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1.
Front Public Health ; 9: 653481, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733811

RESUMO

Since 2019, the ATLAS project, coordinated by Solthis in collaboration with national AIDS programs, has introduced, promoted and delivered HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. Several delivery channels have been defined, including key populations: men who have sex with men, female sex workers and people who use injectable drugs. At project initiation, a qualitative study analyzing the perceptions and attitudes of key stakeholders regarding the introduction of HIVST in their countries and its integration with other testing strategies for key populations was conducted. The study was conducted from September to November 2019 within 3 months of the initiation of HIVST distribution. Individual interviews were conducted with 60 key informants involved in the project or in providing support and care to key populations: members of health ministries, national AIDS councils, international organizations, national and international non-governmental organizations, and peer educators. Semi structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose© software for thematic analyses. We found that stakeholders' perceptions and attitudes are favorable to the introduction and integration of HIVST for several reasons. Some of these reasons are held in common, and some are specific to each key population and country. Overall, HIVST is considered able to reduce stigma; preserve anonymity and confidentiality; reach key populations that do not access testing via the usual strategies; remove spatial barriers; save time for users and providers; and empower users with autonomy and responsibility. It is non-invasive and easy to use. However, participants also fear, question and doubt users' autonomy regarding their ability to use HIVST kits correctly; to ensure quality secondary distribution; to accept a reactive test result; and to use confirmation testing and care services. For stakeholders, HIVST is considered an attractive strategy to improve access to HIV testing for key populations. Their doubts about users' capacities could be a matter for reflective communication with stakeholders and local adaptation before the implementation of HIVST in new countries. Those perceptions may reflect the West African HIV situation through the emphasis they place on the roles of HIV stigma and disclosure in HIVST efficiency.


Assuntos
Infecções por HIV , Profissionais do Sexo , Minorias Sexuais e de Gênero , Atitude , Costa do Marfim , Feminino , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Humanos , Masculino , Mali , Percepção , Autoteste , Senegal
2.
Afr J Prim Health Care Fam Med ; 13(1): e1-e3, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34636617

RESUMO

Family medicine has not received appropriate attention in the sub-Saharan African context. In particular, family medicine is rarely recognised as a medical speciality and most African countries are silent on the role of family medicine in their health systems. There is, however, an emerging interest in developing family medicine as a key component of primary healthcare. Postgraduate training in family medicine is progressing and many countries have already established specific training programmes. In addition, there have been attempts to define the importance of family medicine, which, we expect, this short report contributes to. Interviews were conducted with physicians, partners and beneficiaries of two international development projects funded by the Canadian government. The one project supports training of health professionals and the other education of healthy women and girls in the community. The objective was to document the strengthening of primary healthcare through the creation and adaptation of a new family and community medicine postgraduate medical programme (which includes both family and community medicine) emphasising field training, immersion in local communities and interdisciplinary collaboration. This article underlines the importance of family medicine in Mali by documenting how what is now termed family and community medicine can promote community-orientated health services. To do so, we use the examples of initiatives and actions done through two international health development projects.


Assuntos
Serviços de Saúde Comunitária , Medicina de Família e Comunidade , Canadá , Feminino , Humanos , Mali , Atenção Primária à Saúde
3.
Hum Resour Health ; 19(1): 119, 2021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583729

RESUMO

BACKGROUND: The World Health Organization's Global Strategy on Human Resources for Health (HRH) emphasizes the importance of dynamic and effective health worker regulation for achieving the health-related Sustainable Development Goals, with the establishment of education standards and quality assurance of education programs being critical. Governments in West Africa have struggled to address the problems within their higher education systems for health professionals, and it is now generally acknowledged that private institutions can play a crucial role in revitalizing the region's outdated universities. However, the rapid expansion of private schools raises concerns about the quality of education and adequacy of regulatory mechanisms. The USAID-funded Mali HRH Strengthening Activity, led by IntraHealth International, assisted Mali's Ministry of Health and Social Development to deliver targeted HRH interventions to improve the quality of education in private universities, better manage available health workers, and initiate a decentralized strategy for health worker recruitment and motivation. CASE PRESENTATION: In 2018, the HRH activity leveraged the West African Health Organization (WAHO)'s accreditation system to support 10 private nursing schools to introduce WAHO's regionally accepted, competency-based curriculum in reproductive, maternal, newborn, and child health. The project undertook a 10-step process to work alongside private nursing and midwifery schools to assess their current status against WAHO regional standards, implement action plans to address identified gaps, and support the institutions toward accreditation. As a result, eight schools in Mali are now accredited compared to only three at project inception. CONCLUSIONS: This case study underscores the importance of private school accreditation in Mali to improve the quality of health worker training through a standardized local curriculum. By supporting existing regulatory bodies that oversee accreditation, local capacity for initial accreditation of private nursing schools has been increased. Engaging universities in a partnership that shows the benefits of accreditation while maintaining a focus on the need to protect communities is critical to success. If the global community is to meet the WHO's predicted health worker shortfall, then private education providers will need to be part of the solution. Robust and engaging health worker education accreditation systems are an essential part of that future.


Assuntos
Tocologia , Escolas de Enfermagem , Acreditação , Criança , Currículo , Feminino , Humanos , Recém-Nascido , Mali , Gravidez
4.
Front Public Health ; 9: 653565, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34354973

RESUMO

Background: The ATLAS program promotes and implements HIVST in Côte d'Ivoire, Mali, and Senegal. Priority groups include members of key populations-female sex workers (FSW), men having sex with men (MSM), and people who use drugs (PWUD)-and their partners and relatives. HIVST distribution activities, which began in mid-2019, were impacted in early 2020 by the COVID-19 pandemic. Methods: This article, focusing only on outreach activities among key populations, analyzes quantitative, and qualitative program data collected during implementation to examine temporal trends in HIVST distribution and their evolution in the context of the COVID-19 health crisis. Specifically, we investigated the impact on, the adaptation of and the disruption of field activities. Results: In all three countries, the pre-COVID-19 period was marked by a gradual increase in HIVST distribution. The period corresponding to the initial emergency response (March-May 2020) witnessed an important disruption of activities: a total suspension in Senegal, a significant decline in Côte d'Ivoire, and a less pronounced decrease in Mali. Secondary distribution was also negatively impacted. Peer educators showed resilience and adapted by relocating from public to private areas, reducing group sizes, moving night activities to the daytime, increasing the use of social networks, integrating hygiene measures, and promoting assisted HIVST as an alternative to conventional rapid testing. From June 2020 onward, with the routine management of the COVID-19 pandemic, a catch-up phenomenon was observed with the resumption of activities in Senegal, the opening of new distribution sites, a rebound in the number of distributed HIVST kits, a resurgence in larger group activities, and a rebound in the average number of distributed HIVST kits per primary contact. Conclusions: Although imperfect, the program data provide useful information to describe changes in the implementation of HIVST outreach activities over time. The impact of the COVID-19 pandemic on HIVST distribution among key populations was visible in the monthly activity reports. Focus groups and individual interviews allowed us to document the adaptations made by peer educators, with variations across countries and populations. These adaptations demonstrate the resilience and learning capacities of peer educators and key populations.


Assuntos
COVID-19 , Infecções por HIV , Profissionais do Sexo , Minorias Sexuais e de Gênero , Costa do Marfim/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Humanos , Masculino , Mali/epidemiologia , Pandemias , SARS-CoV-2 , Autoteste , Senegal/epidemiologia
5.
N Engl J Med ; 385(11): 1005-1017, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34432975

RESUMO

BACKGROUND: Malaria control remains a challenge in many parts of the Sahel and sub-Sahel regions of Africa. METHODS: We conducted an individually randomized, controlled trial to assess whether seasonal vaccination with RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria and whether the two interventions combined were superior to either one alone in preventing uncomplicated malaria and severe malaria-related outcomes. RESULTS: We randomly assigned 6861 children 5 to 17 months of age to receive sulfadoxine-pyrimethamine and amodiaquine (2287 children [chemoprevention-alone group]), RTS,S/AS01E (2288 children [vaccine-alone group]), or chemoprevention and RTS,S/AS01E (2286 children [combination group]). Of these, 1965, 1988, and 1967 children in the three groups, respectively, received the first dose of the assigned intervention and were followed for 3 years. Febrile seizure developed in 5 children the day after receipt of the vaccine, but the children recovered and had no sequelae. There were 305 events of uncomplicated clinical malaria per 1000 person-years at risk in the chemoprevention-alone group, 278 events per 1000 person-years in the vaccine-alone group, and 113 events per 1000 person-years in the combination group. The hazard ratio for the protective efficacy of RTS,S/AS01E as compared with chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to 1.01), which excluded the prespecified noninferiority margin of 1.20. The protective efficacy of the combination as compared with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8) against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against hospital admission with severe malaria according to the World Health Organization definition, and 72.9% (95% CI, 2.9 to 92.4) against death from malaria. The protective efficacy of the combination as compared with the vaccine alone against these outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI, 42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively. CONCLUSIONS: Administration of RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria. The combination of these interventions resulted in a substantially lower incidence of uncomplicated malaria, severe malaria, and death from malaria than either intervention alone. (Funded by the Joint Global Health Trials and PATH; ClinicalTrials.gov number, NCT03143218.).


Assuntos
Amodiaquina/uso terapêutico , Antimaláricos/uso terapêutico , Vacinas Antimaláricas , Malária Falciparum/prevenção & controle , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Antimaláricos/efeitos adversos , Burkina Faso/epidemiologia , Quimioprevenção , Terapia Combinada , Método Duplo-Cego , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Vacinas Antimaláricas/administração & dosagem , Vacinas Antimaláricas/efeitos adversos , Malária Falciparum/epidemiologia , Malária Falciparum/mortalidade , Masculino , Mali/epidemiologia , Estações do Ano , Convulsões Febris/etiologia
6.
BMC Public Health ; 21(1): 1592, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445978

RESUMO

BACKGROUND: Malaria in pregnancy is a crucial public health concern due to the enormous risk it poses to maternal and newborn health. The World Health Organisation therefore recommends insecticide-treated net (ITN) for pregnant women. The world over, sub-Saharan Africa bears the highest prevalence of malaria and its associated complications. This study investigated the individual, community and society level factors associated with ITN use among pregnant women in sub-Saharan Africa. METHODS: The study was conducted with Demographic and Health Survey data of 21 sub-Saharan African countries. A total of 17,731 pregnant women who possessed ITN participated in the study. Descriptive computation of ITN use by survey country and socio-demographic characteristics was conducted. Further, five multi-level binary logistic regression models were fitted with MLwiN 3.05 package in STATA. The Markov Chain Monte Carlo (MCMC) estimation procedure was used in estimating the parameters whilst the Bayesian Deviance Information Criterion was used for the model fitness test. RESULTS: On average, 74.2% pregnant women in SSA used ITN. The highest prevalence of ITN use occurred in Mali (83.7%) whilst the least usage occurred in Namibia (7%). Women aged 30-34 were more likely to use ITN compared with those aged 45-49 [aOR = 1.14; Crl = 1.07-1.50]. Poorest women were less probable to use ITN relative to richest women [aOR = 0.79; Crl = 0.70-0.89]. Compared to women who did not want their pregnancies at all, women who wanted their pregnancies [aOR = 1.06; Crl = 1.04-1.19] were more probable to use ITN. Women in male-headed households had higher likelihood of ITN use compared to those from female-headed households [aOR = 1.28; Crl = 1.19-1.39]. On the whole, 38.1% variation in ITN use was attributable to societal level factors whilst 20.9% variation was attributable to community level factors. CONCLUSION: The study has revealed that in addition to individual level factors, community and society level factors affect ITN use in SSA. In as much as the study points towards the need to incorporate community and societal variations in ITN interventions, active involvement of men can yield better outcome for ITN utilisation interventions in SSA.


Assuntos
Mosquiteiros Tratados com Inseticida , Inseticidas , Teorema de Bayes , Feminino , Humanos , Recém-Nascido , Masculino , Mali , Gravidez , Gestantes
7.
BMC Public Health ; 21(1): 1490, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340668

RESUMO

BACKGROUND: In early March 2020, the COVID-19 pandemic hit West Africa. In response, countries in the region quickly set up crisis management committees and implemented drastic measures to stem the spread of the SARS-CoV-2 virus. The objective of this article is to analyse the epidemiological evolution of COVID-19 in seven Francophone West African countries (Benin, Burkina Faso, Côte d'Ivoire, Guinea, Mali, Niger, Senegal) as well as the public health measures decided upon during the first 7 months of the pandemic. METHODS: Our method is based on quantitative and qualitative data from the pooling of information from a COVID-19 data platform and collected by a network of interdisciplinary collaborators present in the seven countries. Descriptive and spatial analyses of quantitative epidemiological data, as well as content analyses of qualitative data on public measures and management committees were performed. RESULTS: Attack rates (October 2020) for COVID-19 have ranged from 20 per 100,000 inhabitants (Benin) to more than 94 per 100,000 inhabitants (Senegal). All these countries reacted quickly to the crisis, in some cases before the first reported infection, and implemented public measures in a relatively homogeneous manner. None of the countries implemented country-wide lockdowns, but some implemented partial or local containment measures. At the end of June 2020, countries began to lift certain restrictive measures, sometimes under pressure from the general population or from certain economic sectors. CONCLUSION: Much research on COVID-19 remains to be conducted in West Africa to better understand the dynamics of the pandemic, and to further examine the state responses to ensure their appropriateness and adaptation to the national contexts.


Assuntos
COVID-19 , Pandemias , África Ocidental/epidemiologia , Benin , Burkina Faso , Controle de Doenças Transmissíveis , Costa do Marfim , Guiné , Humanos , Mali/epidemiologia , Níger , SARS-CoV-2 , Senegal/epidemiologia
8.
BMJ Open ; 11(8): e049732, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353803

RESUMO

OBJECTIVES: To quantify conflict events and access across countries that remain to be certified free of transmission of Dracunculus medinensis (Guinea worm disease) or require postcertification surveillance as part of the Guinea Worm Eradication Programme (GWEP). SETTING AND PARTICIPANTS: Populations living in Guinea worm affected areas across seven precertification countries and 13 postcertification sub-Saharan African countries. OUTCOME MEASURES: The number of conflict events and rates per 100 000 population, the main types of conflict and actors reported to be responsible for events were summarised and mapped across all countries. Chad and Mali were presented as case studies. Guinea worm information was based on GWEP reports. Conflict data were obtained from the Armed Conflict Location and Event Data Project. Maps were created using ArcGIS V.10.7 and access was measured as regional distance and time to cities. RESULTS: More than 980 000 conflict events were reported between 2000 and 2020, with a significant increase since 2018. The highest number and rates were reported in precertification Mali (n=2556; 13.0 per 100 000), South Sudan (n=2143; 19.4), Democratic Republic of Congo (n=7016; 8.1) and postcertification Nigeria (n=6903; 3.4), Central Africa Republic (n=1251; 26.4), Burkina Faso (n=2004; 9.7). Violence against civilians, protests and battles were most frequently reported with several different actors involved including Unidentified Armed Groups and Boko Haram. Chad and Mali had contracting epidemiological and conflict situations with affected regions up to 700 km from the capital or 10 hours to the nearest city. CONCLUSIONS: Understanding the spatial-temporal patterns of conflict events, identifying hotspots, the actors responsible and their sphere of influence is critical for the GWEP and other public health programmes to develop practical risk assessments, deliver essential health interventions, implement innovative surveillance, determine certification and meet the goals of eradication.


Assuntos
Dracunculíase , Dracunculus , Animais , Burkina Faso , Certificação , Dracunculíase/epidemiologia , Dracunculíase/prevenção & controle , Humanos , Mali/epidemiologia
9.
Viruses ; 13(7)2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34372565

RESUMO

More than a year after the first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the causative agent of the 2019 coronavirus disease (COVID-19) in China, the emergence and spread of genomic variants of this virus through travel raise concerns regarding the introduction of lineages in previously unaffected regions, requiring adequate containment strategies. Concomitantly, such introductions fuel worries about a possible increase in transmissibility and disease severity, as well as a possible decrease in vaccine efficacy. Military personnel are frequently deployed on missions around the world. As part of a COVID-19 risk mitigation strategy, Belgian Armed Forces that engaged in missions and operations abroad were screened (7683 RT-qPCR tests), pre- and post-mission, for the presence of SARS-CoV-2, including the identification of viral lineages. Nine distinct viral genotypes were identified in soldiers returning from operations in Niger, the Democratic Republic of the Congo, Afghanistan, and Mali. The SARS-CoV-2 variants belonged to major clades 19B, 20A, and 20B (Nextstrain nomenclature), and included "variant of interest" B.1.525, "variant under monitoring" A.27, as well as lineages B.1.214, B.1, B.1.1.254, and A (pangolin nomenclature), some of which are internationally monitored due to the specific mutations they harbor. Through contact tracing and phylogenetic analysis, we show that isolation and testing policies implemented by the Belgian military command appear to have been successful in containing the influx and transmission of these distinct SARS-CoV-2 variants into military and civilian populations.


Assuntos
COVID-19/virologia , Militares , SARS-CoV-2/classificação , SARS-CoV-2/genética , Afeganistão/epidemiologia , Bélgica , COVID-19/epidemiologia , China/epidemiologia , República Democrática do Congo/epidemiologia , Genoma Viral , Genômica , Humanos , Mali/epidemiologia , Epidemiologia Molecular , Mutação , Níger/epidemiologia , Filogenia , Viagem , Sequenciamento Completo do Genoma
10.
Pan Afr Med J ; 38: 389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381533

RESUMO

Introduction: despite the high prevalence and significant burden of mental disorders, they remain grossly under-diagnosed and undertreated. In low-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. This program aimed to provide a mental health training intervention to rural general practitioners (GPs), to organize community awareness activities, and to evaluate the impact on mental health knowledge and through the number of new patients diagnosed with mental disorders and managed by these general practitioners. Methods: a pre-test/post-test design and the monthly monitoring of the number of new patients diagnosed with mental disorders by the trained GPs were used to evaluate the effect of the training interventions (two face-to-face group training workshops followed by individual follow-up supervisions) and of the community awareness activities. Results: the mean knowledge score of the 19 GPs who completed the initial 12-day group training raised from 24.6/100 at baseline, to 61.5/100 after training (p<0.001), a 150% increase. Among them, sixteen completed the second 6-day group training with a mean score increasing from 50.2/100 to 70.1/100 (p<0.001), a 39.6% improvement. Between July 2018 and June 2020, 2,396 new patients were diagnosed with a mental disorder by the 19 GPs who took part in the program. Conclusion: despite limited data regarding the effect of the community awareness component at this stage, the findings from this study suggest that the training intervention improved GPs' knowledge and skills, resulting in a significant number of new patients being identified and managed.


Assuntos
Fortalecimento Institucional , Clínicos Gerais/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Competência Clínica , Clínicos Gerais/educação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mali , Transtornos Mentais/diagnóstico , Saúde Mental , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração
11.
Malar J ; 20(1): 356, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461901

RESUMO

BACKGROUND: Artemisinin-based combination therapy (ACT) was deployed in 2005 as an alternative to chloroquine and is considered the most efficacious treatment currently available for uncomplicated falciparum malaria. While widespread artemisinin resistance has not been reported to date in Africa, recent studies have reported partial resistance in Rwanda. The purpose of this study is to provide a current systematic review and meta-analysis on ACT at Mali study sites, where falciparum malaria is highly endemic. METHODS: A systematic review of the literature maintained in the bibliographic databases accessible through the PubMed, ScienceDirect and Web of Science search engines was performed to identify research studies on ACT occurring at Mali study sites. Selected studies included trials occurring at Mali study sites with reported polymerase chain reaction (PCR)-corrected adequate clinical and parasite response rates (ACPRcs) at 28 days. Data were stratified by treatment arm (artemether-lumefantrine (AL), the first-line treatment for falciparum malaria in Mali and non-AL arms) and analysed using random-effects, meta-analysis approaches. RESULTS: A total of 11 studies met the inclusion criteria, and a risk of bias assessment carried out by two independent reviewers determined low risk of bias among all assessed criteria. The ACPRc for the first-line AL at Mali sites was 99.0% (95% CI (98.3%, 99.8%)), while the ACPRc among non-AL treatment arms was 98.9% (95% CI (98.3%, 99.5%)). The difference in ACPRcs between non-AL treatment arms and AL treatment arms was not statistically significant (p = .752), suggesting that there are potential treatment alternatives beyond the first-line of AL in Mali. CONCLUSIONS: ACT remains highly efficacious in treating uncomplicated falciparum malaria in Mali. Country-specific meta-analyses on ACT are needed on an ongoing basis for monitoring and evaluating drug efficacy patterns to guide local malaria treatment policies, particularly in the wake of observed artemisinin resistance in Southeast Asia and partial resistance in Rwanda.


Assuntos
Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Malária Falciparum/tratamento farmacológico , Plasmodium falciparum/efeitos dos fármacos , Humanos , Mali
12.
Philos Trans R Soc Lond B Biol Sci ; 376(1835): 20200331, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34420391

RESUMO

Human social interactions often involve carefully synchronized behaviours. Musical performance in particular features precise timing and depends on the differentiation and coordination of musical/social roles. Here, we study the influence of musical/social roles, individual musicians and different ensembles on rhythmic synchronization in Malian drum ensemble music, which features synchronization accuracy near the limits of human performance. We analysed 72 recordings of the same piece performed by four trios, in which two drummers in each trio systematically switched roles (lead versus accompaniment). Musical role, rather than individual or group differences, is the main factor influencing synchronization accuracy. Using linear causal modelling, we found a consistent pattern of bi-directional couplings between players, in which the direction and strength of rhythmic adaptation is asymmetrically distributed across musical roles. This differs from notions of musical leadership, which assume that ensemble synchronization relies predominantly on a single dominant personality and/or musical role. We then ran simulations that varied the direction and strength of sensorimotor coupling and found that the coupling pattern used by the Malian musicians affords nearly optimal synchronization. More broadly, our study showcases the importance of ecologically valid and culturally diverse studies of human behaviour. This article is part of the theme issue 'Synchrony and rhythm interaction: from the brain to behavioural ecology'.


Assuntos
Música , Periodicidade , Desempenho Psicomotor , Estimulação Acústica , Percepção Auditiva , Humanos , Mali
13.
J Community Health ; 46(5): 1036-1049, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34435304

RESUMO

Between 1100 A.D. and 1700 A.D., terracotta statues were created in the Interior Delta of the Niger River in what is now the Republic of Mali. They are known as Djenné-Jeno terracottas because of their geographic proximity to an ancient town of that name. Some of these statues possess surface excrescences that have long perplexed archaeologists, art historians, curators, and others. This study of these surface excrescences employed clinical, diagnostic, and epidemiological methodologies to elucidate their possible meanings. It has not been possible to ascribe these excrescences to a single cause. However, examination of all the evidence permitted consideration of several possibilities. These include diseases such as smallpox, onchocerciasis, and the secondary stage of venereal syphilis. On certain statues, the anatomic placement of excrescences possibly symbolizes intentional cicatrization that resulted in keloid formation which may have been a form of beautification.


Assuntos
Oncocercose , Varíola , Sífilis , Cidades , Humanos , Mali/epidemiologia
14.
Transbound Emerg Dis ; 68(5): 2842-2852, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34323385

RESUMO

African swine fever (ASF) has been endemic in sub-Saharan Africa since the 1960s. Following its introduction in Senegal, in 1957, ASF steadily progressed through West Africa, reaching Burkina Faso in 2003, and later Mali in 2016. Despite the heavy burden of disease on pig production, little information is available on the genetic diversity of Africa swine fever virus (ASFV) in Burkina Faso, Mali and Senegal. Here, we used real-time PCR ASFV to detect the ASFV genome in samples collected between 1989 and 2016, in Burkina Faso, Mali and Senegal, and conventional approaches for isolate characterization. The C-terminal end of the p72 protein gene, the full E183L gene and the central variable region (CVR) within the B602L gene in ASFV genome were sequenced and compared to publicly available sequences. ASFV genome was found in 27 samples, 19 from Burkina Faso, three from Mali and five from Senegal. The phylogenetic analyses showed that all viruses belong to genotype I, with the ASFVs from Burkina Faso and Mali grouping with genotype Ia and ASFV serogroup 4, and those from Senegal with genotype Ib and the ASFV serogroup 1. The analysis of the CVR tetrameric tandem repeat sequences (TRS) showed four TRS variants in Burkina Faso, two in Senegal and one in Mali. The three countries did not share any common TRS, and all CVRs of this study differed from previously reported CVRs in West Africa, except for Senegal. Three of the five isolates from Senegal fully matched with the CVR, p72 and p54 sequences from ASFV IC96 collected during the 1996 ASF outbreak in Ivory Coast. This study shows the spread of the same ASFV strains across countries, highlighting the importance of continuous monitoring of ASFV isolates. It also calls for an urgent need to establish a regional plan for the control and eradication of ASF in West Africa.


Assuntos
Vírus da Febre Suína Africana , Febre Suína Africana , Doenças dos Suínos , Febre Suína Africana/epidemiologia , Vírus da Febre Suína Africana/genética , Animais , Burkina Faso/epidemiologia , Variação Genética , Genótipo , Mali/epidemiologia , Filogenia , Senegal/epidemiologia , Análise de Sequência de DNA/veterinária , Suínos
15.
Vaccine ; 39(35): 5037-5045, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34325934

RESUMO

IMPORTANCE: Low- and middle-income countries have a high burden of respiratory syncytial virus lower respiratory tract infections. A monoclonal antibody administered monthly is licensed to prevent these infections, but it is cost-prohibitive for most low- and middle-income countries. Long-acting monoclonal antibodies and maternal vaccines against respiratory syncytial virus are under development. OBJECTIVE: We estimated the likelihood of respiratory syncytial virus preventive interventions (current monoclonal antibody, long-acting monoclonal antibody, and maternal vaccine) being cost-effective in Mali. DESIGN: We modeled age-specific and season-specific risks of respiratory syncytial virus lower respiratory tract infections within monthly cohorts of infants from birth to six months. We parameterized with respiratory syncytial virus data from Malian cohort studies, as well as product efficacy from clinical trials. Integrating parameter uncertainty, we simulated health and economic outcomes for status quo without prevention, intra-seasonal monthly administration of licensed monoclonal antibody, pre-seasonal birth dose administration of a long-acting monoclonal antibody, and maternal vaccination. We then calculated the incremental cost-effectiveness ratio of each intervention compared to status quo from the perspectives of the government, donor, and society. RESULTS: At a price of $3 per dose and from the societal perspective, current monoclonal antibody, long-acting monoclonal antibody, and maternal vaccine would have incremental cost-effectiveness ratios of $4280 (95% CI $1892 to $122,434), $1656 (95% CI $734 to $9091), and $8020 (95% CI $3501 to $47,047) per disability-adjusted life-year averted, respectively. CONCLUSIONS AND RELEVANCE: In Mali, long-acting monoclonal antibody is likely to be cost-effective from both the government and donor perspectives at $3 per dose. Maternal vaccine would need higher efficacy over that measured by a recent trial in order to be considered cost-effective.


Assuntos
Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Análise Custo-Benefício , Humanos , Lactente , Mali , Políticas , Infecções por Vírus Respiratório Sincicial/prevenção & controle
17.
Biomed Res Int ; 2021: 5529375, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239924

RESUMO

Background: Child marriage is a major public health problem globally, and the prevalence remains high in sub-Saharan African countries, including Mali. There is a dearth of evidence about factors associated with child marriage in Mali. Hence, this studyaimed at investigating the individual/household and community-level factors associated with child marriage among women in Mali. Methods: Using data from the 2018 Mali Demographic and Health Survey, analysis was done on 8,350 women aged 18-49 years. A Chi-square test was used to select candidate variables for the multilevel multivariable logistic regression models. Fixed effects results weree xpressed as adjusted odds ratios (aOR) at 95% confidence intervals (CI). Stata version 14 software was used for the analysis. Results: The results showed that 58.2% (95% CI; 56.3%-60.0%) and 20.3% (95%; 19.0%-21.6%) of women aged 18-49 years were married before their 18th and 15th birthday, respectively. Educational status of women (higher education: aOR = 0.25, 95% CI; 0.14-0.44), their partner's/husband's educational status (higher education: aOR = 0.64, 95% CI; 0.47-0.87), women's occupation (professional, technical, or managerial: aOR = 0.50, 95% CI; 0.33-0.77), family size (five and above: aOR = 1.16, 95% CI; 1.03-1.30), and ethnicity (Senoufo/Minianka: aOR = 0.73, 95% CI; 0.58-0.92) were the identified individual/household level factors associated with child marriage, whereas region (Mopti: aOR = 0.27, 95% CI; 0.19-0.39) was the community level factor associated with child marriage. Conclusions: This study has revealed a high prevalence of child marriage in Mali. To reduce the magnitude of child marriage in Mali, enhancing policies and programs that promote education for both girls and boys, creating employment opportunities, improving the utilization of family planning services, and sensitizing girls and parents who live in regions such as Kayes on the negative effects of child marriage is essential. Moreover, working with community leaders so as to reduce child marriage in the Bambara ethnic communities would also be beneficial.


Assuntos
Demografia , Inquéritos Epidemiológicos , Casamento , Adolescente , Adulto , Criança , Comportamento Contraceptivo/estatística & dados numéricos , Escolaridade , Família , Características da Família , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Análise Multinível , Prevalência , Análise de Regressão , Fatores Socioeconômicos , Adulto Jovem
18.
BMC Womens Health ; 21(1): 261, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187435

RESUMO

BACKGROUND: The effective use of contraception among adolescents and young women can reduce the risk of unintended pregnancies. However, the prevalence of contraceptive use remains low in this age group. The objective of this study was to estimate the rate of contraceptive method discontinuation among adolescents and young women and to identify its associated factors in Burkina Faso, Mali, and Niger. METHOD: This was a secondary analysis of data from Demographic and Health Surveys of Burkina Faso (2010), Mali (2012-2013), and Niger (2012). The dependent variable was the time to discontinuation of contraceptive methods. Independent variables were represented by sociodemographic, socioeconomic, and cultural characteristics. Mixed-effects survival analysis with proportional hazards was used to identify the predictors. RESULTS: A total of 2,264 adolescents and young women aged 15 to 24 years were included in this analysis, comprising 1,100 in Burkina Faso, 491 in Mali, and 673 in Niger. Over the last five years, the overall contraceptive discontinuation rate was 68.7% (50.1% in Burkina Faso, 59.6% in Mali, and 96.8% in Niger). At the individual level, in Burkina Faso, occupation (aHR = 0.33), number of living children (aHR = 2.17), marital status (aHR = 2.93), and region (aHR = 0.54) were associated with contraceptive discontinuation. Except for education and marital status, we found the same factors in Mali. In Niger, a women's education level (aHR = 1.47) and her partner (aHR = 0.52) were associated with discontinuation. At the community level, the region of origin was associated with discontinuation of contraceptive methods. CONCLUSION: Most adolescents and young women experienced at least one episode of discontinuation. Discontinuation of contraceptive methods is associated with the level of education, occupation, number of children, marital status, and desire for children with the spouse. Promotion of contraceptive interventions should target adolescents, young women, and their partners, as well as those with a low education level or in a union.


Assuntos
Comportamento Contraceptivo , Anticoncepção , Adolescente , Burkina Faso , Criança , Feminino , Humanos , Mali , Níger/epidemiologia , Gravidez
19.
Antimicrob Agents Chemother ; 65(8): e0087321, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34060901

RESUMO

A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of pfcrt and pfmdr1 were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale.


Assuntos
Antimaláricos , Malária Falciparum , Antimaláricos/uso terapêutico , Artemeter/uso terapêutico , Combinação Arteméter e Lumefantrina , Burkina Faso , Combinação de Medicamentos , Etanolaminas/uso terapêutico , Humanos , Malária Falciparum/tratamento farmacológico , Mali , Parasitemia/tratamento farmacológico , Plasmodium falciparum/genética , Falha de Tratamento
20.
Pan Afr Med J ; 39: 2, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178230

RESUMO

Genital schistosomiasis is mainly located in the neck of the uterus and the vagina, less frequently on the vulva, the fallopian tubes and ovaries and rarely in the body of the uterus. We here report the case of a 10-year-old girl admitted with a swelling on the vulva in whom histological examination showed cutaneous schistosomiasis due to Schistosoma haematobium. Outcome was favorable with a single 40 mg/kg mg dose of praziquantel, with tumor regression.


Assuntos
Praziquantel/administração & dosagem , Esquistossomose Urinária/diagnóstico , Doenças da Vulva/diagnóstico , Animais , Anti-Helmínticos/administração & dosagem , Criança , Feminino , Humanos , Mali , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/parasitologia
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