[Safe motherhood initiative: from control to trust]. / Maternité sans risque: du contrôle à la confiance Analyse anthropologique du risque au Mali (Afrique de l'Ouest).

OBJECTIVES: This article addresses risk management in maternal health in Mali. Risk concept is used as a tracer to investigate uncertainties and their answers at the different levels of maternal health. Representations and practices related to risk are analyzed through concept of trust and uncertainties linked to the maternal health system reform. METHODS: We investigated the conceptions and practices related to risks, changes and uncertainties through qualitative investigations and analyses, taking into account different levels of health reforms (policy-makers, regional managers, practitioners, consumers). Forty-nine qualitative and semi-structured interviews were carried out in urban, semi-urban and rural environment in Mali. RESULTS: In order to reach a better management of risk in maternal health, through action coordination, it is necessary to analyzed real, observed and perceived risks through its different meanings. Depending on representations, risk is seen as measurable data or uncertainty; all revealing specific approaches of unpredictable event. CONCLUSION: Safe motherhood call for a better control on danger associated to pregnancy and birth. Such control is allowed by the elaboration of a relation of trust between population and its health system.

["Safe motherhood initiative: from control to trust." Anthropologic analysis of risk in Mali (West Africa)]. / "Maternité sans risque: du contrôle à la confiance". Analyse anthropologique du risque au Mali (Afrique de l'Ouest).

OBJECTIVES: This article addresses risk management in maternal health in Mali. Risk concept is used as a tracer to investigate uncertainties and their answers at the different levels of maternal health. Representations and practices related to risk are analyzed through concept of trust and uncertainties linked to the maternal health system reform. METHODS: We investigated the conceptions and practices related to risks, changes and uncertainties through qualitative investigations and analyses, taking into account different levels of health reforms (policy-makers, regional managers, practitioners, consumers). Forty-nine qualitative and semi-structured interviews were carried out in urban, semi urban and rural environment in Mali. RESULTS: In order to reach a better management of risk in maternal health, through action coordination, it is necessary to analyze real, observed and perceived risks through its different meanings. Depending on representations, risk is seen as measurable data or uncertainty; all revealing specific approaches of unpredictable event. CONCLUSION: Safe Motherhood call for a better control on danger associated to pregnancy and birth. Such control is allowed by the elaboration of a relation of trust between population and its health system.

[Onchocerciasis and epilepsy. Epidemiological survey in Mali]. / Onchocercose et épilepsie. Enquête épidémiologique au Mali.

A door-to-door survey was conducted in 18 villages in Mali with a total of 5,243 inhabitants classified according to the endemicity of onchocerciasis. Each epileptic was matched with two controls. The survey protocol included the following steps in cases and controls: census taking, socioeconomic data, screening for epilepsy, clinical examination, laboratory testing to detect parasites in stools and urine, and snip-test. The crude prevalence of epilepsy was 13.35 per 1,000 (n = 70). Epidemiological study provided a number of valuable demographic insights concerning age at onset, type of seizure activity during seizure and personal and family medical history. A transverse study showed that the prevalence of epilepsy was not significantly higher (p = 9.09) in zones of high endemicity of onchocerciasis (16.1 per 1000) than in zones of low endemicity (10.8 per 1000). Case-control findings showed evidence of onchocerciasis in 22.4 p. 100 of epileptics and 21.7 p. 100 of controls (odds ratio = 1.02 IC 95 p. 100: 0.4-2.19, not significant). Various risk factors including genetic factors and low socio-economic status could explain the trend toward a higher incidence of epilepsy as well as higher morbidity rates in zones of high endemicity of onchocerciasis.

[Sociocultural dimension of epilepsy (kirikirimasien) in a Bambara rural area (Mali)]. / La dimension socioculturelle de l'épilepsie (kirikirimasien) en milieu rural bambara (Mali).

The anthropological study of kirikirimasien (epilepsy) in Mali constitutes an integral part of a research programme devoted to the epidemiology of epilepsy and onchocerciasis in Mali. This programme is run jointly by scientists of the Ecole Nationale de Médecine et de Pharmacie (National School of Medicine and Pharmacy) of Bamako, Mali, and the Faculté de Médecine (Faculty of Medicine) of Marseilles, France. Preliminary results of the anthropological study are presented, based on the qualitative analysis of 132 interviews, conducted over 6 months. Those interviewed were mainly persons affected by kirikirimasien, but included members of the family circle, traditional healers, and outsiders as well. Participatory interview techniques used the national language bambara. The interviews were unstructured and semi-structured so as to identify themes in the bambara language concerning kirikirimasien. Two dominant trends were identified, concerning the aetiology and nosography of the disease, and the social dimension of kirikirimasien, respectively. In terms of aetiology and nosography, diagnosis, contamination and appelation are--in order of priority--the most important aspects of the disease. Yet the social dimension of kirikirimasien appears largely to surpass its aetiological and nosographic aspects. The social dimension is crucial to the anthropological understanding of kirikirimasien. This was amply illustrated by various references which arose during the interviews. First, how is the notion of contamination represented and which practices are associated with it? Second, invalidity and handicap appear to play an essential role in the way people deal with the disease. The notion of tolerance in the bambara environment is also addressed, mainly through a spatial study of the adherence of the person affected by the disease (family, village and outsiders). The third part of the study deals with the social understanding of kirikirimasien and looks at how those affected are cared for, both within their social setting and in terms of seeking treatment.

[Kirikirimasien (epilepsy) in Mali: etiologic and nosologic dimensions]. / Etude du Kirikirimasien (épilepsie) au Mali: dimensions étiologique et nosographique.

Epilepsy is a chronic, disabling disease. Its incidence in Mali is 15.6 cases per 1000 people which is four to five times higher than in the West. Kirikirimasien is the name of a local bambaran disease entity similar to epilepsy with respect to both manifestations and course. A field study in a rural, bambaran area was performed to ascertain the nosologic nature of kirikirimasien and determine whether it was comparable with epilepsy in the west. Interviews with patients, family, friends, and healers were carried out and analyzed using qualitative investigative techniques, results showed that diagnosis was established on the basis of symptoms as well as underlying etiology. Nosologic information from the descriptions was correlated with contextual data in order to better understand the nature of the disease. To some extent close attention to pathologic signs associated with this disease such as dreaming and running away, revealed the important sociocultural dimension of kirikirimasien. This dimension is further supported by circumlocutions to avoid pronouncing the name of this disease considered as socially unacceptable. In summary, the sociocultural implications of kirikirimasien are evident in both criteria used for diagnosis and language used to describe it.