[Vitamin A supplementation in children under five during a one-week nutrition intensification program in Mali]. / Processus de supplémentation en vitamine A chez les enfants de moins de cinq ans lors d'une semaine d'intensification des activités de nutrition au Mali.

INTRODUCTION: The National Nutrition Week (NNW) is designed to achieve 80% coverage of vitamin A supplementation among children aged 6 to 59 months. The objectives of this study were to describe the modalities of implementation of the NNW in 2006 in Mali and to document parents' and health workers' opinions. METHODS: A qualitative and quantitative cross-sectional study was conducted in two phases in May and June 2006 in four health districts (Kita, Kolondiéba, Dire and town VI of Bamako) selected at random. Individual interviews were conducted with Ministry of Health officials, partners and health workers. The focus groups were conducted with community leaders, carers / mothers of children. The coverage survey was conducted among 1,699 children aged 6 to 59 months. RESULTS: The channels most commonly used to increase public awareness were local radio (6/7 cases), public criers (5/7) and community health workers or traditional leaders (2/7). The main sources of information for mothers were: health workers (39%), relatives / neighbours / friends (37%), local leaders (24%) and radio (25%). Vitamin A supplementation coverage was 90% (1,520/1,699) for children aged 6 to 59 months. CONCLUSION: The NNW achieved its goal, but the National Department of Health should implement a door-to-door strategy and enhance communication in order to change behaviour.

[Training mothers: a strategy to improve the treatment of acute respiratory infections among children in Mali]. / Formation des mères : stratégie pour améliorer le traitement des infections respiratoires aiguës au Mali.

Acute respiratory infections (ARI) are a major public health issue in Mali. The objective of this study was to examine the management of ARI within the community among children aged 2 to 59 months. The study was based on a pilot community intervention over a period of 15 months (June 2008-August 2009) in 4 health districts in Mali. A survey was conducted two weeks before the intervention in order to determine the incidence of ARI. During the intervention phase, 80 community health workers (CHW) and 1,123 mothers were trained, equipped and supervised. 3,532 children aged 2 to 59 months were managed. Two health areas were selected in each district. A "CHW" area (i.e. an area where CHWs were trained and supervised) and a "mother" area (i.e. an area where mothers were trained and supervised) were randomly selected. Among the managed ARI cases, there were more cases of pneumonia in the "mother" areas (29.5%) than in the "CHW" areas (24.9%) (p = 0.003). The study also found that the duration of the prescription period was more appropriate in "CHW" areas (99.5%) than in "mother" areas (97.6%) (p = 0.03). In addition, the reduction in the incidence of complicated cases (before and after intervention) was more significant in "mother" areas (from 69? to 6?, with p = 10?6) than in "CHW" areas (from 24? to 11?, with p = 0.01). The results suggest that mothers with the appropriate training, equipment and supervision are able to manage cases of ARI.

[Knowledge and practices of traditionnal birth attendant on birth asphyxia in Kolokani (Mali)]. / Connaissance et pratique des accoucheuses traditionnelles sur l'asphyxie du nouveau-ne dans le district sanitaire de Kolokani.

INTRODUCTION: In Mali, according to the DHS IV in 2006, the neonatal mortality rate is 46 per thousand live births and is higher in rural areas (61‰) than in urban areas (45‰). The proportion of home births is 54%.The aim of our study was to assess the knowledge and practices of traditional birth attendants (TBAs) on pregnancy and newborn asphyxia in the health district of Kolokani. METHODOLOGY: It was a descriptive cross-sectional study conducted in the health district Kolokani 1st September to 04 October 2004. The study population consisted of traditional birth attendants TBAs. Our study covered 10% of the villages is Kolokani 28 villages randomly selected in 22 health areas. A total of 43 TBAs were interviewed. Data were entered with software EPI-Info version 6 and analyzed on SPSS11. RESULTS: TBAs have said that the main pathologies compromising reproductive health were toxoplasmosis (79%), pelvic pain (74.4%), malaria (46.5%). The main diseases were heralds of a difficult delivery were toxoplasmosis (16.2%), pelvic pain (16.2%), polyhydramnios (11.6%), but 67.4% of TBAs unaware of these pathologies.The main actions carried out before and during childbirth were displays of loin cloth (48.8%), floor sweeping (34.8%), display of drawsheet (30.2%), incantations (27.9%), the knotted strings "tafo" (32.5%). Deliveries conducted by TBAs have been estimated at 52% for all areas. CONCLUSION: At the end of our study we recommend TBA training to reduce the risks associated with home births.

INTRODUCTION: Au Mali, selon l'EDSM IV de 2006, le taux de mortalité néonatale est de 46 pour mille naissances vivantes et est plus élevé en zone rurale (61‰)qu'en zone urbaine(45‰).La proportion d'accouchement à domicile est de 54%. L'objectif de notre étude était d'évaluer les connaissances etles pratiques des accoucheuses traditionnelles sur la grossesse et l'asphyxie du nouveau-né dans le district sanitaire de Kolokani. MÉTHODOLOGIE: Il s'agissait d'une étude transversale descriptivemenée dans le district sanitaire de Kolokani du 1er septembre au 04 Octobre 2004. La population d'étude était constituée par les accoucheuses traditionnelles (AT). Notre étude couvrait 10% des villages de Kolokani soit 28 villages sélectionnés de façon aléatoire dans les 22 aires de santé. Au total 43 AT ont étéinterrogées.Les données ont été saisies sur EPI-Info version 6fr, analysé sur SPSS11. RÉSULTATS: Les AT ont déclaré que les principales pathologies compromettant la santé de la reproduction étaient la toxoplasmose (79%), la douleur pelvienne (74,4%), le paludisme (46,5%). Les principales pathologies annonciatrices d'accouchement difficile étaient la toxoplasmose (16,2%), la douleur pelvienne (16,2%), l'hydramnios (11,6%) et par contre 67,4% des AT ignoraient ces pathologies. Les principaux gestes effectués avant et pendant l'accouchement ont été l'étalage de pagne (48,8%), le balayage de sol (34,8%), l'étalage de l'alèze (30,2%), les incantations (27,9%), les cordelettes à nœuds « tafo ¼ (32,5 %).Les accouchements effectués par les AT on été estimés à 52% pour l'ensemble des aires. CONCLUSION: Au terme de notre étude nous recommandons la formation des AT en vue de réduire les risques liés aux accouchements à domicile.

[Management of sickle cells disease by households in Bamako]. / Enquete cap des menages sur la prise en charge de l'enfant drepanocytaire a Bamako.

The sickle cell disease constitutes a major problem of public health. We find 5% to 20% of carriers of this disease in West Africa and 40% among some populations in central Africa (Congo, Zaire) and Nigeria (Beguè). In Mali prevalence is estimated to 12% with 3% for the homozygote form. It is a known disease and well documented on the scientific plan and its management is better and better codified nowadays, which contributes to the improvement of life quality. For this reason, Centre for Research and Documentation on Child Survival (CREDOS) lead this study. The aim was to assess the knowledge of the mothers for a best management of sickle cell disease in the households. We conducted a cross-sectional study with single passage realized in the households in 6 communes of Bamako district. We inquired 360 parents of children less than 5 years, according to the method of cluster sampling. The study found that 95.8% of mothers know the sickle cell disease. In addition 63.9% of the mothers didn't know the complications of the sickle cell disease and 58% the causes. In the event of discovered sickle cell disease, 58.3% of the mothers stated to want to resort to a medical structure in first intention, 18.3% with self medication and 13.9% with the traditional practitioner. In front of a sickle cell disease crisis, 56% stated to have recourse to modern medicine against 15.2% with the traditional practitioner. Household's implication in the management of the child sickle cell disease suffers a low knowledge of cause, clinical signs, and complications of this disease by the parents. For a better knowledge of this pathology by the families, information and education of the populations through messages BCC are necessary.

[Management of sickle cell disease by health professional in Bamako]. / Enquete cap des agents de sante sur la prise en charge de l'enfant drepanocytaire a Bamako.

The sickle cell disease is a genotypic affection, suited to the black race, characterized by the presence of an abnormal haemoglobin S (HbS). The purpose of this survey was to assess the knowledge, the attitudes and the practices of the health professionals on management of children with sickle cells diseases. We carried out a cross-sectional survey in the health centres and involved 140 health professional of Community Health Centres (CSCOM) and 6 health districts in Bamako. The study found that 72% of health professionals had between 24 and 39 year old; 39% were physician; 77% didn't know the name of the drugs used in case of non complicate sickle cells diseas. Among the health professionals, 81% knew that the sickle cells disease was a blood illness. Our findings suggest that management of children with sickle cells diseases was not performed better due to the knowledge insufficiency of health professionals. We recommend training the health staff.