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Background: Healthcare-associated infections (HAIs) are increasing in health facilities in Mali, due to health disparities and growing costs. Twenty to fifty percent of HAIs in the surgery department can be prevented with appropriate measures. Objectives: This study aimed to determine the burden of HAI and its risk factors. Materials and Methods: This was a prospective cohort study from January to June 2021 at the CHU Gabriel TOURE, Bamako, Mali. The sample size was determined based on the CDC Atlanta criteria, used to confirm HAI in surgical settings. Demographic, clinical, and biological parameters were determined. For the confirmed case of infection, the incriminated bacteria were isolated and tests were performed for the choice of drugs. Results: Of the total 1001 patients included in this study, 195 patients (19.48%) have HAIs. The types of infections were as follows: 70 cases of surgical site infections, 54 infections on burns victims, 40 urinary tract infections, and 31 cases of bacteraemia. Germs such as Escherichia Coli, Klebsiella pneumoniae, and Acinetobacter were often isolated. We found increasing hospital stays as well as some postoperative mortality related to infections. At the end of this study, corrective efforts were implemented to prevent HAI. Among them are improvements in sterilisation techniques as far as surgical materials were concerned. In addition to a surgical checklist, locally used drapes were replaced with single-use surgical supplies. Advanced training of the surgical team on things such as bladder catheterisation was also conducted in the department. It is important to put in place a committee, to prevent nosocomial infection in our hospital. The selected committee will be responsible for planning and implementing diverse strategies to prevent infections. Conclusions: The prevention of HAIs will reduce health costs and improve the quality of surgical care.
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ContextIn low-income settings where access to biological diagnosis is limited, data on the spread of the COVID-19 epidemic are scarce. In September 2020, after the first COVID-19 wave, Mali reported 3,086 confirmed cases and 130 deaths. Most reports originated form Bamako, the capital city, with 1,532 reported cases and 81 deaths for an estimated 2.42 million population. 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 also assessed demographic, social and living conditions, health behaviors and knowledge associated with SARS-CoV-2 seropositivity. Material and methodsWe conducted a cross-sectional multistage cluster household survey in commune VI, which reported, September 2020, 30% (n=466) of the total cases reported at Bamako. We measured serological status by detection of SARS-CoV-2 spike protein Antibodies in venous blood sampled after informed consent. We documented housing conditions and individual health behaviors through KABP questionnaires among participants aged 12 years and older. We estimated the number of SARS-CoV-2 infections and deaths in the total population of Bamako using the age and sex distributions of SARS-CoV-2 seroprevalence. A logistic generalized additive multilevel model was performed to estimate household conditions and demographic factors associated with seropositivity. ResultsWe recruited 1,526 inhabitants in the 3 investigated areas (commune VI, Bamako) belonging to the 306 sampled households. We obtained 1,327 serological results, 220 household questionnaires and collected KABP answers for 962 participants. The prevalence of SARS-CoV-2 seropositivity was 16.4% after adjusting on the population structure. This suggested that [~]400,000 cases and [~] 2,000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. KABP analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown or curfew), and limited mask wearing. ConclusionIn spite of limited numbers of reported cases, 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. This highlight the difficulty of developing epidemic control strategies when screening test are not available or not used, even more when the transmission modalities are not well known by the population. Targeted policies based on health education prevention have to be implemented to improve the COVID-19 risk perception among the local population and fight to false knowledge and beliefs.
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Objective To compile available data and to estimate the burden, characteristics and risks factors of cutaneous leishmaniasis (CL) in Mali. Methods Articles in English and French were searched in Hinari, Google scholar and PubMed. Unpublished studies were identified by searching in Google.com. Terms used were cutaneous leishmaniasis Mali; Leishmaniasis Mali, Leishmania major Mali; or Phlebotomus Mali or Sergentomyia Mali. We select descriptive studies on CL and sandflies in Mali. Data were extracted and checked by the author, then analyzed by region, by study population and type of biological tests, meta-analysis approach with STATA software was used. Results Nineteen published (n = 19) and three unpublished were included. CL epidemiology was characterized by occurrence of clinical cases in different areas of Mali, outbreaks restricted to known areas of transmission and isolated cases diagnosed in travelers. In endemic areas, population at risk are young age persons, farmers, ranchers, housewives, teachers and military personnel. The annual incidence ranged from 290 to 580 cases of CL. Leishmania major is the main species encountered throughout the country (North Savanna, Sahel and Sub-Saharan areas), and Phlebotomus duboscqi has been identified as the vector and Sergentomyia (Spelaeomyia) darlingi as possible vector. The overall estimated prevalence of positive LST (Leishmanin Skin Test) was 22.1%. The overall frequency of CL disease among suspected cases was 40.3%. Conclusions Although descriptive, hospital-based and cross-sectional studies are robust enough to determine the extent of CL in Mali; future well-designed eco-epidemiological studies at a nationwide scale are needed to fully characterize CL epidemiology and risk factors in Mali.
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OBJECTIVE@#To compile available data and to estimate the burden, characteristics and risks factors of cutaneous leishmaniasis (CL) in Mali.@*METHODS@#Articles in English and French were searched in Hinari, Google scholar and PubMed. Unpublished studies were identified by searching in Google.com. Terms used were cutaneous leishmaniasis Mali; Leishmaniasis Mali, Leishmania major Mali; or Phlebotomus Mali or Sergentomyia Mali. We select descriptive studies on CL and sandflies in Mali. Data were extracted and checked by the author, then analyzed by region, by study population and type of biological tests, meta-analysis approach with STATA software was used.@*RESULTS@#Nineteen published (n = 19) and three unpublished were included. CL epidemiology was characterized by occurrence of clinical cases in different areas of Mali, outbreaks restricted to known areas of transmission and isolated cases diagnosed in travelers. In endemic areas, population at risk are young age persons, farmers, ranchers, housewives, teachers and military personnel. The annual incidence ranged from 290 to 580 cases of CL. Leishmania major is the main species encountered throughout the country (North Savanna, Sahel and Sub-Saharan areas), and Phlebotomus duboscqi has been identified as the vector and Sergentomyia (Spelaeomyia) darlingi as possible vector. The overall estimated prevalence of positive LST (Leishmanin Skin Test) was 22.1%. The overall frequency of CL disease among suspected cases was 40.3%.@*CONCLUSIONS@#Although descriptive, hospital-based and cross-sectional studies are robust enough to determine the extent of CL in Mali; future well-designed eco-epidemiological studies at a nationwide scale are needed to fully characterize CL epidemiology and risk factors in Mali.
