Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Infantile Hydrocephalus: An Experience from Mali.

INTRODUCTION: Pediatric hydrocephalus is a common disease in sub-Saharan Africa. In Mali, 350-400 new cases are diagnosed in our center yearly. With a total land mass of 1,241,000 km2, patients in remote areas must travel up to 1,500 km to access neurosurgical care. Hence, treatment and follow-ups of "shunted" patients are difficult. In this context, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) provides an opportunity for an affordable and less constraining treatment for hydrocephalus children under 12 months of age. METHODS: We performed a retrospective analysis of ETV/CPC performed on infants from July 2013 to January 2015. Patients were followed postoperatively on day 15, month 6, and month 12. Statistical analysis was conducted using Prism 9 GraphPad software. ETV successes were categorized according to the patient's age into 3 groups: ≤3 months, 3-6 months, and 6-12 months. Statistical significance was defined at p < 0.05. RESULTS: During the study period, 199 patients were included with 40% of patients aged between 0 and 6 months. The head circumference ranged from 35 cm to 79 cm. The etiology was congenital malformation in 55%. ETV/CPC was a success in 69% of 6- to 12-month-old patients, 54% in the 3- to 6-month-old patients, and 29% in ≤3-month-old patients. Overall, 94 (47%) patients were successfully treated without a shunt. The postoperative infection rate was 1% and mortality at 12 months was 8%. CONCLUSION: In a low-income environment such as Mali, ETV/CPC stands as a viable and alternative treatment option for pediatric hydrocephalus patients; our findings suggest that age is an important factor in predicting ETV success.

The Global Otolaryngology-Head and Neck Surgery Workforce.

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

Knowledge and factors influencing schistosomiasis control interventions in the hyperendemic health district of Kalabancoro in Mali, 2020.

Introduction: schistosomiasis is a public health concerns in many countries including Mali. In Kalabancoro District, during the 2017 assessments, the National schistosomiasis and soil-transmitted helminths control program reported prevalence´s of 10.83% and 50.83% for urinary schistosomiasis and intestinal schistosomiasis respectively. This district recorded the highest prevalence of intestinal schistosomiasis among the 46 districts evaluated. To better understand these high rates, this study investigated the knowledge of schistosomiasis in children and adults in this district. Methods: a cross-sectional study was conducted which involved 947 participants. A univariate analysis and multiple logistic regression were performed. Data collection was through questionnaire administration. Results: during the study, 76.1% of participants claimed to know about schistosomiasis (p<0.001) among them, 85.6% did not know the mode of contamination (p=0.001) and 66.3% knew the traditional treatment (p=0.004). Participants whose households were close to water impoundment were 2.16 times more likely to know schistosomiasis than those who were not (95% CI = [1.49 - 3.11]). Conclusion: most of the majority of participants reported being aware of schistosomiasis. However, the modes of transmission, prevention, and treatment of schistosomiasis were not well known. Misconceptions persist, hindering effective prevention and control. This is a tangible obstacle to the elimination of schistosomiasis in the Kalabancoro Health District and requires interventions tailored for these endemic communities.