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PubMed2004

Invasive pneumococcal infections among hospitalized children in Bamako, Mali.

BACKGROUND: Prevention of invasive pneumococcal disease (IPD) in children is a global public health priority, and determination of the most common serotypes is crucial for vaccine development and implementation. METHODS: We performed prospective surveillance for IPD in hospitalized children in Bamako, Mali. All febrile children and others suspected to have invasive bacterial disease had an admission blood culture and cultures of additional anatomic sites when indicated. Standard microbiologic methods were used to identify, serotype and determine antibiograms for pneumococcal isolates. RESULTS: Of 2,049 children enrolled, 106 (5%) had an IPD, including 47 cases of meningitis and 44 bacteremic pneumonias. The incidence was highest in infants (84/100,000/year). The overall IPD case fatality rate was 24%. Only 2 of 96 isolates were nonsusceptible to penicillin. The serotypes isolated were 5 (54%), 2 (14%), 7F (10%), 19F (8%), 6A/B (3%), 9V (3%), 1 (2%) and 14 (1%). CONCLUSIONS: IPD is common and frequently fatal among hospitalized children in Mali, but surprisingly little resistance has occurred. Notably, 91% of the serotypes causing IPD in Bamako children are found in the 11-valent pneumococcal conjugate vaccine.

Adolescent↗
PubMed2005

Season, fever prevalence and pyrogenic threshold for malaria disease definition in an endemic area of Mali.

BACKGROUND: Modelling malaria parasitaemia as function of fever has been proposed as best alternative to estimate the attributable fraction of malaria fever and the sensitivity and specificity of different case definitions of malaria disease. OBJECTIVES: To determine the prevalence of fever and its relation to malaria parasitaemia and to establish a pyrogenic threshold for malaria disease in the area. METHODS: We conducted two cross-sectional surveys in children of 6 months to 9 years of age (2434 during the rainy season of 1993 and 2353 during the dry season of 1994) randomly selected from 21 areas of Bandiagara district, Mali. RESULTS: The relationship between fever and Plasmodium falciparum parasitaemia depends strongly on the season, thus affecting the malaria-attributable fraction of fever cases and the sensitivity and specificity of malaria case definitions. The overall proportion of fever attributable to malaria parasitaemia was 33.6% during the rainy season and 23.3% during the dry season, with the highest proportion occurring among the youngest children. The cut-off value, where the sensitivity curve crosses the specificity curve, was around 3200 pf/microl for all age categories during the rainy season and 200 pf/microl during the dry season. CONCLUSIONS: Malaria remains a main cause of fever in this area of Mali. The pyrogenic threshold of parasitaemia depends strongly on the season, and different cut-off levels of parasitaemia should be used during the two seasons to define malaria cases in this area.

Age Distribution↗
PubMed2006

Mitochondrial DNA variation in Mauritania and Mali and their genetic relationship to other Western Africa populations.

Mitochondrial DNA (mtDNA) variation was analyzed in Mauritania and Mali, and compared to other West African samples covering the considerable geographic, ethnic and linguistic diversity of this region. The Mauritanian mtDNA profile shows that 55% of their lineages have a west Eurasian provenance, with the U6 cluster (17%) being the best represented. Only 6% of the sub-Saharan sequences belong to the L3A haplogroup a frequency similar to other Berber speaking groups but significantly different to the Arabic speaking North Africans. The historic Arab slave trade may be the main cause of this difference. Only one HV west Eurasian lineage has been detected in Mali but 40% of the sub-Saharan sequences belong to cluster L3A. The presence of L0a representatives demonstrates gene flow from eastern regions. Although both groups speak related dialects of the Mande branch, significant genetic differences exist between the Bambara and Malinke groups. The West African genetic variation is well structured by geography and language, but more detailed ethnolinguistic clustering suggest that geography is the main factor responsible for this differentiation.

Africa, Western↗
PubMed2003

Evaluation of case management in the integrated schistosomiasis-control programme in Mali.

Currently, schistosomiasis control in Mali is mainly based on treatment with praziquantel (PZQ). The policy is to ensure (1). the treatment, every 3 years, of school-age children in all areas where the prevalence of haematuria (an indicator of Schistosoma haematobium infection) in this age-group is >30%, and (2). the sound management of all patients presenting with haematuria or (bloody) diarrhoea (an indicator of S. mansoni infection) at health centres. In the present study, the application of case management was evaluated by visiting 60 healthcare facilities in four geographical areas and interviewing the health-workers at these facilities. The presence of S. haematobium and S. mansoni was reported in the coverage areas of 83% and 37%, respectively, of the healthcare facilities investigated. Health-worker knowledge of the main symptoms of schistosome infection was good and patients exhibiting symptoms attributable to schistosome infection were very likely to receive adequate treatment, particularly (at a frequency of about 80%) when they presented with haematuria. At health-centre level, patients were often directly treated with PZQ, whereas health-workers in district hospitals and private clinics requested a diagnostic test prior to any treatment. PZQ was available in most healthcare facilities but not in the private clinics. The mean cost of treatment of a patient with S. haematobium infection (euro; 2.30) was very similar to the corresponding cost for S. mansoni infection (euro; 2.37). The cost of the PZQ represented approximately 50% of the total costs borne by the patients when presenting at health centres. Patients with the symptoms of S. haematobium infection in Mali can expect adequate diagnosis and treatment in agreement with the recommendations of the World Health Organization. Patients presenting with symptoms related to S. mansoni infection are, however, less likely to be correctly diagnosed. The relatively high costs of treatment and the infrequency with which cases of schistosomiasis seek healthcare necessitate policy decisions, to ensure an affordable and more attractive, clinical system of case management.

Case Management↗
PubMed2003

RHD allele distribution in Africans of Mali.

BACKGROUND: Aberrant and non-functional RHD alleles are much more frequent in Africans than in Europeans. The DAU cluster of RHD alleles exemplifies that the alleles frequent in Africans have evaded recognition until recently. A comprehensive survey of RHD alleles in any African population was lacking. RESULTS: We surveyed the molecular structure and frequency of RHD alleles in Mali (West Africa) by evaluating 116 haplotypes. Only 69% could be attributed to standard RHD (55%) or the RHD deletion (14%). The aberrant RHD allele DAU-0 was predicted for 19%, RHDPsi for 7% and Ccdes for 4% of all haplotypes. DAU-3 and the new RHD allele RHD(L207F), dubbed DMA, were found in one haplotype each. A PCR-RFLP for the detection of the hybrid Rhesus box diagnostic for the RHD deletion in Europeans was false positive in 9 individuals, including all carriers of RHDPsi. Including two silent mutations and the RHD deletion, a total of 9 alleles could be differentiated. CONCLUSION: Besides standard RHD and the RHD deletion, DAU-0, RHDPsi and Ccdes are major alleles in Mali. Our survey proved that the most frequent alleles of West Africans have been recognized allowing to devise reliable genotyping and phenotyping strategies.

Alleles↗
PubMed2005

Ethnopharmacological survey of different uses of seven medicinal plants from Mali, (West Africa) in the regions Doila, Kolokani and Siby.

An ethnopharmacological survey was carried out to collect information on the use of seven medicinal plants in rural areas in the nearby regions of Bamako, Mali. The plants were Opilia celtidifolia, Anthocleista djalonensis, Erythrina senegalensis, Heliotropium indicum, Trichilia emetica, Piliostigma thonningii and Cochlospermum tinctorium. About 50 medical indications were reported for the use of these plants in traditional medicine. The most frequent ailments reported were malaria, abdominal pain and dermatitis. The highest number of usages was reported for the treatment of malaria (22%). The majority of the remedies were prepared from freshly collected plant material from the wild and from a single species only. They were mainly taken orally, but some applications were prepared with a mixture of plants or ingredients such as honey, sugar, salt, ginger and pepper. Decoction of the leaves was the main form of preparation (65%) and leaf powder was mostly used for the preparation of infusions (13%). The part of the plants most frequently used was the leaves. There was a high degree of informant consensus for the species and their medicinal indications between the healers interviewed. The results of this study showed that people are still dependent on medicinal plants in these rural areas of Mali.

Adult↗
PubMed1992

A case of human ehrlichiosis acquired in Mali: clinical and laboratory findings.

We report on the clinical, epidemiologic, and laboratory characteristics of the first case of human ehrlichiosis acquired outside the United States caused by an Ehrlichia sp. other than E. sennetsu. The patient, a 24-year-old woman, presumably acquired the infection in Mali in northern Africa; the diagnosis was made when she returned to North America. The patient reported a fever and diarrhea a week before she left Mali; the diarrhea resolved, but the fever and chills continued. She also reported intermittent tingling in both hands and feet and muscle discomfort. Her temperature was 37.8 degrees C and her pulse rate was 100 per minute. She had two erythematous maculopapules (0.5 x 0.7 mm) on her thigh and ankle that resembled infected insect bites. Her hemoglobin level was 148 g/l with normal indices, and her white blood cell count was 10, 500/mm3 with many atypical lymphocytes and platelets. This report is intended to increase physicians' awareness of ehrlichiosis in foreign travelers and other patients, and suggests the need for further research to determine the prevalence and distribution of this disease.

Adult↗
PubMed1998

The public health significance of urinary schistosomiasis as a cause of morbidity in two districts in Mali.

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

Adolescent↗
PubMed1999

Pyrimethamine-sulfadoxine efficacy and selection for mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase in Mali.

To assess pyrimethamine-sulfadoxine (PS) efficacy in Mali, and the role of mutations in Plasmodium falciparum dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) in in vivo PS resistance, 190 patients with uncomplicated P. falciparum malaria were treated with PS and monitored for 56 days. Mutation-specific polymerase chain reactions and digestion with restriction endonucleases were used to detect DHFR and DHPS mutations on filter paper blood samples from pretreatment and post-treatment infections. Only one case each of RI and RII level resistance and no cases of RIII resistance or therapeutic failure were observed. Post-PS treatment infections had significantly higher rates of DHFR mutations at codons 108 and 59. No significant selection for DHPS mutations was seen. Pyrimethamine-sulfadoxine is highly efficacious in Mali, and while the low level of resistance precludes assessing the utility of molecular assays for in vivo PS resistance, rapid selection of DHFR mutations supports their role in PS failure.

Animals↗
PubMed2005

Malaria prevention practices in Mopti region, Mali.

OBJECTIVES: To assess insecticide-treated nets (ITNs) use, other malaria prevention measures, knowledge of malaria and diffusion of information about ITNs by the National Malaria Control Programme (NMCP) in Mali. DESIGN: A descriptive cross-sectional study. SETTING: Four villages in Mopti region, Mali that had participated in the Mopti Regional Malaria Control Program (MRMCP) ITN Education Programme five years prior. PARTICIPANTS: Three hundred thirty nine randomly-selected households. Within each household, mothers of children one to nine years of age were interviewed regarding knowledge of malaria and prevention practices. RESULTS: Overall, 11% of households used ITNs, with 97% of these in two villages. Ninety eight percent of households used bednets, 22% used insecticide sprays and 39% used mosquito coils. Significant predictors of ITNs use were: head of household literacy, larger family size, Bambara ethnicity, hearing about the NMCP and hearing about ITNs from health agents. Reasons why ITNs were not used included not knowing anything about ITNs, cost and not having net impregnation services readily available in the village. Levels of knowledge concerning malaria disease, transmission and prevention varied amongst the four villages. ITN households had significantly higher levels of knowledge about malaria and its prevention. CONCLUSION: Five years after the implementation of the MRMCP, ITNs use was low and diffusion of malaria prevention information was unequal among villages. Future efforts in improving the programme must recognise these differences in knowledge and ITNs utilisation and make village-specific changes that are acceptable for each village.

Adolescent↗
PubMed1998

[Cartography of trachoma in Mali: results of a national survey].

Prior to a campaign to eliminate blinding trachoma, a survey of the prevalence of the disease was conducted in the seven administrative regions of Mali between March 1996 and June 1997. In each region (with the exception of Bamako District) a random sample of thirty clusters was taken from the general population, in accordance with the principle of probability proportionate to the size of the communities. All children under 10 years of age and all women over 14 years were examined. The simplified coding proposed by WHO was used for data gathering. A total of 15,310 children and 11,530 women were examined. The prevalence of active trachoma, follicular (TF) or intense (TI), was estimated to be 34.9% among children under 10 years of age (95% CI: 32.3-37.6). The prevalence of TI showing the intensity of trachoma was 4.2% (95% CI: 3.5-5.0) among the same children. The prevalence increased up to the age of 3 years, when it reached 49.2%. The prevalence of TF/TI was 35.7% among boys and 34.3% among girls. The prevalence of entropion trichiasis among women over 14 years of age was 2.5% (95% CI: 2.1-2.9), and 1% had central corneal opacity (95% CI: 0.8-1.3). These prevalences increased with age, such that 10% of women over 70 years of age had trichiasis. By region of the country, the prevalence ranged from 23.1% of active trachoma among children in Ségou, to 46.2% in Gao. The prevalence of entropion trichiasis was 0.65% in Gao region and 3.9% in Koulikoro region. This survey allows the trachoma treatment needs of Mali to be quantified. We estimate that 1.09 million children under 10 years are carriers of active trachoma and require local or general antibiotic treatment. If all the under-10-year-olds from all villages where TF/TI exceeded 20% were to be treated, a total of 2.436 million children would be involved. A total of 85,000 adults should have surgery to correct trichiasis and avoid the onset of blindness.

Adolescent↗
PubMed1998

The distribution and inversion polymorphism of chromosomally recognized taxa of the Anopheles gambiae complex in Mali, West Africa.

Data from polytene chromosome studies on the Anopheles gambiae complex in Mali were reviewed. The banding pattern was successfully scored in 17,705 specimens from 76 sampling sites representing the main ecological strata of the country. Two members of the complex, namely An. arabiensis and An. gambiae, were found widespread and frequently sympatric, with the latter prevalent in most localities. Population genetic analysis of the inversion polymorphisms indicated the existence of panmictic conditions for An. arabiensis only, whereas the parallel study of An. gambiae supported its splitting into at least three reproductive units, characterized by different 2R chromosome arrangements, designated Bamako, Mopti and Savanna. The chromosomal evidence was consistent with the hypothesis of complete reproductive isolation between Bamako and Mopti. Partial isolation between these two taxa and Savanna was suggested by the scoring of hypothetical hybrid 2R heterokaryotypes in various samples, but the actual hybrid origin of these specimens was not confirmed. Different patterns of geographical and seasonal distribution were shown as follows. An. arabiensis prevails in arid savannas (Sahel and Northern Sudan savanna) out of the flooded or irrigated zones; it is able to withstand the most arid conditions of Saharan localities and its breeding might extend throughout the dry season. An. gambiae Savanna and Bamako prevail in relatively humid savannas (Southern Sudan savanna) and their breeding generally occurs only during the rainy season. The Savanna taxon was almost absent in flooded or irrigated zones and in riverine localities; the Bamako taxon is distributed along the upper river Niger and its tributaries. An. gambiae Mopti extends its range in all ecological zones present in Mali including the Sahel and predesertic areas, showing high relative frequencies up to absolute dominance in flooded or irrigated areas; its breeding is highly successful also during the dry season. Rainfall at the sampling sites was found to correlate positively with the frequency of Savanna and negatively with the frequency of Mopti. The remarkable ecological flexibility of the latter was found associated with wide seasonal and geographical variations in its 2R inversion polymorphism bc/u. Higher frequencies of the bc arrangement were recorded both in the Southern localities during the dry season and in the Northern more arid localities during the rainy season. The absence or scarcity of An. arabiensis and An. gambiae Savanna in most flooded or irrigated zones suggests their competitive exclusion by An. gambiae Mopti.

Animals↗
PubMed2000

Hemoglobin C associated with protection from severe malaria in the Dogon of Mali, a West African population with a low prevalence of hemoglobin S.

The malaria hypothesis proposes a survival advantage for individuals with hemoglobin variants in areas of endemic Plasmodium falciparum malaria. Hemoglobin C (HbC) is a possible example in West Africa, where this hemoglobin has a centric distribution with high frequencies among certain populations including the Dogon ethnic group. To test whether HbC is associated with protection from malaria, we performed a case-control study in the Dogon of Bandiagara, Mali. HbC was present in 68 of 391 (17.4%) of uncomplicated malaria control cases, whereas it was detected in only 3 of 67 cases (4.5%) of severe malaria (odds ratio [OR], 0.22; P =. 01). Further, HbC was present in only 1 of 34 cases (2.9%) with cerebral manifestations, the most common presentation of severe malaria in this population (OR, 0.14; P =.03). Episodes of uncomplicated malaria and parasitemias (4800-205 050/microL) were identified in cases of homozygous HbC (HbCC), which indicates that P falciparum parasites are able to efficiently replicate within HbCC erythrocytes in vivo. These findings suggest that HbC does not protect against infection or uncomplicated malaria but can protect against severe malaria in the Dogon population of Bandiagara, Mali. The data also suggest that the protective effect associated with HbC may be greater than that of HbS in this population.

Anemia, Sickle Cell↗
PubMed2002

[Breast cancer: factors influencing the therapeutic itinerary of patients in a medical oncology unit in Bamako (Mali)].

Early therapy is a determining factor to the recovery in patients with breast cancer. The situation in Mali is characterized by the delayed diagnosis of this cancer which raises the hypothesis that medical itinerary of patients received in specialized oncology unit is particular. In order to verify this hypothesis, 44 patients including 43 women and one man aged 25 to 80 years (mean age 46.0 19.6 years), seen in medical oncology unit in Point G, were subjects of an interview about the motivation of their therapeutic itinerary. 22.7% was initially seen by a traditional physician and 77.3% by a health care professional. The request of care was influenced by the patient's representation of the disease and by their neighboring. The therapeutic itinerary: "from traditional medicine to conventional medicine" was the more frequently observed in our patients with a long delay between the first consultation and the specialized one. Very few patients have received information about their illness before their specialized consultation. We conclude that the medical itinerary of our patients is particular, that this itinerary is influenced by the patient's representation of the cancer and by difficulty in the relationship between patients and health professional. This raise questions about the quality of both the communication and the provided health care. So, health care for patients with breast cancer in Mali might widely consider the anthropological dimension of the disease.

Adult↗
PubMed2003

[Frequency, risk factors and prognostic value of anemia associated with HIV/AIDS in the adult in Mali].

Anaemia is a common complication of the HIV infection. To understand the mechanism of HIV associated anaemia and to suggest a consequent therapeutic approach in adults in Mali, we undertook a prospective case/control study in two services of reference with essentially adults recruitment in Bamako. We studied the frequency, the risk factors and the prognosis value of this complication in 133 patients with HIV infection matched to 133 others non HIV infected. The average age of our patients was 36.08 +/- 8.80 years (age range: 19 to 66 years). The frequency of anaemia was significantly higher in patients with HIV infection compared to the controls (78.9% vs. 51.9%; OR = 2.46; 95% CI [1.56-3.92]). Anaemia was more frequent in women than in men (p = 0.00003). A significant association between anaemia and thrombopenia or lymphopenia was observed only in patients with HIV infection. The severity of anemia was positively associated with the HIV2 infection and the progression of the HIV disease. Mortality was more frequently associated to the anaemia (p < 10(-5)) in patients infected by HIV. These findings suggest that bone marrow depression leading to a decreased red blood cells production is the main mechanism of HIV associated anaemia in adult in Mali. Therefore, without evidence of a best cost-effectiveness ratio of a human recombinant erythropoietin treatment in the context of countries with a low income, the therapy of this haematological complication must be an emergency focusing on red blood cells transfusions.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Assessment of vitamin A deficiency in a rural area in Mali. Estimation of sample size for the impression cytology test.

The prevalence of vitamin A deficiency among two to ten years old children in a rural area of Mali was assessed by ophthalmic examination, determination of plasma retinol levels and impression cytology with transfer tests. A Public Health problem of vitamin A deficiency was identified in this rural area by: the prevalence of nightblindness significantly (p < 0.001) above the cut-off (1%) defined by the World Health Organization (WHO); the prevalence of corneal scarring significantly (p < 0.001) above the WHO's cut-off (0.05%); the percentage of subjects with plasma retinol levels below 0.35 mumol/l (10 micrograms/dl) significantly (p < 0.001) higher than the WHO's threshold (5%); and 52.8 +/- 8.2% children with "Abnormal" impression cytology as determined by the impression cytology test (IC). This preliminary survey confirmed widespread vitamin A deficiency in Mali. The minimum sample size required for a study using the impression cytology test to determinate a Public Health problem in a population was calculated for different situations. Ophthalmic examination indicated a very high rate of active trachoma (29.6 +/- 7.0%), and a relationship between active trachoma and impression cytology results was identified.

Child↗
PubMed2004

[Plasma selenium and peripartum cardiomyopathy in Bamako, Mali].

Peripartum heart failure due to unexplained dilated cardiomyopathy is a common disorder as Savannak-Sahelian Africa. One of the many suspected risk factors identified is selenium deficiency. The purpose of this study was to measure plasma selenium levels in patients with peripartum heart failure due to cardiomyopathy in Bamako, Republic of Mali and compare data with healthy Sahalian women with the same obstetrical status. Plasma selenium was measured in a patient group consisting of 28 Malian women presenting peripartum heart failure and in a control group of 28 healthy breast-feeding Nigerien women of comparable age. The criteria for matching the two groups was parity (similar number of deliveries) since multiparity is a risk factor for peripartum cardiomyopathy. The Wilcoxon test (nonparametric) was used to compare the 2 groups considering up value < 0.05 as significant. Plasma selenium was significantly lower in patients from Mali than in controls from Niger (65 +/- 17 ng/ml vs. 78 +/- 17 ng/ml, p = 0.01). The results of this study showing lower plasma selenium in Bamako patients with peripartum cardiomyopathy than in a matching healthy control population confirms the previous data from the Niamey study.

Female↗
PubMed2004

[Study of antigen HBs and antivirus antibodies of hepatitis C during hepatopathies in Mali].

A prospective study carried out in Bamako, Mali between July 1998 and January 1999 has assessed the seroprevalence of hepatitis C virus (HCV) in 91 carrier patients of chronic hepatopathy at a cirrhrosis stage (53) or of hepato-cellular carcinoma (38) and to compare with in 92 blood donors as a control population. Only seroprevalence confirmed by a complementary test has been taken into account (RIBA). HCV seroprevalence reached 25% including all hepatopathies, 24% in cirrhrosis and 26% in hepato-cellular carcinomae (HCC) versus 4% in blood donors. Antigen HBs of hepatitis B virus has been found in 55% of patients, versus 25% of the control cases (p = 0.0006). On the whole, the two markers have been notified a little more often in HCC than in cirrhosis and the combination of the two markers has been more frequent during cirrhosis as well. The role of HCV played in cirrhosis and HCC onset in Mali appears to be important.

Adult↗