[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.