Access to oncology care in Mali: a qualitative study on breast cancer.

BACKGROUND: Breast cancer is the most common cancer in terms of incidence and mortality among women worldwide, including in Africa, and a rapid increase in the number of new cases of breast cancer has recently been observed in sub-Saharan Africa. Oncology is a relatively new discipline in many West African countries, particularly Mali; thus, little is known about the current state of cancer care infrastructure and oncology practices in these countries. METHODS: To describe the challenges related to access to oncology care in Mali, we used a qualitative approach, following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Thirty-eight semistructured interviews were conducted with health professionals treating cancer in Mali (n = 10), women with breast cancer (n = 25), and representatives of associations (n = 3), and 40 participant observations were conducted in an oncology unit in Bamako. We used the theoretical framework on access to health care developed by Levesque et al. a posteriori to organise and analyse the data collected. RESULTS: Access to oncology care is partly limited by the current state of Mali's health infrastructure (technical platform failures, repeated strikes in university hospitals, incomplete free health care and the unavailability of medicines) and exacerbated by the security crisis that has been occurring the country since 2012. The lack of specialist doctors, combined with limited screening campaigns and a centralised and fragmented technical platform in Bamako, is particularly detrimental to breast cancer treatment. Women's lack of awareness, lack of information throughout the treatment process, stereotypes and opposition to amputations all play a significant role in their ability to seek and access quality care, leading some women to therapeutically wander and others to want to leave Mali. It also leaves them in debt and jeopardises the future of their children. However, the high level of trust in doctors, the involvement of international actors, the level of social support and the growing influence of civil society on the issue of cancer also represent great current opportunities to fight cancer in Mali. CONCLUSION: Despite the efforts of successive Malian governments and the commitment of international actors, the provision of health care is still limited in the country, entrenching global inequalities in women's bodies.

Radiothérapie et lutte contre les cancers : défis de maintenance de l'unique accélérateur linéaire à l'Hôpital du Mali.

Cancer incidence and mortality rates are increasing in West Africa. Cancer is a recent discipline in Mali and the means available to treat patients are insufficient. Mali has only one radiotherapy machine for the country and its malfunctions are regularly reported in the media. In order to understand the recurrent dissatisfactions linked to access to radiotherapy in Mali, we retraced the history of this machine and described its functioning. Based on semi-directive interviews with patients’ associations and health professionals involved in cancer care in Bamako, we describe how radiotherapy in Mali reveals global health issues through the intervention of numerous international cooperations. In addition, based on data collection from medical registers and institutional reports, we report that the average time to get a radiotherapy appointment is 3 to 6 months in Mali, but also that the radiotherapy machine has experienced 198 breakdowns between April 3, 2014 and September 24, 2021, which represents more than 54 weeks of cumulative downtime. Radiotherapy is a crucial element in the treatment of cancer and the lack of access to this treatment worsens the vital diagnosis of patients. While the Malian government is committed to universal health coverage reforms, strengthening cancer treatment facilities should also be considered a public health priority for Mali.

Characterisation of camel breeding practices in the Ansongo Region, Mali.

Despite its importance in Mali's economy, camel breeding in the country remains poorly documented, impeding effective policy-making in this regard. This study consisted in a 3-month survey and aimed at characterising camel breeding systems in Ansongo, in the region of Gao, Mali. It highlights the diversity of strategies adopted by breeders and their evolutions. Supplementary feeding and veterinary care were seldom practised. In zones close to the Niger River, cattle were substituted to camels. Transhumance routes also are modified but mobility keeps its vital role in the breeding system. Important differences within the study region in the classification of camel breeds have been reported that will influence the implementation of a collective action for animal genetic improvement. The improvement goals should take the actual management, including mobility and the mixed nature of the herds into account.

Phenotypic parameters affecting reproduction and production performances of dairy cattle in peri-urban of Bamako, Mali.

AIM: The present study was conducted to evaluate the reproduction and production performances of crossbred and local dairy cattle in peri-urban of Bamako, the capital of Mali. MATERIALS AND METHODS: A total of 17 randomly selected households with 450 dairy cattle from four peri-urban of Bamako were individually interviewed, given register format and divided into four focus group discussions. The participants were dairy farmers and they were asked to know the phenotype that seems to them the more interesting for the reproduction and production performances of their dairy cattle. RESULTS: The calving interval (CI) obtained exceeded 433 days in all phenotypic types with average milk yields of 5.13±1.84 kg/day, 4.76±2.41, and 3.05±1.32 kg/day, respectively, for the Holstein crossbred, Montbeliard crossbred, and the local breeds (Zebu Peul and/or Zebu Maure). Crossbred was more productive than local breeds with significant (p<0.05) differences for lactation length, CI and total production and not significant on parity. The results also showed the advantages of the crossbred cows in terms of CI (460±80 days) compared to local zebus breeds (433±115 days) to keep the time of milking as long as possible. However, the Zebu Azawak breed whose cradle is located in Northern Mali, managed under extensive peri-urban rearing conditions, has less favorable production parameters than those of other local cattle breeds in milk production (636±43.3 kg vs. 681±41.1 kg). CONCLUSION: The present study revealed that crossbred dairy cattle performed better in terms of CI, lactation length, and production compared to the local breeds. The study also showed that the local Azawak breed numerically performed less compared to the other local breeds evaluated in this study, namely, Peul and Maure.

[Decentralization of healthcare and analysis of health data: the experience of the community of Zegoua, Mali]. / Decentralisation De La Sante Et Systeme Local D'Information Sanitaire : L'Experience De La Commune De Zegoua (District De Kadiolo, Region De Sikasso, Mali).

GOALS: In the frame of the project "Bringing the healthcare near to the people of Municipality of Zegoua" one goal was the strengthening of SLIS and its adaptation to the context of decentralization. METHODOLOGY: The research included the decentralized collection and analysis of health data (modern and traditional) and the presentation of key indicators in graphical form to local authorities, to support decision making. RESULTS: The analysis of data from 2006-2008 found: the increase in Curative Consultation from 0.24 to 0.40; achieving universal coverage in Pre-Natal Consultations and Assisted Deliveries, 86.12% coverage in Post-Natal Consultations. For 2008, the evolution of key indicators for month was presented to local authorities and the data were also disaggregated by village. The analysis of financial data allowed to draw up the balance of the Zégoua Polycentric CHCs, and to monitor the capital of essential drugs. About Traditional Medicine, it was identified one traditional healer for 236 inhabitants. The average was 277 patients per month. The first cause of consultation was malaria. The availability of essential information presented in an understandable form has enabled local authorities to identify and locate health problems, and to take timely targeted decisions. CONCLUSION: These results demonstrate the importance of strengthening the SLIS and of its adaptation to the context of decentralization, as part of the consolidation of local health systems.

Facteurs associés au faible poids de naissance au centre de santé communautaire de Yirimadio (Mali)

Le faible poids à la naissance (FPN) est défini comme une naissance dont le poids est inférieur à 2500 g. L'objectif de déterminer les facteurs associés au faible poids de naissance à la maternité du centre de santé communautaire de Yirimadio à Bamako.Il s'agit d'une étude transversale qui s'est déroulée sur une période six mois, d'Avri là Septembre 2015. Elle a inclue toutes les femmes ayant accouchées durant lapériode ainsi que leurs enfants.L'âge gestationnel, l'âge maternel, la gestité, la parité, le suivi des consultations prénatales ont été retrouvé comme facteursassociés au faible poids de naissance dans notre étude. Cependant cette étude n'a pas mis en évidence de lien entre le faiblepoids de naissance et le niveau scolaire, la profession des mères, le début des consultations prénatales et le sexe du nouveau né.La prise en charge des facteurs associés au faible poids de naissance permettrait de réduire les risques de la morbidité et la mortalité infantile