Seasonality and shift in age-specific malaria prevalence and incidence in Binko and Carrière villages close to the lake in Selingué, Mali.

BACKGROUND: Malaria transmission in Mali is seasonal and peaks at the end of the rainy season in October. This study assessed the seasonal variations in the epidemiology of malaria among children under 10 years of age living in two villages in Selingué: Carrière, located along the Sankarani River but distant from the hydroelectric dam, and Binko, near irrigated rice fields, close to the dam. The aim of this study was to provide baseline data, seasonal pattern and age distribution of malaria incidence in two sites situated close to a lake in Selingué. METHODS: Geographically, Selingué area is located in the basin of Sakanrani and belongs to the district of Yanfolila in the third administrative region of Mali, Sikasso. Two cross-sectional surveys were conducted in October 2010 (end of transmission season) and in July 2011 (beginning of transmission season) to determine the point prevalence of asymptomatic parasitaemia, and anaemia among the children. Cumulative incidence of malaria per month was determined in a cohort of 549 children through active and passive case detection from November 2010 through October 2011. The number of clinical episodes per year was determined among the children in the cohort. Logistic regression was used to determine risk factors for malaria. RESULTS: The prevalence of malaria parasitaemia varied significantly between villages with a strong seasonality in Carrière (52.0-18.9 % in October 2010 and July 2011, respectively) compared with Binko (29.8-23.8 % in October 2010 and July 2011, respectively). Children 6-9 years old were at least twice more likely to carry parasites than children up to 5 years old. For malaria incidence, 64.8-71.9 % of all children experienced at least one episode of clinical malaria in Binko and Carrière, respectively. The peak incidence was observed between August and October (end of the rainy season), but the incidence remained high until December. Surprisingly, the risk of clinical malaria was two- to nine-fold higher among children 5-9 years old compared to younger children. CONCLUSIONS: A shift in the peak of clinical episodes from children under 5-9 years of age calls for expanding control interventions, such as seasonal malaria chemoprophylaxis targeting the peak transmission months.

[Spatio-temporal analysis of the incidence of morbidity and mortality from severe malaria in the Sélingué health district, Mali]. / Analyse spatio­temporelle de l'incidence de la morbidite et de la mortalite du paludisme grave dans le district sanitaire de Selingue, Mali.

AIMS/OBJECTIVES/ASSUMPTION: In Mali, malaria is the leading cause of death and consultations in health facilities. The objective of this study was to examine trends in morbidity and mortality among children aged 0 to 15 years and to establish accurate mapping of the distribution of cases in health areas of the Sélingué health district. MATERIALS AND METHOD: A retrospective analysis of hospital records at the Sélingué district reference health center from 2010 to 2013 was conducted. Trend Chi2 and logistic regression were used, respectively, to compare changes in trends between health areas and to identify risk factors associated with malaria mortality. RESULTS: Among the 1282 cases of malaria, the incidence of severe malaria gradually decreased from 96.75 ‰ (671 cases) in 2010 to 34.23 ‰ (291 cases) in 2011, 19.76 ‰ (168 cases) in 2012 and 19.43 ‰ (152 cases) in 2013. From 2010 to 2013, there was an average monthly variation in October of 26, 6% cerebralmalaria and 23.3% malaria anemia by the month of July of the same year. Spatial variation of anemic forms of malaria between health areas (p < 0.001) was observed from 2010 to 2013. From 2012 to 2013, there was an overall decrease in the frequency of hospitalizations, incidence and death rate for severe malaria. In multivariate analysis, in the final model, malaria lethality was associated with the duration of hospitalization for more than three days (OR = 0.124); the year of hospitalization from 2010 to 2012 (OR = 0.813); the absence of blood transfusion of the patient (OR = 0.282); at the age of the patient in children under one year (OR = 0.356) and at the emergency anti-malarial treatment instituted with artemether (OR = 3.006) adjusting for the form of malaria. On the other hand, malaria lethality was not related to the form of malaria (p = 0.072), sex (p = 0.390), residence (p = 0.308), prior treatment before hospitalization (p = 0.949). at fever in children (p = 0.153) adjusting for other variables in the model. CONCLUSION: Hospital case fatality remains high with a drop in the incidence of morbidity and mortality; a monthly variation in morbidity and mortality with two peaks, July - August and October-November and the emergency treatment instituted with artemether, the length of hospital stay could be identified as associated factors.

BUT/OBJECTIFS/HYPOTHÈSE: Au Mali, le paludisme est la principale cause de décès et de consultations dans les formations sanitaires. L'objectif de cette étude était de déterminer l'incidence de la morbidité et de la mortalité chez les enfants de 0 à 15 ans et d'établir une cartographie précise de la répartition des cas dans les aires de santé du district sanitaire de Sélingué. MATÉRIELS, MÉTHODE: Une analyse rétrospective des dossiers d'hospitalisation des enfants de 0 à 15 ans au niveau du centre de santé de référence du district de Sélingué de 2010 à 2013 a été réalisée. Le test de Chi2 de tendance et la régression logistique ont été utilisés respectivement pour comparer les variations de l'incidence entre les aires de santé et identifier les facteurs de risque associés à la mortalité palustre. RÉSULTATS: Parmi les 1282 cas de paludisme, l 'incidence du paludisme grave a diminué progressivement de 96,75‰ (671 cas) en 2010 à 34,23 ‰ (291 cas) en 2011, 19,76‰ (168 cas) en 2012 et 19,43‰ (152 cas) en 2013 (Chi2 de tendance p < 0,001). La létalité palustre a été de 15,13%, et n'a pas significativement varié, avec 13,31 % en 2010 et 14,05 % en 2013. De 2010 à 2013, on notait une variation mensuelle moyenne en octobre de 26,6% neuro paludisme et 23,3% de paludisme anémique vers le mois de juillet de la même année. Une variation spatiale des formes anémiques du paludisme entre les aires de santé (p < 0,001) a été observée de 2010 à 2013. De 2012 à 2013, il a été observé une baisse globale de la fréquence des hospitalisations, de l'incidence et du taux de décès pour le paludisme grave. En analyse multivariée, dans le modèle final, la létalité palustre était associée à la durée de l'hospitalisation de plus de trois jours (OR = 0,124) ; à l'année d'hospitalisation de 2010 à 2012 (OR = 0,813) ; à l'absence de transfusion sanguine du patient (OR = 0,282) ; à l'âge du patient chez les moins d'un an (OR = 0,356) et au traitement d'urgence anti paludique institué avec l'artemether (OR = 3,006) en ajustant pour la forme du paludisme. En revanche la létalité palustre n'était pas liée à la forme du paludisme (p = 0,072), au sexe (p = 0,390), à la résidence (p = 0,308), au traitement antérieur avant l'hospitalisation (p = 0,949), à la fièvre chez l'enfant (p = 0,153) en ajustant sur les autres variables dans le modèle. CONCLUSION: La létalité palustre hospitalière reste élevée avec une baisse des incidences de la morbidité et de la mortalité ; une variation mensuelle de la morbidité et de la mortalité avec deux pics, juillet - août et octobre-novembre et le traitement d'urgence institué avec l'artemether, la durée d'hospitalisation ont pu être identifiés comme des facteurs associés.

[Epidemiological And Clinical Survey Of The Diabetes Sweetens In A Center Of Health Of Reference Of Sikasso]. / Etude Epidemiologique Et Clinique Du Diabete Sucre Dans Un Centre De Sante De Reference De Sikasso.

GOAL: To study the diabetes sweetened in farming environment in the sanitary district of Selingue (CS Ref of Selingue). MATERIALS AND METHODS: It was about a descriptive survey done from January 01 to June 30, 2016 with a prospective compilation of data in the center of health of reference of Selingue (CS Ref of Selingue). All our patients benefitted from a complete clinical exam with research of factor of risk and reverberation of the diabetes.The statistical test used was Chi-square 2 with a threshold of significance p ≤ 0.05. RESULTS: Among the 1 525 patients collected, 84 were diabetic is a hospitable frequency of 5, 51% and the average age of 51, 43 years ±12, 25.The sex ratio was 1, 33. Diabetes type 2 was in 98% of cases. We did not record specific diabetes or gestational diabetes. A sedentary lifestyle was found in 70, 23% of the cases followed by Dyslipidemia with 42.85% of the cases. 1.2% of our patients presented an AOMI, a fifth of our patients have suffered from erectile dysfunction, 2/3 had a diabetic neuropathy and 4% had a wound. (P: 0.048) neuropathy and nephropathy (p: 0.016) diabetic were correlated with blood sugar imbalance. CONCLUSION: the gravity, the inaccessibility and the cost raised of the follow-up balances in Selingue limit the hold in charge of the diabetes in this sanitary district.

BUT: Etudier le diabète sucré en milieu rural dans le district sanitaire de Sélingué (CS Réf Sélingué). MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude descriptive effectuée du 01 janvier au 30 juin 2016 avec un recueil prospectif des données au Centre de Santé de Référence de Sélingué (CS Réf de Sélingué). Tous nos patients ont bénéficié d'un examen clinique complet avec recherche de facteurs de risque et de retentissement du diabète. Le test statistique utilisé était le Khi 2 avec un seuil de significativité p ≤ 0,05. RÉSULTATS: Parmi les 1 525 dossiers de patients colligés, 84 était diabétiques soit une fréquence hospitalière de 5,51 % et l'âge moyen de 51,43 ans ± 12,25. Le sex ratio était de 1, 33. Le diabète était de type 2 dans 98% des cas. La sédentarité était retrouvée dans 70,23 % des cas suivie de la dyslipidémie avec 42,85 % des cas. 1,2 % de nos patients ont présenté une AOMI, un cinquième de nos patients ont souffert d'une dysfonction érectile, 2/3 avaient une neuropathie diabétique et 4 % avait une plaie. La neuropathie (p: 0,048) et la néphropathie (p: 0,016) diabétique étaient corrélées au déséquilibre glycémique. CONCLUSION: La gravité, l'inaccessibilité et le coût élevé des bilans de suivi à Sélingué limitent la prise en charge du diabète dans ce district sanitaire.

Ethnobotanical study of plants used against malaria in Sélingué subdistrict, Mali.

ETHNOPHARMACOLOGICAL RELEVANCE: Plants have contributed to food security and disease treatments to rural populations in sub Saharan Africa for many centuries. These plants occupy a significant place in the treatment of diseases, such as malaria. In Mali, malaria is the leading cause of medical consultation and death. This infection is particularly dangerous for pregnant women and children under 5 years. The general aim of this research was to collect data on the knowledge of traditional health practitioners on malaria in the Sélingué area; particularly to document how traditional healers conceptualize and diagnose malarial disease and to collect and identify medicinal plants or other substances used for their health and well-being. MATERIALS AND METHODS: An ethnobotanical survey was conducted on simple and complicated malaria in six villages in Sélingué subdistrict in a period of 2 months. The ethnobotanical data was collected by means of semi-structured interviews and questionnaires. In total 50 traditional healers were interviewed. RESULTS: Two concepts of malaria (simple and complicated malaria) were cited and 97 plants used to treat malaria were identified. Decoctions and bathing (whole body) proved to be the most commonly used mode of application. Food attitudes and mosquitoes are perceived to be the most important causes of the disease. Trichilia emetica, Mitragyna inermis, Sarcocephalus latifolius, Cassia sieberiana, Cochlospermum tinctorium, Anogeissus leiocarpa, Guiera senegalensis and Entada africana were quoted as the most used in the treatment of malaria. CONCLUSION: Knowledge about malaria and traditional treatment practices exist in Sélingué subdistrict. Herbal remedies are commonly used by people for the treatment of malaria because they are believed to be cost-effective and more accessible. Many of the plant species used for the treatment of malaria have not been well documented as well as their phytochemical and antimalarial activity.