SARS-CoV-2 seroprevalence and living conditions in Bamako (Mali): a cross-sectional multistage household survey after the first epidemic wave, 2020.

OBJECTIVES: In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity. SETTINGS: We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported. PARTICIPANTS: We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years). PRIMARY AND SECONDARY OUTCOME MEASURES: We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions. RESULTS: The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing. CONCLUSIONS: The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting. ETHICS: This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH.

[Clinical and epidemiological characteristic of COVID-19 deaths in Mali]. / Caracteristiques clinique et epidemiologique des deces COVID-19 au Mali.

INTRODUCTION: Mali recorded its first COVID-19's death related case on March 26, 2020. The aim of this study was to evaluate the comorbidity of COVID-19's death related cases in the Malian context. METHOD: A cross-sectional study was conducted between March 25 and October 11, 2020. Community death information was analyzed from the patient descriptive list, and from the hospitalization registry of the treatment sites. RESULT: Of the 3,286 COVID-19 confirmed cases, 132 died making a lethality rate of 4.00% (132/3286). Men were the most represented with 75.76% (100/132). The mean age was 63.77 ± 15.25 years. The mean time of hospital stay was 4.50 days ± 6.35. Diabetes and cardiovascular disease remain the most frequent comorbidities with death patients with 20.45% and 17.42%, respectively. CONCLUSION: The results of this study allow to draw map of patients who died from COVID-19 as well as provide information on the comorbidities for better management of hospitalized patients.

INTRODUCTION: Le Mali a enregistré son premier cas de décès lié à la COVID-19, le 26 mars 2020.Le but de cette étude est d'étudier la comorbidité des cas de décès de COVID-19 dans le contexte malien. MÉTHODE: Il s'agissait d'une étude transversale allant de la période du 25 mars au 11 octobre 2020. Nous avons réalisé une analyse des informations de la liste descriptives des cas pour les décès communautaire et des registres d'hospitalisation des sites de prise en charge. RÉSULTAT: Sur les 3286 cas confirmés par la COVID-19, 132 malades en sont décédés soit une létalité de4,00%. Les hommes étaient les plus représentés avec 75,76 % (100/132). La moyenne d'âge était de 63,77 ans ± 15,25. La durée moyenne d'hospitalisation était de4,50 jours ± 6,35. Le diabète et l'HTA étaient les facteurs de comorbidité les plus fréquents rencontrés dans les cas de décès avec respectivement 20,45% et 17,42%. CONCLUSION: Cette étude a montré que les cas de décès liés au COVID-19 au Mali étaient observés chez les personnes âgées, diabétiques et hypertendues. Ces informations aideront à optimiser la prise en charge des malades hospitalisés.

[Management of addictions at the University Hospital Center Point G, Bamako-Mali]. / Prise en charge des addictions au Centre Hospitalier Universitaire du Point G, Bamako-Mali.

OBJECTIVE: To evaluate the health impact of drug use among patients in care in the psychiatric unit of the University Hospital Center Point G. METHOD: This was a prospect in description study of drug users admitted to the G-UHC for care. From January to July 2018. It was performed in the Psychiatry Department of the University Hospital Center Point G in Bamako, which is the only structure in Mali that deals with addiction. RESULTS: Our results show that young people in the 20-30 year group were the most affected. Cannabis was the most consumed, followed by Alcohol, and Tramadol Hydrochloride. There were cases of poly-drug abuse as well as new forms of consumption. Drug use has multiple negative consequences on health and social life: addiction, psychopathological disorders. CONCLUSION: Substance abuse of drugs is a reality that is gaining momentum in Mali. Our study have demonstrated its sanitary impact among patients with adduction. The fight against the use of drugs requires the combined efforts of all the actors involved.

OBJECTIF: Evaluer l'impact sanitaire de la consommation des drogues chez les patients pris en charge au service de psychiatrie du Centre Hospitalier universitaire du Point G. MÉTHODE: Il s'agissait d'une étude prospective descriptive chez les patients consommateurs de drogues admis au CHU du Point G pour des soins. Elle a été réalisée de janvier à juillet 2018. Elle a été réalisée dans le service de Psychiatrie du Centre Hospitalier Universitaire du Point G à Bamako, Mali, l'unique structure au Mali qui fait la prise en charge de l'addiction. RÉSULTATS: Nos résultats ont montré que les jeunes de la tranche 20-30 ans étaient les plus touchés. Le Cannabis était le plus consommé, suivi la de l'Alcool, et du Chlorhydrate de Tramadol. La polytoxicomanie ainsi que des nouvelles formes de consommation avait été notée. La consommation de drogues avait généré de multiples conséquences néfastes sur la santé et la vie sociale : la dépendance, les troubles psychopathologiques. CONCLUSION: L'abus de substances psychoactives, est une réalité qui prend de l'ampleur au Mali. Notre étude a démontré son impact sur la santé des consommateurs. La lutte contre l'usage des drogues nécessite la conjugaison des efforts de tous les acteurs impliqués.

[Management of acquired urethral stricture: our experience in the Division of General Surgery in Sikasso]. / Prise en charge du rétrécissement urétral acquis: expérience du Service de Chirurgie Générale de Sikasso.

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.

[Urogenital fistulas at Sikasso: about 150 cases]. / Fistule urogénitale à Sikasso: à propos de 150 cas.

This study aims to analyze the epidemiological, clinical, therapeutic and anatomopathologic features of urogenital fistulas. We conducted a retrospective study of patients with urogenital fistulas admitted to the department of general surgery and gynecology and obstetrics between January 1, 2014 and December 30, 2015, including the first 5 fistula repair campaigns organized by the Fistula Mali project. Urogenital fistulas account for 19.53% of all urologic disorder treated during our daily practice. The median age at first marriage was 16.57 years. The majority of our patients (96.70%) was illiterate and self-employed, coming from rural areas (85.36%). Obstructed labour was the dominant etiology, with 91.50% of stillborn children. The patients were primiparous women (43.33%) and, among them, 53.60% received no prenatal care. The divorce rate associated with the disease was 7.30%. Most patients underwent simple fistulorraphy, of whom 121 underwent lower fistulorraphy, 26 upper fistulorraphy and 3 mixed fistulorraphy. Outcomes were satisfactory in 65.33% patients and poor in 34.66% of patients. Patients with type I and type V obstetric fistulas had the highest healing rate compared to patients with type IV fistulas. Urogenital fistulas are a real public health problem. Treatment is mainly based on surgery and prognosis is compromised by the narrowness of the surgical field, the complexity of the lesions and the condition of the surrounding tissue. The focus must be on the implementation of women's socio economic development programs and on emergency obstetric care access. The research and discussion should continue to facilitate the development of a standard classification.

[Bladder leiomyosarcoma: about 3 cases]. / Le léiomyosarcome de la vessie: à propos de 3 cas.

Bladder leiomyosarcoma is a rare highly malignant tumor. It can occur in children and adults with a maximum incidence in patients over 60 years of age. It mainly affects men, with a sex ratio of 3/1. Its clinical features are non-specific and dominated by the haematuria. Endoscopic resection of the bladder associated with anatomo-pathological examination allow the diagnosis. Its treatment remains controversial due to the rarity of cases reported in the literature. Neoadjuvant chemotherapy followed by radical cystectomy is the treatment of choice, if the patient's clinical condition permit. We report 3 cases of bladder leiomyosarcoma treated by radical cystectomy and with uneventful postoperative course.