the quality of care standards. The two indicators of interest were the compliance with fever care standards and the compliance with structural quality standards. Both standards were derived from the Ministry of Health of Mali's standards for health care delivery. The study examined 36 providers, 12 of whom were part of the intervention and 24 of whom were part of the control group over a 3 month period from May to July 2001. Overall, the research team found a significant difference between the intervention and control groups in terms of overall compliance (p < 0.001) and in terms of assessment of fever (p < 0.005). The total costs for the intervention for 36 providers was less than US$250, which translated to approximately $6 per provider. The data appear to suggest that self-assessment, when used in a regular fashion, can have a significant effect on compliance with standards. However, it is clear that self-assessment is not a resource-neutral intervention. All of the individuals from the intervention pool interviewed cited the extra work that they had to do to comply with the intervention protocol as a burden. In particular, study participants put an emphasis on the 'long duration' of the study that 'discouraged' the study participants. Future research on self-assessment should include a larger sample of providers and should examine the impact of self-assessment over time.

Attitude of Health Personnel↗
PubMed1994

Institutional maternal mortality in Mali.

OBJECTIVES: To measure the institutional maternal mortality ratio (MMR) in Mali and suggest ways to reduce it. METHODS: Routinely recorded data from 24 health institutions in three regions were reviewed for 1988 to 1992. RESULTS: The overall MMR in the institutions was 201 maternal deaths per 100,000 live births. Hemorrhage, toxemia and infections accounted for 80% of the 360 recorded maternal deaths, almost all of which were preventable. The main reasons why these conditions result in death lie in poor quality and maldistribution of health services, lack of transport and late use of allopathic services. CONCLUSIONS: Maternal mortality is still a major public health problem in Mali, even among the small proportion of women who reach health facilities. Substantial new initiatives are urgently needed to reduce this major cause of preventable adult female mortality.

Adolescent↗
PubMedDate not supplied

Schistosomiasis in Dogon country, Mali: identification and prevalence of the species responsible for infection in the local community.

The prevalence of schistosomiasis amongst the Dogon people in 4 villages and one school of the Bankass district of Mali was determined during 2 surveys in 1992; 1398 urine and 1199 stool samples were examined. The most common schistosome was Schistosoma haematobium, with an overall prevalence of 51.3%; S. mansoni had a prevalence of 12%. No S. intercalatum egg was seen in the stools. Biomphalaria pfeifferi and Bulinus truncatus were found in pools at the base of the Dogon cliffs; Bulinus forskalii was found in smaller numbers in brick pits. Two isolates from urine samples of children were identified as S. haematobium in the laboratory using an alpha-glycerophosphate marker, restriction enzyme analysis of ribosomal deoxyribonucleic acid (rDNA) and random amplification of polymorphic DNA. The isolates did not develop in Bulinus forskalii or B. crystallinus of the B. forskalii group. Some evidence for past hybridization of S. haematobium and S. intercalatum is provided by the enzyme and rDNA results as well as the positive Ziehl-Neelsen staining of polymorphic eggs in urine samples. The findings are discussed in relation to the published observations concerning schistosomiasis in travellers returning from this region of Mali.

Adolescent↗
PubMedDate not supplied

Comparison of the circulating anodic antigen detection assay and urine filtration to diagnose Schistosoma haematobium infections in Mali.

The applicability of a circulating Schistosoma antigen detection assay for determining rates of infection and efficacy of chemotherapy was evaluated in Mali. Urine egg counts were compared to circulating anodic antigen enzyme-linked immunosorbent assay (CAA-ELISA) titres in serum, before and 6 weeks after treatment with a single dose of praziquantel (40 mg/kg), in 2 villages in Dogon Country, an area endemic for S. haematobium, the predominant schistosome infection in Mali. In Kassa, a village with a moderate prevalence of infection, the serological prevalence (48%) was significantly higher than the parasitological prevalence (31%). In Boro, a village with high parasitological prevalence (76%), no difference was observed between the results of both methods (prevalence by CAA-ELISA was 75%). Cure rates estimated by CAA-ELISA were lower than those determined parasitologically, suggesting that cure rates are overestimated by egg counting. The sensitivity of the CAA-ELISA was 78%. In both villages, before treatment, a positive correlation was found between the number of eggs in urine and serum CAA titres. It is concluded that, although further simplification and improvement of the sensitivity of the assay is needed, in its present ELISA format the antigen detection assay is useful for monitoring sentinel populations. Furthermore, the serum CAA assay performed adequately in a public health laboratory within an endemic country.

Animals↗
PubMedDate not supplied

Skin diseases of children in Mali: a public health problem.

In order to estimate the importance as a public health problem of skin diseases, we investigated the prevalence and severity of skin diseases in a representative sample of children in Mali. 1817 children were randomly selected in 30 clusters by probability-proportional-to-size sampling in Koulikoro region. The mean prevalence (+/- 2 SD) of skin diseases was 34 +/- 4%. The most frequent dermatoses were pyoderma (12.3 +/- 1.6%), tinea capitis (9.5 +/- 2.5%), pediculosis capitis (4.7 +/- 1.4%), scabies (4.3 +/- 1.5%), and molluscum contagiosum (3.6 +/- 1%). The most troublesome dermatoses were scabies and severe pyoderma. Pyoderma was the only dermatosis associated with poor individual or household hygiene. Public health services were little used by the population for skin diseases, probably because of the lack of an adequate response by the services and the high cost of treatment. The high prevalence and the severity of many of the lesions, and the discomfort caused, make pyoderma and scabies a significant public health problem in Mali.

Child↗
PubMed1986

Infant feeding in Mali, West Africa: variations in belief and practice.

Research conducted in Mali during 1982 and 1983 reveals a wide range of variation in both the growth and development of infants and infant feeding practices. Overall, growth patterns of the Malian children (N = 136) are similar to those reported for children in other West African urban or rural poor populations. However, the use of the averages of growth measures disguises the fact that some children are severely malnourished, while others are growing at or above the 50th percentile of NCHS standards. Socio-economic status, as an indicator of the family's financial ability to provide food and medical care, does not account for the variation in nutritional status. From a series of open-ended interviews with mothers, fathers and other relatives of children in the study, as well as observation of mealtimes, several fundamental beliefs regarding infant feeding can be identified: (1) a child does not need to eat solid food before approx. 8 months; (2) if a child is hungry, he will eat, if he does not want to eat he should not be forced to eat; and (3) only the child himself knows when he is hungry and when he is full. These beliefs are expressed in the community in a variety of specific practices and behaviors. Additionally, mothers differ with respect to the importance they attach to medical care for sick children. These various beliefs and practices concerning infant feeding and, tangentially, medical care, tend to form divergent clusters, which allows the ranking of women on a three level scale of 'maternal attitude.' In the sample, growth performance, as indicated by membership in 'low weight' or 'high weight' groups, is positively correlated with maternal attitude (Chi2 = 13.85, P = 0.001). It is clear that in Mali, the cultural belief system regarding infant feeding and the variations in implementation of this system reflected in maternal attitudes, play an important role in determining the nutritional status and growth patterns of children, primarily through their effect on diet, and secondarily through their effect on medical care. The data show that within the same general cultural framework, and in the face of abject poverty, subtle differences in maternal attitudes result in some children who thrive, while others suffer varying degrees of malnutrition.

Attitude↗
PubMed2005

A survey of toxic plants on the market in the district of Bamako, Mali: traditional knowledge compared with a literature search of modern pharmacology and toxicology.

In Mali, the empirical knowledge on plant medicine is held by traditional practioners. Scientific studies have been carried on some plants and they have confirmed their local uses, but few data are available on the toxicity of Malian medicinal plants. In the present work, we record the toxic plants used as medicines in the Bamako district, Mali, with the aim to evaluate the knowledge of traditional healers and herbalists on the toxicity of the plant used. A survey was carried out on the market places in the Bamako district and 106 healers and herbalists were interviewed. A survey of the scientific literature was conducted to verify or sustain the claimed toxicological data. Nineteen plants are arranged according to their frequency of quotation based on the questionnaire. The information includes the botanical name, literature survey on the pharmacology of the plants, the healers' knowledge on plant toxicity and its prevention by some of the healers.

Clinical Competence↗