[Epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré Teaching Hospital]. / Aspects epidemiologiques, cliniques et evolutifs des traumatises cranio-encephaliques graves au service de reanimation polyvalente du CHU Gabriel Toure.

Among traumas, cranial involvement occupies a special place due to their severity and the importance of the sequelae that they can cause. They are said to be serious when the Glasgow Scale (GCS) ≤ 8. The frequency of severe brain injury in the population in African studies ranges from 3.5 to 7. Mortality is, however, poorly known in developing countries, which led us to initiate this work, which aimed to study the epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré University Hospital. MATERIAL AND METHOD: 24-month retrospective study, descriptive and analytical, including all severe traumatic brain injury patients hospitalized in the resuscitation department of Gabriel Touré University Hospital during this study period. RESULTS: During the periodof 1165 patients admitted to the service, 72 were hospitalized for severe cranio-encephalic trauma for a prevalence of 6%. The age group of 21 - 40 years was the majority with (23) or 44.4% and the average age was 30.93 ± 18.8 years with extremes of 8 months and 79 years.The male sex was predominant with (65) or 90.3%, and a sex ratio of 9.28. During our study, (57) or 79.2% of serious traumatic brain injuries were due to road accidents with motorcycle-motorcycle collisions as a mechanism in (20) or 27.8%. Shopkeepers, and students were the most affected social strata with respectively (22) or 30.6% and (20) or 27.8%. Patient transport was provided by non-medical ambulances for (31) or 43.1% and admission time was between 30 minutes and 6 hours in (16) or 22.2% of cases. (62) or 86.1% had GCS between 6-8 and bilateral mydriasis was present in (10) or 13.9% of patients. (9)or 12.5% of patients had hypotension (systolic blood pressure<90 mm Hg) on admission and average blood pressure<90 mmHg was observed in (32) or 44.4% of patients. (23) or 31.9% had a SPO2 <90%. Cranio-encephalic scanning was performed in 62 or 86.1% and discovered as lesions (25) or 34.9% hemorrhagic contusions followed by extradural hematomas (13) or 18.1%. (63) or 87.5%, patients were intubated-ventilated-sedated in addition to resuscitation. (28) or 38.9% of patients had undergone a surgical intervention with (9) or 12.5% having osmotherapy.The evolution was marked by death of (48) or 66.7%. CONCLUSION: Severe cranio-encephalic trauma represents a major cause of morbidity and mortality. The establishment of pre-hospital medicine will allow better care and reduction of mortality by early and continuous management of ACSOS and respiratory and / or hemodynamic distress, which are very often associated with severe TCE.

Parmi les traumatismes, les atteintes crâniennes occupent une place particulière du fait de leur gravité et de l'importance des séquelles qu'elles peuvent entraîner. Ils sont dits graves quand le score de Glasgow (GCS) ≤ 8. La fréquence des traumatismes crânio-encéphaliques (TCE) graves au sein de la population dans les études africaines varie entre 3,5 et 7. La mortalité est cependant mal connue dans les pays en voie de développement ce qui nous a conduit à initier ce travail qui avait pour objetd'étudier les aspects épidémiologiques, cliniques et évolution des traumatisés crâniens graves au service de réanimation polyvalente du centre hospitalier universitaire Gabriel Touré. MATÉRIEL ET MÉTHODE: Etude, descriptive et analytique à collecte rétrospective s'étant déroulée sur 24 mois, incluant tous les patients traumatisés crânio-encéphaliques graves hospitalisés dans le service de réanimation du centre hospitalier universitaire Gabriel Touré durant cette période d'étude. RÉSULTATS: Durant la période sur 1165 patients admis dans le service.72 ont été hospitalisés pour traumatisme crânio-encéphalique grave soit une prévalence de 6%. La tranche d'âge de 21 - 40 ans était majoritaire avec(32) soit 44,4% et l'âge moyen était de 30,93 ±18,8 ans avec des extrêmes de 8 mois et 79 ans. Le sexe masculin était prédominant avec (65) soit 90,3%, et un sex-ratio de 9,28. Durant notre étude (57) soit 79,2% des TCE graves étaient dus aux accidents de la voie publique avec comme mécanisme les collisions moto-moto dans (20) soit27,8%. Les commerçants, et les élèves et étudiants étaient les couches sociales les plus touchées avec respectivement(22) soit 30,6% et (20) soit 27,8%. Le transport était assuré par des ambulances non médicalisées à(31) soit 43,1% et le délai d'admission était compris entre 30 minutes et 6 heures dans (16) soit 22,2% des cas.(62) soit 86,1% avaient GCS entre 6-8 et une mydriase bilatérale était présente chez (10) soit 13,9 % des patients. (9) soit 12,5% des patients avaient présenté une hypotension (pression artérielle systolique< 90 mm Hg) à l'admission et une pression artérielle systolique ≤ 90 mm Hg avait été observée chez (32) soit 44,4% des patients. Durant notre (23) soit 31,9% avaient une SPO2 < 90%. Le scanner cranio-encéphalique a été réalisé chez (62) soit 86,1% et retrouvait comme lésions, les contusions hémorragiques (25) soit 34,9% suivis des hématomes extraduraux (13) soit 18,1%.(63) soit 87,5% des patients ontété intubés -ventilés-sédatés en plus à des mesures de réanimation. (28) soit 38,9% des patients avaient subi une intervention chirurgicale associée chez (9) soit 12,5% à une osmothérapie. L'évolution a été marquée par une létalité de (48) soit 66,7%. CONCLUSION: Les traumatismes crânio-encéphaliques graves représentent une cause majeure de morbi-mortalité. La mise en place d'une médecine préhospitalière permettra une meilleure prise en charge et la réduction de lamortalité.Par une prise en charge précoce et continue des ACSOS et des détressés respiratoires et/ou hémodynamiques qui sont très souvent associées au TCE grave.

The use of adjunctive antipsychotics to treat depression in UK primary care.

OBJECTIVE: Adjunctive antipsychotic therapy can be prescribed to patients with depression who have inadequate response to antidepressants. This study aimed to describe the use of adjunctive antipsychotics over a time period that includes the authorization in 2010 of prolonged-release quetiapine as the first adjunct antipsychotic to be used in major depressive disorder in the UK. RESEARCH DESIGN AND METHODS: Adults with an episode of depression between January 1, 2005 and July 31, 2013 were identified from antidepressant prescriptions and depression diagnoses in the UK Clinical Practice Research Datalink. Patients with prior records of bipolar disorder, schizophrenia, or antipsychotic prescriptions were excluded. MAIN OUTCOME MEASURES: Rates of adjunct antipsychotic initiation and characteristics and management of patients with adjunct antipsychotics. RESULTS: Of 224,353 adults with depression, 5,807 (2.6%) initiated adjunct antipsychotic therapy. Overall incidence of antipsychotic initiation was 7.4 per 1,000 patient-years (95% CI = 7.2-7.6). Between 2005-2013, the overall rate did not change, although initiation of typical antipsychotic prescribing decreased (57.7% to 29.1%), while atypical antipsychotics, especially quetiapine (14.1% to 49.7%), increased. Of those who initiated antipsychotics, 59.4% were women (typical antipsychotics = 62.8%, atypical antipsychotics = 56.1%) and median age was 46 years (typicals = 49 years, atypicals = 44 years). CONCLUSIONS: Antipsychotics were rarely used to treat depression between 2005-2013 in UK primary care. The choice of adjunctive antipsychotic therapy changed over this time, with atypical antipsychotics now representing the preferred treatment choice. However, information on patients strictly cared for in other settings, such as by psychiatrists or in hospitals, potentially more severe patients, was unavailable and may differ. Nonetheless, the high off-label use in primary care, even after the authorization of quetiapine, suggests that there is a need for more licensed treatment options for adjunctive antipsychotic therapy in major depressive disorder.

[Evaluation of rational prescribing and dispensing of medicines in Mali]. / Evaluation de la prescription rationnelle et de la dispensation des médicaments au Mali.

Pharmaceutical policy in Mali is based on the concept of essential medicines and procurement of generic medicines. Unfortunately, increasing availability of generic medicines via different promotional programs can often be accompanied by their irrational use. This survey was thus designed to evaluate rational prescribing and dispensing of medicines in Mali. A cross-sectional survey was conducted from 1998 to 2005 in 30 primary health centers and 30 private dispensaries; in Bamako and in 6 of the 8 other regions of the country. In each of the visited facilities, 20 prescriptions dispensed at the time of the survey were collected. The average number of medicines per prescription was 3.2+/-1.3 and 2.8+/-1.2 respectively in the public and private sectors. Medicines were prescribed under generic name in 88.2% of the public sector prescriptions and in 30.9% of the private sector ones. Antibiotics were prescribed in 70.4% of the public sector prescriptions and in 50.0% of the private sector prescriptions. In the public sector 33.2% of the prescriptions had injections compared with 14.3% in the private sector (p<0.001). The median price per prescription was lower in the public sector (1575.0 CFA F, or 2.4 Euros, of which 91.3% were actually purchased by the patient) than in the private sector (5317.5 CFA F, or 8.1 Euros, of which 84.6% were purchased). Generic medicines are being used in the public sector but less frequently than in private practice. As therapeutic guidelines are already available, it would be useful to institute interactive information for practitioners through intensive visits by more experienced supervisors. The quality of the prescriptions could thus be optimized.

[Study on the availability and cost of medicines in the private sector in Mali]. / Etude sur la disponibilité et les prix des médicaments dans le secteur privé au Mali.

As part of a drive to implement a national pharmaceutical policy in Mali, a joint commission was set up to monitor pharmaceutical products intended for human usage. The commission recommended a study to evaluate the costs of drug procurement by private wholesale importers in Mali, prices charged by wholesalers to private pharmacies and prices paid by patients in private pharmacies. This report describes a study that was carried out in the district of Bamako and regions of Sikasso, Segou and Kayes in June 2004. Data was compiled on 13 importers and 89 pharmacies. Findings showed that the prices of products were relatively stable and that the prices of generic products were highly variable. These findings led to two decrees regulating the price of generic drugs, i.e., first in the public sector (2003) and then in the private sector (2006).

[Emergency contraception among health students in Benin and Mali]. / Conntraception d'urgence chez les etudiantes en sante au Bénin et au Mali.

AIM: The purpose of this study is to help prevent the consequences associated with early sexual activity and fertility in young people. It is intended to analyze the logical use of emergency contraception among health students. MATERIALS AND METHODS: Cross-sectional, the study involved students enrolled for the 2012-2013 academic year. It took place in Bamako and Cotonou over two stages. It had two components, a qualitative preparatory and qualitative decisional one. RESULTS: All students surveyed had heard of contraception. The proportion of students who have had sexual intercourse is 91.2%. During their first sexual intercourse, only 20.3% of sexually active students used a contraceptive method. With regards to the use of emergency contraception by sexually active students, 9 out of 10 have used emergency contraception. CONCLUSION: The analysis of data from this study helps to know that emergency contraception is well known by students in medical academia. And although they are aware of its limitations in terms of protection against unwanted pregnancy and STIs/HIV, they are not ready to focus on condom, which offers them the double protection.

BUT: Le but de cette étude est de contribuer à prévenir les conséquences liées à une activité sexuelle et une fécondité précoces chez les jeunes. Elle se veut d'analyser les logiques d'utilisation de la contraception d'urgence chez les étudiantes en santé. MATÉRIELS ET MÉTHODES: Transversale, l'étude a concerné les étudiants inscrits pour l'année académique 2012­2013 à Bamako et Cotonou. Elle avait deux volets dont un qualitatif préparatoire et l'autre qualitatif décisionnel. RÉSULTATS: Toutes les étudiantes enquêtées ont entendu parler de la contraception. La proportion d'étudiantes ayant déjà eu un rapport sexuel a été de 91,2%. Lors du premier rapport sexuel, seulement 20,3% des étudiantes sexuellement actives ont utilisé un moyen contraceptif. Par rapport au recours à la contraception d'urgence par les étudiantes sexuellement actives, neuf sur dix ont eu recours à la contraception d'urgence. CONCLUSION: L'analyse des données de cette étude permet de savoir que la contraception d'urgence est bien connue des étudiantes en milieu universitaire médical. Et bien qu'elles soient conscientes de ses limites en termes de protection contre une grossesse non désirée et des IST/VIH, elles ne sont pas prêtes à privilégier le préservatif qui leur offre cette double protection.

[Epidemiological aspects of stroke in CT-scan department of the Point-G Hospital in Bamako, Mali]. / Aspects epidémiologiques des accidents vasculaires cérébraux dans le service de tomodensitométrie a L'Hopital du Point G.

The purpose of this prospective study conducted between January 2000 and December 2001 was to identify tomodensitometric aspects of stroke. The relationship between lesion type (hemorrhagic, ischemic, and transient ischemic) and prognosis was assessed. Axial sections were made through the posterior fossa (5 mm at 5mm intervals) and subtentorial region (10 mm at 10 mm intervals). The Virchow plan was used as the reference for sections. The chi square test was used to evaluate the correlation between lesion type and prognosis. A total of 159 stroke patients with a mean age of 44.5 years were enrolled during the study period. There were 90 men (56.6%) and 69 women (43.3%). In 118 patients (74.2%), CT scans showed cerebral abnormalities including ischemic lesions in 71 (44.6%) and hemorrhagic lesions in 47 (29.6%). Overall mortality was 45.7% (54/118). Hemorrhagic lesions were fatal in 51.1% (24/47) of cases and ischemic lesions in 35.2% (25/71). Transitory ischemic accidents were fatal in 0.12% of cases (5/41). This study demonstrates that CT scan is an important tool for stroke management by identifying the type and location of lesions.

Increases in correct administration of chloroquine in the home and referral of sick children to health facilities through a community-based intervention in Bougouni District, Mali.

Save the Children/USA in collaboration with the Ministry of Health of Mali has established over 300 village drug kits in southern Mali since 1996. A cluster-randomized trial was conducted between November 2001 and February 2002 in 10 health zones of Bougouni District to evaluate an intervention to (i) improve the skills of the village drug kit managers to counsel parents on correct home administration of chloroquine (CQ), and (ii) increase the referral of sick children to community health centres (CHC). Children's carers were interviewed 5 d after the sale of CQ about knowledge of danger signs requiring referral, quality of counselling, administration of CQ, and referral. The intervention was associated with significant increases in knowledge of danger signs requiring referral, reported quality of counselling by the manger of the drug kit, and correct administration of CQ in the home. Parents reported that 42.1% of children in the intervention group were referred to the CHC by the drug kit manager compared with 11.2% in the comparison group (odds ratio = 7.12, 95% CI 2.62-19.38). CHC registers indicated that 87.0% of referrals recorded in drug kit referral notebooks arrived at the health centre. Further research is needed to increase the effectiveness of the counselling and the community referral mechanism tested in this study.

Impact of IMCI training and language used by provider on quality of counseling provided to parents of sick children in Bougouni District, Mali.

This study evaluates the impact of the Integrated Management Of Childhood Illness (IMCI) training on quality of counseling provided to caregivers about administration of antimalarials to their children. Ten community health centers in southern Mali were randomized to either training or comparison arms of the study, and health providers' consultations with caregivers were observed. Out of a 10-point counseling scale (Cronbach's alpha=0.77), IMCI-trained providers completed an average of 1.47 (95% CI, -0.25, 3.2) more tasks than did providers who had not received IMCI training in a linear regression analysis that accounted for intra-provider correlations. Drug consultations done in both French and the local language, Bambara, had higher scores than those conducted exclusively in Bambara. The effect of providers receiving IMCI training was more pronounced in bilingual consultations, with an average increase of 2.49 (95% CI, 0.76, 4.22) in IMCI, bilingual consultations, and average increase of 0.87 (95% CI, -0.95, 2.69) in IMCI monolingual (Bambara) consultations as compared to non-IMCI-trained providers in monolingual consultations. IMCI training showed a non-significant trend overall in improving drug counseling provided to caregivers, with significant improvements in bilingual consultations. The IMCI program in Mali should consider strategies such as role-playing of counseling in Bambara or other local languages during training to improve patient-provider communication. Similar problems related to counseling by health workers in local languages are likely to be present throughout Africa, and warrant further study.

[Assessment of chloroquine resistance two years after stopping chemoprophylaxis in 0 to 9-year-old children living in a malaria-endemic village of Mali]. / Evaluation de la chloroquino-résistance après deux années d'arrêt de la chimioprophylaxie chez les enfants de 0-9 ans dans un village d'endémie palustre au Mali.

This study was carried out in the village of Faladié, Mali located in the malaria-endemic Kati region, two years after routine use of chloroquine prophylaxis was discontinued in children 0 to 9 years old. The main purpose of this study was to assess changes in chloroquine resistance. Two cross-sectional surveys in association with WHO in vivo chloroquine sensitivity testing were conducted, i.e., one in September 2000 and one in December 2002. Findings in 2000 showed that 77.5% of mothers administered chloroquine prophylaxis to their children in compliance with physician orders. The plasmodic index was 62%. The overall level of parasitologic resistance (based on the 1996 WHO in vivo tests) was 80%. The overall therapeutic failure rate was 17.5%. Findings in 2002 demonstrated a plasmodic index of 28%, an overall parasitologic resistance rate of 45% (based on WHO in vivo tests), and an overall therapeutic failure rate of 15%. The diminution of resistance in 2002 may be due to the decrease of drugs pressure and to low exposure of individuals to mosquitoes at the end of transmission season. Althougt these data indicate a 44% drop in chloroquine resistance (P=0.0001), no increase in the clinical efficacy of chloroquine was observed (P=0.05). In view of these results we propose more emphasis on information campaigns to increase public awareness of the need for chemoprophylaxis only for pregnant women, on the promotion of the use of bednets and insecticide-impregnated materials, and on environmental management.

Asenapine treatment and health-related quality of life in patients experiencing bipolar I disorder with mixed episodes: post-hoc analyses of pivotal trials.

OBJECTIVE: To evaluate the baseline impact of episode type (manic vs. mixed), defined using DSM-IV-TR criteria, in bipolar I disorder (BD-I) on health-related quality of life (HRQoL), and to investigate the differential effect of asenapine vs. placebo and olanzapine on HRQoL in BD-I patients with mixed episodes. METHODS: In two identically designed 3 week, randomized, double-blind, flexible-dose, placebo- and olanzapine-controlled trials of asenapine, HRQoL was assessed using the 36-item Short-Form Health Survey (SF-36v2) administered at baseline and endpoint. In addition to evaluating the impact of clinical presentation (manic vs. mixed episodes) on baseline HRQoL, the impact of treatment intervention on HRQoL was assessed via analysis of covariance models at study endpoint, with center and treatment-by-diagnosis interaction as fixed effect and baseline score as covariates. RESULTS: A total of 960 BD-I patients (asenapine: 372; olanzapine: 391; placebo: 197) were included in the two studies. The observed burden of disease on HRQoL was substantial compared to general US population norms, particularly in patients experiencing mixed episodes. The greatest impairments were observed in the mental domains of HRQoL (Mental Component Summary scores: mixed = 31.9; manic = 42.8). For patients with mixed episodes, when compared to olanzapine, asenapine treatment was associated with improvements noted in every domain, which did not reach statistical significance except for Vitality (asenapine = 55.0, olanzapine = 51.3; p = 0.014) and Role-Emotional (asenapine = 44.8, olanzapine = 40.3; p = 0.020). Compared to placebo patients with mixed episodes, asenapine treatment provided significant improvements (p < 0.05) in Bodily Pain (asenapine = 50.9, placebo = 45.9), Social Functioning (asenapine = 44.1, placebo = 39.6) and Mental Health (asenapine = 46.6, placebo = 42.7) by Week 3; by comparison, olanzapine treatment did not lead to significant improvements in any domain of HRQoL compared to placebo. CONCLUSIONS: Post-hoc analyses of two trials showed that BD-I patients with mixed episodes reported considerable impairments in HRQoL compared to patients with manic episodes. At 3 weeks, in patients with mixed episodes, asenapine was shown to lead to significant improvements in HRQoL compared to olanzapine and placebo. Results from these post-hoc analyses should be confirmed in prospective studies. TRIAL REGISTRATION: NCT00159744, NCT00159796.

[Anti-tetanus vaccine coverage of mothers of infants under 23 months of age in the Bamako District]. / Couverture vaccinale anti-tetanique des meres d'enfants de moins de 23 mois dans le District de Bamako.

Mali makes left of the 26 important countries in the world of which 18 in Africa for the elimination of tetanus neonatal. The plan of action conceived to this effect doesn't keep the District of Bamako like zone of intervention, had consideration to the sanitary conditions judged among best in the country. However, the district of Bamako arranges today of a number important of peripheral districts whose isolated sanitary realities can generate some indicators different of the middle indicators of the District. It is for this reason that we undertook this work, while using the LQAS method separately in each of the six communes of the district of Bamako, for i) to determine the percentage of mothers of children of 15 at 49 years having received at least two doses of antitetanus vaccine at the time of their last pregnancy in each of the six communes of the district, ii) to identify the non effective zones of the district concerning vaccination of mothers of children of less than 23 months. It was about an investigation of antitetanus vaccinal coverage of mothers of children of less than 23 months by gone residents since at least 3 months in the six communes of the district of Bamako in April 2004. The vaccinal status of targets of the survey was established from the card of vaccination or the notebook of health delivered at the time of the prenatal consultations. In the first five communes, for topics not having card or notebook of health us established the vaccinal status also by cross-examination, what has been qualified of determination of the statute by " history ", Of the survey it comes out again that the rates of cover in at least two doses of antitetanus antigen of mothers of children of less than 23 months vary from 17.6 ± 7.2% (Commune V ) to 78.4 ± 7.0% (Commune II) according to the card. In the first five townships these rates go from 46.3 ± 9.5 % (commune V) to 94.01 ± 3.4% (commune IV) according to the card and history. According to the card, the communes I, IV and V, didn't record any zone of cover of the CSCOMS concerning vaccinations where the rate of mothers having received the VAT2 reaches 80%, in reference to the value of decision (6) either vaccinated at least 13 topics (68,4%) by lot. The assessment of the coverage according to the card and history improves this weak performance noted in certain zones of cover (communes I, III, IV). Results of this survey put as it was always the case the problem of data compilation concerning assessment of the vaccinal coverage. And for reasons of efficiency, an approach associating the backing of the routine's vaccination, of countries of mass magazines and a highly efficient surveillance of tetanus neonatal is to consider.

[Coverage rate and satisfaction of populations after mass treatment with praziquantel and albendazole in Mali]. / Taux de couverture et satisfaction des populations apres traitement de masse au praziquantel et a l'albendazole au Mali.

In Mali, schistosomiasis always remains a major public health problem. In 2005, mass treatment campaigns with praziquantel and albendazole have been organized in all endemic regions. The present study aimed to assess the impact of these mass treatment campaigns and the recipient's satisfaction in two endemic areas (Mopti and Ségou). It was a cross-sectional study with one passage from February to March 2006. The study carried out on political authorities (n=142), teachers and school administers (n=70), health workers (n=46), community distributors (n=33), community members (n=2170) and pupils (n=2480). We used Lot Quality Assurance Sample (LQAS) to determine treatment coverage and recipient's satisfaction. Two types of lots were considered, villages and schools. Questionnaires were used for investigation. In Ségou, the treatment rates varied from 100% at school level and in community in Bla district to 97.2% in the community of Ségou town. In Mopti, a treatment rate of 100% was observed in Bankass and Douentza both at school and in the community. The proportion of happiest individuals (to feel well) after the mass treatment campaign was 72.3% among pupils and 76.6% in the community. The results of this study suggest that the high treatment coverage rates observed during these campaigns should be sustained by a yearly chemotherapy strategy preceded by a community's health education programmes.

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

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

[Haemophilus influenzae b among bacterial meningitis in Bamako (2002-2004)]. / Haemophilus influenzae b parmi les méningites bactériennes a Bamako (2002-2004).

In Mali little study exist on the meningitis with Haemophilus influenzae b (Hib). This weak data availability on Hib meningitis, didn't permit to introduce the immunization against this pathology in the Expanded Program Immunization (EPI) of Mali. The present survey aims to improve the availability of the data on Hib meningitis and to advocate for the introduction of immunization against Hib in EPI in Mali. The survey consisted to the exploitation of spinal fluid examination data for the suspected cases of meningitis, sent by the different health centers to National Institute for Public Health Research (INRSP) on the period going from October 1st, 2002 to September 30, 2004. According to the survey, on 230 cases of meningitis whose germs have been identified to the latex and the culture, Hib occupies the 3rd place with 21.3% among the bacterial meningitises. In Bamako Hib occupies the 2nd place (27.4%) according to the source. The persons less than 1 year (59.6%) were the more affected (p < 0.001) and the diseases distribution has been observed during the dry seasons (51.0%) and rainy (49.0%) without meaningful impact of temperature and rainfall (p > 0.05) (p = 0.8249). The cases of Hib identified were more sensitive to ciprofloxacine (100%) and to ceftriaxone (100%). Taken into consideration the cost raised of quinolones and cephalosporines, and in reference to the high mortality and frequent complications known of Hib meningitis, the introduction of immunization against Haemophilus influenzae in the Expanded Program Immunization should contribute to a better control of this disease.

[Prescribing and drug utilization at community health centers]. / Pratiques de prescription dans les centres de sante communautaires (CSCOM) et utilisation des midicaments par les populations.

The rationalization of the prescription and the good use of the drugs generally constitute a major problem in the health facilities. The present survey led in November 2002 in Mali assessed the practices of prescription and the use of the drugs by the populations. The indicators of drugs use rational have been measured from 600 drawn prescriptions randomly select at the level of 20 community health center (CSCOM) retained at random in the regions of Ségou, Sikasso, Mopti and the District of Bamako. The means of drugs by order (2.8), the percentages of prescription with antibiotic (61.6%) and injectable drugs (35%) are raised in relation to the normative values of WHO (Wold Health Organization). The rate of conformity to the treatments standardized estimated on exploitation of consultations registers in the centers is estimated to 0.5% for the simple diarrhoea, 13.5% for the acute respiratory infections (ARI) without pneumonia and 60.5% for the pneumonia. On 293 patients in the households our survey permitted to estimate to 84.6% the observance of the treatment by the persons having bought the prescribed drugs totality. The percentage of antibiotics prescription and injectable drugs, and the big insufficiency in the non respect of the treatment standard constitutes some practices potentially to high risk justifying the necessity of an urgent training to the rational prescription.

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

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

Prevalence and perception of schistosomiasis in irrigated rice field area in Mali.

Summary The aim of this work was to assess prevalence and clinic of schistosomiasis as well as the knowledge, attitude and practice (KAP) of populations living in the village of Molodo, a rice irrigated area of Mali. By cross sectional survey with a single passage, we enrolled 346 children aged of 7 to 14 years and 308 parents. The prevalence of Schistosoma haematobium and S. mansoni were respectively 72% and 68%. Micro-hematuria (Sy=86%; Sp=45%), urinary difficulty (Se=828% ; Sp=33%), high frequency of urine (Se=76% ; Sp=31%) and suspubians pain (Se=78% ; Sp=31%) associated with urinary schistosomiasis indicated that these symptoms could be relevant diagnosis signs. Similar observations could be considered as a good sign of diagnosis of intestinal schistosomiasis due to S. mansoni with abdominal pains (Se=75% ; Sp=36%), to have a fancy of stool (Se=75% ; Sp=32%), diarrhea (Se=71% ; Sp=32%), des conjunctival paleness (Se=85,% ; Sp=33%) et de spleen enlargement (Se=71% ; Sp=33%). The transmission patterns of schistosomiasis were not well known by populations, because only 15% of pupils and 38% of parents incriminated the canal and/or the 'fala" (the lake) as genitourinary bilharzias contamination source especially after bathing. The intestinal form was known by 11% of pupils and by 24% of parents. These results show that in spite of schistosomiasis endemic pattern, in this area, populations didn't know well this pathology.

Attitude and practice of health staff in the management of simple malaria in the health district of niono in mali.

Summary The aim of this work was to assess the attitude and practice of health staff about malaria. We undertook a cross sectional survey in the district hospital, two community health centers (CSCOM), one private doctor's cabinet and one private nurse's cabinet. We observed the doctors and the nurses during the visit of 261 patients. The most frequent presumption diagnosis was simple malaria without vomiting (53%). Among presumption diagnosis the high frequency of confirmed cases was malaria with vomiting (42%). In the health center, injectable quinine was the most prescribed drug (82%), followed by chloroquine (23%). The injectable quinine was more prescribed by nurses (85%) than doctors (15%) (p=10-6). At the time of follow-up, 98% of patients was cured clinically. Even though malaria was the first reason of visit (99,2%), only one out of ten practitioners checked up temperature of patients. Treatment administered dit not follow guidelines suggested by the national program for malaria control. We thus suggested the training of health staff as well as regular supervision of health centers.