Analysis of care-seeking pathways and factors influencing early and appropriate care-seeking for malaria patients in the Republic of Guinea: a cross-sectional study.

BACKGROUND: Malaria is a major public health issue in Guinea and care-seeking behaviour is dominated by self-medication and delayed access to appropriate care. However early and appropriate care-seeking are essential to control and reduce complicate forms and mortality, particularly for the most vulnerable. This study was conducted to analyse the diagnostic pathway, and the factors associated with early and appropriate care-seeking for malaria patients in the Republic of Guinea. METHODS: A cross-sectional study was carried out between December 2022 to March 2023 in nine health districts within health facilities and at community level. The study population was confirmed malaria patients with RDT or microscopy. Kroeger's conceptual framework was used to design the questionnaire. Conventional recourse was defined as using a healthcare facility or community services, early and appropriate care-seeking was defined as within 24 h of symptom onset in a conventional recourse, and care pathway as the sequence of recourses followed by each patient. Sankey alluvial plots were used to represent patients' diagnostic pathways, and logistic regression to identify factors associated with early and appropriate care-seeking. RESULTS: A total of 3300 malaria patients were studied, of which 1632 (49.45%) were female and 1132 (34.30%) were under 5 years of age, with a median age of 23 months. At the time of the survey, 1337 (40.52%), 1423 (43.12%), and 437 (13.85%) of patients were respectively in their first, second and third recourse. A total of 2002 (60.67%) patients had sought care from a conventional recourse as a first line. Of all patients, 1757 (53.25%) had sought care within 24 h, while 28.55% had sought early and appropriate care. In the initial stages of treatment, self-medication was the most common approach, used by 1214 (37.30%). Patients from the health districts of Boffa (Lower Guinea, coastal region) OR = 0.48 95% CI 0.33-0.70, Dabola (Upper Guinea, savanna region) OR = 0.43 95% CI 0.30-0.63 and Labe (Middle Guinea, mountain region) OR = 0.63 CI 95% 0.43-0.91 (p < 0.05) were more likely to delay appropriate care-seeking, when compared to those in Dixinn, (Conakry). However, the under 5-year-old group OR = 1.55 95% CI 1.30-1.85 (p < 0.001) and the availability of a stable monthly household income OR = 4.98 95% CI 3.03, 8.27 (p < 0.001) were positively associated with early and appropriate care seeking. CONCLUSION: A low rate of early and appropriate care-seeking was observed. Patients sought care through multiple means, often resulting in a delay in adequate management. The results show the need to deploy strategies adapted to the needs of communities.

Internally displaced persons in Mali facing the COVID 19 pandemic: A qualitative study / Les personnes déplacées internes au Mali face à la COVID-19 : une étude qualitative

Introduction: The COVID-19 pandemic has exacerbated an already existing security crisis leading to massive population displacements that have been taking place since 2012. Purpose of research: This study aims to explore the representations of internally displaced persons (IDPs) about the existence of COVID-19 and their knowledge about its signs, symptoms, modes of transmission and prevention measures. Methods: The study was qualitative and exploratory. Individual and group interviews were used to collect data from 52 IDPs in six sites in Bamako and Segou. All interviews were recorded and transcribed. Thematic content analysis and N-Vivo software were used. Results: The majority of IDPs believed in the existence of COVID-19 and had good knowledge of the signs, symptoms, modes of transmission and prevention measures against the disease. However, this was not sufficient for the adoption of public health measures. Among those who believed in its existence, some thought that it was a disease of the white and rich. Finally, a group of participants believed in conspiracy theories and claimed that the government and humanitarian organizations were only trying to make money through these campaigns. Conclusion: To our knowledge, this is the first study in Mali to explore IDPs' beliefs and knowledge about COVID-19. These results could inform policies, strategies, and interventions to combat COVID-19 in IDP sites and in the general population.

Introduction: Le Mali fait face depuis 2012 à une crise sécuritaire qui a entraîné des déplacements massifs des populations à laquelle s'est greffée la pandémie de la COVID-19. But de l'étude: Cette étude vise à explorer les représentations des personnes « déplacées internes ¼ (PDIs), c'est-à-dire des personnes forcées de fuir leur lieu d'origine, sur l'existence de la COVID-19 ainsi que leurs connaissances sur ses signes, ses symptômes, les modes de transmission et les mesures de prévention. Méthodes: L'étude est qualitative et exploratoire. Des entretiens individuels et en groupes ont permis de collecter les données auprès de 52 PDIs de six sites de Bamako et Ségou. Tous les entretiens ont été enregistrés et transcrits. L'analyse de contenu thématique et le logiciel NVivo ont été utilisés. Résultats: Dans leur majorité, les PDIs croyaient en l'existence de la COVID-19 et avaient de bonnes connaissances sur les signes, les symptômes, les modes de transmission et les mesures de prévention contre la maladie. Toutefois, cela n'a pas été suffisant pour l'adoption des mesures de santé publique. Parmi ceux qui croient en son existence, certains pensent que c'est toutefois une maladie des blancs et des riches. Enfin, un groupe de participants croyait plutôt en des théories du complot selon lesquelles le gouvernement et les organisations humanitaires ne chercheraient qu'à gagner de l'argent à travers ces campagnes. Conclusions: Il s'agit à notre connaissance de la première étude au Mali explorant les représentations et les connaissances des PDIs sur la COVID-19. Ces résultats pourraient éclairer les politiques, stratégies et interventions de lutte contre la COVID-19 dans les sites PDI et dans la population générale.

Human Herpesvirus 8 seroprevalence among blood donors in Mali.

In sub-Saharan Africa, the Human Herpesvirus 8 (HHV-8) is endemic but with disparities between regions and population studied. Although the virus remains mostly latent, there is some evidence that blood transfusion may represents one of the transmission way for this virus. Here, we evaluated HHV-8 seroprevalence among blood donors in Mali. This cross-sectional study recruited blood donors from the Blood Transfusion Center at Gabriel Touré Hospital, Bamako. Serum was used for the detection of latent HHV-8 immunoglobulin G directed against latent associated nuclear antigen 1 by an indirect immunofluorescence assay. Human immunodeficiency virus 1 (HIV-1), Hepatitis B Virus (HBV), HCV, and Treponema pallidum were also screened. HHV-8 seroprevalence was 10.4% in Malian blood donors. None of the sociodemographic characteristics were associated with HHV-8 infection, although there is a tendency of a higher HHV-8 seroprevalence among participants living in Bamako than those not living there. One individual had coinfection HHV-8/HBV, another HHV-8/HCV while another had HCV and T. pallidum. None has been tested positive for HIV infection. This intermediate seroprevalence in Malian blood donors suggests that the risk of HHV-8 transmission by transfusion should be considered. Further investigations are needed to assess impact of HHV-8 in polytransfused patients residing in an endemic area for this virus.

Co-developing a common glossary with stakeholders for engagement on new genetic approaches for malaria control in a local African setting.

Stakeholder engagement is an essential pillar for the development of innovative public health interventions, including genetic approaches for malaria vector control. Scientific terminologies are mainly lacking in local languages, yet when research activities involve international partnership, the question of technical jargon and its translation is crucial for effective and meaningful communication with stakeholders. Target Malaria, a not-for-profit research consortium developing innovative genetic approaches to malaria vector control, carried out a linguistic exercise in Mali, Burkina Faso and Uganda to establish the appropriate translation of its key terminology to local languages of sites where the teams operate. While reviewing the literature, there was no commonly agreed approach to establish such glossary of technical terms in local languages of the field sites where Target Malaria operates. Because of its commitment to the value of co-development, Target Malaria decided to apply this principle for the linguistic work and to take the opportunity of this process to empower communities to take part in the dialogue on innovative vector control. The project worked with linguists from other institutions (whether public research ones or private language centre) who developed a first potential glossary in the local language after better understanding the project scientific approach. This initial glossary was then tested during focus groups with community members, which significantly improved the proposed translations by making them more appropriate to the local context and cultural understanding. The stepwise process revealed the complexity and importance of elaborating a common language with communities as well as the imbrication of language with cultural aspects. This exercise demonstrated the strength of a co-development approach with communities and language experts as a way to develop knowledge together and to tailor communication to the audience even in the language used.

[Midwives' intention to leave primary level care services in Mali]. / Intention de quitter les services de premier niveau chez les sages-femmes et infirmières-obstétriciennes au Mali.

BACKGROUND: Mali is a country with a high rate of maternal and neonatal deaths and a low density of human resources for health. The health system faces understaffing and inequitable distribution of available resources. Health staff are reluctant to take positions and stay in first level care services. This study examines midwives and obstetric nurses' intention to leave their current positions in first level structures and management factors that influence this intention. METHODS: A cross-sectional mixed method study was conducted with 220 midwives and obstetric nurses in 46 primary healthcare services of three health regions. Questionnaires and interview guide were used. Descriptive statistics and bi-varied analyses tested the links between managerial practices, demographic characteristics and intention to leave. A thematic analysis of the qualitative data examined the factors underlying the intention to leave. RESULTS: Nearly half of midwives and obstetric nurses in primary healthcare services had the intention to leave their current positions. This intention to leave is more marked among midwives who have very little attraction for first-level service. Age, type of structure and area of assignment are strongly associated with the intention to leave. Managerial practices that differ according to locations and type of structures seem to influence the intention to leave. CONCLUSION: There is a high intention to leave their position among midwives and obstetric nurses in first level services. Managerial practices seem to have more influences on the intention to leave in rural areas and among obstetric nurses.

Strategic roles for behaviour change communication in a changing malaria landscape.

Strong evidence suggests that quality strategic behaviour change communication (BCC) can improve malaria prevention and treatment behaviours. As progress is made towards malaria elimination, BCC becomes an even more important tool. BCC can be used 1) to reach populations who remain at risk as transmission dynamics change (e.g. mobile populations), 2) to facilitate identification of people with asymptomatic infections and their compliance with treatment, 3) to inform communities of the optimal timing of malaria control interventions, and 4) to explain changing diagnostic concerns (e.g. increasing false negatives as parasite density and multiplicity of infections fall) and treatment guidelines. The purpose of this commentary is to highlight the benefits and value for money that BCC brings to all aspects of malaria control, and to discuss areas of operations research needed as transmission dynamics change.

[National reference unit of neonatology: state of play]. / Unit6é de néonatologie de référence nationale du Mali: état des lieux.

BACKGROUND: The neonatal mortality rate in Mali is one of the highest in the world. Only one national reference neonatology unit is available in the country. AIM: To describe the time-course of morbidity, mortality, staff and accommodation facilities from 2008 to 2009 in Mali's unique national reference neonatology unit. METHODS: This descriptive and cross-sectional study was conducted in the neonatology unit of Gabriel Touré Teaching Hospital, Bamako. Data concerning staff number of admissions, sex ratio, diseases, patients outcome, capacity and length-of-stay were compiled for the period from 1st January 2008 to 31 December 2012. RESULTS: Medical staff increased from one to three in 2009 and the number of nurses and midwives decreased from 16 to 14 with an average number of beds of 44. The mean number of hospitalizations per year was 3,900 (range: 3667-4585) with 14% of in-born deliveries and a mean length-of-stay of 3.7 days. Prematurity birth asphyxia and infection represented 80.5% of reasons for admission and 79.5% of deaths. The mortality rate varied from 28.5% to 36.8% with an annual mean of 33.2%. The diseases associated with the highest mortality were tetanus (60.8%), prematurity (42.7%), birth asphyxia (29.4%) and infection (25.7%). CONCLUSION: Neonatal mortality remains very high in Mali. Health authorities should take measures to decentralize the care of sick newborns in order to reduce neonatal mortality in Mali.

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis.

Objectives: This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa. Methods: This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias. Results: A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis. Conclusion: The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).

Mixed influence of COVID-19 on primary maternal and child health services in sub-Saharan Africa: a scoping review.

Introduction: The COVID-19 pandemic profoundly affected the provision of and demand for routine health services in the world. The objective of this scoping review was to synthesize the influence of the COVID-19 pandemic on primary maternal and child health (MCH) services in sub-Saharan Africa. Methods: The studies searched original studies reporting on the influence of the COVID-19 pandemic on primary MCH services. Four scientific databases (Pubmed, AJOL, CAIRN, CINAHL) and one gray literature database (Google Scholar) were used for this search. We also searched through the snowball citation approach and study reference lists. Results: The influence of the COVID-19 pandemic on primary MCH services has been mixed in sub-Saharan Africa. Attendance at some health centers declined for antenatal care, deliveries, immunization, and pneumonia cases. Other health centers did not experience a significant influence of the pandemic on some of these services. In fact, antenatal care increased in a number of health centers. MCH service indicators which declined during COVID-19 were linked on the demand side to regulatory measures against COVID-19, the perceived unavailability of resources for routine services, the perceived negative attitude of staff in these facilities, the perceived transmission risk in primary health care facilities and the perceived anticipated stigma. On the supply side, factors included the lack of equipment in primary facilities, the lack of guidelines for providing care in the pandemic context, the regulatory measures against COVID-19 taken in these facilities, and the lack of motivation of providers working in these facilities. Conclusion: This study recommends prioritizing the improvement of infection prevention measures in primary health care facilities for resilience of MCH indicators to epidemic crises. Improvement efforts should be tailored to the disparities in preventive measures between health centers. The identification of best practices from more resilient health centers could better guide these efforts.

Evaluating the effects of an intervention to improve the health environment for mothers and children in health centres (BECEYA) in Mali: a qualitative study.

Introduction: an intervention aiming to improve the maternal and children environment in healthcare facilities (BECEYA) was launched in three regions of Mali. This study aimed to explore the perceptions and experiences of patients and their companions, community actors, and healthcare facilities staff on the effects of the BECEYA intervention in two regions of Mali. Methods: we conducted a qualitative study using an empirical phenomenological approach. Through purposive sampling, women who attended antenatal care in the selected healthcare centres, companions, and health facility staff members were recruited. Data were collected during January and February 2020 through semi-structured individual interviews and focus groups. According to Braun and Clarke's approach, audio recordings were transcribed verbatim, and a thematic analysis was conducted in five main steps. Donabedian conceptual framework of quality of care was used to present the perceived changes following the implementation of the BECEYA project. Results: we recruited 26 participants in individual interviews (20 women attending prenatal care and maternity services, 10 per health centre, four companions, and two healthcare centre managers) and 21 healthcare centre staff members (10 in Babala, 11 in Wayerma 2) in focus groups. Themes that emerged from data analysis are perceived changes in terms of infrastructure (perceived changes in the characteristics of the healthcare facilities setting, including the infrastructure introduced by the BECEYA project), process (changes in the delivery and use of care introduced or resulting from BECEYA activities), and outcome (the direct and indirect effects of these changes on the health status of patients and the population). Conclusion: the study highlighted some positive effects on women users of the services, their companions, and health centre staff following the implementation of the intervention. This study contributes to showing some links between improving the environment of healthcare centres and the quality of care in developing countries.

Stakeholder engagement in the development of genetically modified mosquitoes for malaria control in West Africa: lessons learned from 10 years of Target Malaria's work in Mali.

From 2012 to 2023, the Malaria Research and Training Center (MRTC), based out of the University of Sciences, Techniques and Technologies of Bamako (USTTB), was part of the Target Malaria research consortium working towards developing novel gene drive-based tools for controlling populations of malaria vector mosquitoes. As part of this work, Target Malaria Mali has undertaken a range of in-depth engagement activities with the communities where their research is conducted and with other stakeholders nationally. These activities were meant to ensure that the project's activities took place with the agreement of those communities, and that those communities were able to play a role in shaping the project's approach to ensure that its eventual outcomes were in line with their needs and concerns. This paper aims to conduct a critical assessment of those 10 years of stakeholder engagement in order to identify good practices which can inform future engagement work on gene drive research in West Africa. It sets out a range of approaches and practices that enabled the Target Malaria Mali team to engage a variety of stakeholders, to share information, collect feedback, and determine community agreement, in a manner that was inclusive, effective, and culturally appropriate. These can be useful tools for those working on gene drive research and other area-wide vector control methods in West African contexts to ensure that their research is aligned with the interests of the communities who are intended to be its ultimate beneficiaries, and to allow those communities to play a meaningful role in the research process.

Progress in measles mortality reduction in Ethiopia, 2002-2009.

BACKGROUND: In 2002, Ethiopia adopted the African regional accelerated measles control strategies to reduce measles mortality. Routine measles vaccination is provided for infants at 9 months of age. A second opportunity for measles vaccination through supplementary immunization activities (SIAs) started in 2002, targeting children aged 6 months-14 years; periodic follow-up SIAs were conducted, targeting children aged 6-59 months from 2005 through 2009. METHODS: The administrative coverage data for routine measles vaccination and the respective World Health Organization-United Nations Children's Fund vaccination coverage estimates, as well as administrative coverage during measles SIAs and the measles case-based surveillance data from 2004 through 2009, were reviewed and analyzed. RESULTS: The administrative coverage with routine measles vaccination increased from 37% in 2000 to 76% in 2009. The SIAs coverage was 92% for the catch-up SIAs, 88% for the first follow-up SIAs, and 92% for the second follow-up SIAs. Measles case-based surveillance met the targets set for the 2 main performance indicators during 2005-2009. CONCLUSIONS: Following the adoption of the measles control strategies, a reduction in the number of reported measles cases and measles outbreaks was documented. However, measles outbreaks continued to occur in Ethiopia, mainly because of suboptimal measles vaccination coverage.

The epidemiology of rubella disease in Ethiopia: data from the measles case-based surveillance system.

BACKGROUND: Rubella is usually a mild rash illness. However, when a woman contracts rubella early in pregnancy, serious consequences may occur, including birth defects known as congenital rubella syndrome (CRS). Information is limited on the epidemiology of rubella and CRS in Ethiopia. METHOD: Rubella cases reported through the measles case-based surveillance system during 2004-2009 were analyzed. RESULTS: A total of 8212 samples were tested for rubella immunoglobulin (Ig) M, and 992 (12.1%) of these specimens had test results that were positive for rubella IgM. The age distribution of patients with rubella-positive cases ranged from 3 months to 44 years. The majority (94.7%) of the cases were in individuals <15 years of age. The proportion of positive specimens from urban areas (19.4%) was higher than that from rural areas (11.6%). CONCLUSIONS: Rubella is endemic in Ethiopia and mainly occurs among children and young adolescents. To better understand the burden of rubella and CRS, and to develop a national strategy for rubella control in Ethiopia, CRS surveillance will need to be established, and appropriate studies need to be conducted.

[Do West African cardiologists adhere to the guidelines for the management of heart failure ?] / Les cardiologues ouest-africains suivent-ils les « guidelines ¼ sur la prise en charge de l'insuffisance cardiaque ?

INTRODUCTION: Adherence to guidelines for the management of heart failure (HF) has been shown to be a strong predictor of reduced hospitalisations. The aim of this study was therefore to investigate the adherence of West African cardiologists to guidelines for the management of HF. METHODOLOGY: This was a prospective cross-sectional multicentric study (Côte d'Ivoire, Togo, Benin and Burkina-Faso). The "ADDress your Heart" survey developed was administered online to assess cardiologists' adherence to the guidelines for the management of heart failure. RESULTS: 62.3% of the 106 participants reported that they followed the guidelines closely. The therapeutic classes indicated as first-line by the latest guidelines were insufficiently suggested by physicians: 57.5% for mineralocorticoid receptor antagonists, 41.5% for gliflozins and 30.1% for sacubitril-valsartan In univariate logistic regression, affiliation with a teaching hospital OR [95% CI] = 3.0 [1.3-6.8], p < 0.01 ; access to scientific cardiology journals OR [95 % CI] = 3.4 [1.3-8.9], p = 0.01; and frequent attendance at conferences OR [95% CI]=1.8 [1.2-2.9], p < 0.01, were associated with guideline compliance. These factors persisted in multivariate analysis. CONCLUSION: Adherence of West African cardiologists to guidelines on the management of heart failure was moderate. If affiliation to a university hospital is difficult to apply to all cardiologists, access to scientific cardiology journals and frequent attendance in conference should be encouraged.

Exploring the Genetic Variability and Potential Correlations Between Nutritional Quality and Agro-Physiological Traits in Kabuli Chickpea Germplasm Collection (Cicer arietinum L.).

Chickpea is an important source of plant-based protein and mineral elements such as iron (Fe) and zinc (Zn). The development of superior high-yielding germplasm with high nutritional value becomes central for any breeding program. Chickpea biofortified and nutrient-dense seeds can contribute to mitigate many human health problems associated with protein and micronutrients deficiency. In this study, 282 advanced chickpea lines were grown under field conditions to evaluate their agronomic performances and nutritional quality value. The trial was conducted under winter planting conditions during the cropping season 2017/2018 at ICARDA-Marchouch research station, Morocco. Results revealed high genetic variation and significant differences between the tested genotypes for all studied parameters. Under field conditions, the grain yield (GY) varied from 0.57 to 1.81 (t.ha-1), and 100-seed weight (HSW) ranged from 23.1 to 50.9 g. Out of the 282 genotypes, only 4 genotypes (i.e., S130109, S130058, S130066, and S130157) combined both good agronomic performances (GY, HSW) and high nutritional quality (protein, macronutrients, and micronutrients). Protein content ranged from 18.9 to 32.4%. For the whole collection, Fe content varied from 31.2 to 81 ppm, while Zn content ranged from 32.1 to 86.1 ppm. Correlation analysis indicated that the studied traits were significantly intercorrelated, with negative correlation between protein content and Zn concentration. Positive correlations were observed between grain filling time (F2M) and the micronutrients Zn, Cu, and Mn and macroelements K and Mg. Low positive correlation was also recorded between Pr and Fe concentrations. No significant correlation was observed between Fe and Zn. Positive correlations observed between main agronomic and nutritional quality traits makes easy any simultaneous enhancement when combining these traits.

Challenges and difficulties in implementing and adopting isolation and quarantine measures among internally displaced people during the COVID-19 pandemic in Mali (161/250).

Introduction: Isolation and quarantine are among the key measures that protect internally displaced people (IDPs) against COVID-19. This study aims to identify the challenges encountered by humanitarian actors, and health, political, and administrative stakeholders in implementing these measures. It also describes the difficulties faced by IDPs when adopting them, and the local initiatives developed to overcome those difficulties. Method: We conducted a qualitative survey consisting of individual interviews and focus groups among IDPs, humanitarian actors, and health, political, and administrative stakeholders. The data was collected between November and December 2020 in the Bamako and Ségou Regions of Mali. Interviews were recorded with audio recorders, then transcribed and thematically analyzed using the NVivo 13 software. Findings: The study involved 36 individual interviews and eight focus groups with 68 participants of whom IDPs represented 72.3%. The main challenges reported on IDP sites included difficulties in contacting positive cases, a lack of facilities for quarantine and isolation, a lack of physical space for building new facilities, and a lack of financial resources to support IDPs during isolation and quarantine. The difficulties reported included: changes in social behavior and practices, fear of stigma, a poor level of literacy, and language barriers. To address those difficulties, the local initiatives developed by IDPs included strengthening the awareness of IDPs on COVID-19, early warning of sites' leaders about positive and suspected cases, and setting up a toll-free number to facilitate access to appropriate information on COVID-19. Conclusion: The findings of this study could be used as evidence to guide policy, adjust current strategies and take into account with more focus IDPs, a group with increased vulnerability, in COVID-19 response, more precisely during the implementation of isolation and quarantine measures. By doing so, they will help improve the response to COVID-19, IDPs health, and population health.

Effectiveness of Acute Malnutrition Treatment at Health Center and Community Levels with a Simplified, Combined Protocol in Mali: An Observational Cohort Study.

A simplified, combined protocol was created that admits children with a mid-upper-arm circumference (MUAC) of <125 mm or edema to malnutrition treatment with ready-to-use therapeutic food (RUTF) that involves prescribing two daily RUTF sachets to children with MUAC < 115 mm or edema and one daily sachet to those with 115 mm ≤ MUAC < 125 mm. This treatment was previously shown to result in non-inferior programmatic outcomes compared with standard treatment. We aimed at observing its effectiveness in a routine setting at scale, including via delivery by community health workers (CHWs). A total of 27,800 children were admitted to the simplified, combined treatment. Treatment resulted in a 92% overall recovery, with a mean length of stay of 40 days and a mean RUTF consumption of 62 sachets per child treated. Among children admitted with MUAC < 115 mm or edema, 87% recovered with a mean length of stay of 55 days and consuming an average of 96 RUTF sachets. The recovery in all sub-groups studied exceeded 85%. Treatment by CHWs resulted in a similar (94%) recovery to treatment by formal healthcare workers (92%). The simplified, combined protocol resulted in high recovery and low RUTF consumption per child treated and can safely be adopted by CHWs to provide treatment at the community level.

[Direct current cardioversion in Abidjan: report of a ten-year practice in Institute of Cardiology of Abidjan, Ivory Coast]. / Choc électrique externe à Abidjan : bilan de dix ans de pratique à l'Institut de Cardiologie d'Abidjan, Côte d'Ivoire.

UNLABELLED: Direct current cardioversion is effective in arrhythmias' termination. Few is known about its use in our practice. This work aims to report its outcomes over a ten-year period in Abidjan. METHOD: One thousand, three hundred and ninety one charts of arrhythmic patients were reviewed. RESULTS: Cardioversion was attempted in 102 patients. One hundred and eighty one shocks were delivered with a mean energy of 262, 1 joules. Success occurred in 84 patients (82,3%). Cardioversion failed in 18 patients mostly in atrial fibrillation. Eight serious complications (7,8%) occurred including 1 sinus node dysfunction, 1 pulmonary oedema, 1 metrorrhagia, 2 stroke, 1 pulmonary embolism. Two patients with ventricular tachycardia died of end-stage heart failure and aftermath of a mitral valve surgery. CONCLUSION: Direct current cardioversion is effective and safe in our practice. Complications are predominantly due to the medical environment such as antiarrhythmic drugs use or clinical conditions.

[Not Available]. / Choc électrique externe à Abidjan : bilan de dix ans de pratique à l'Institut de Cardiologie d'Abidjan, Côte d'Ivoire.

UNLABELLED: Direct current cardioversion is effective in arrhythmias' termination. Few is known about its use in our practice. This work aims to report its outcomes over a ten-year period in Abidjan. METHOD: One thousand, three hundred and ninety one charts of arrhythmic patients were reviewed. RESULTS: Cardioversion was attempted in 102 patients. One hundred and eighty one shocks were delivered with a mean energy of 262, 1 joules. Success occurred in 84 patients (82,3%). Cardioversion failed in 18 patients mostly in atrial fibrillation. Eight serious complications (7,8%) occurred including 1 sinus node dysfunction, 1 pulmonary oedema, 1 metrorrhagia, 2 stroke, 1 pulmonary embolism. Two patients with ventricular tachycardia died of end-stage heart failure and aftermath of a mitral valve surgery. CONCLUSION: Direct current cardioversion is effective and safe in our practice. Complications are predominantly due to the medical environment such as antiarrhythmic drugs use or clinical conditions.

Challenges to the implementation and adoption of physical distancing measures against COVID-19 by internally displaced people in Mali: a qualitative study.

BACKGROUND: For almost a decade now, Mali has been facing a security crisis that led to the displacement of thousands of people within the country. Since March 2020, a health crisis linked to the COVID-19 pandemic also surfaced. To overcome this health crisis, the government implemented some physical distancing measures but their adoption proved difficult, particularly among internally displaced people (IDPs). The objective of this study is to identify the challenges relating to the implementation and adoption of physical distancing measures and to determine the main mitigation measures taken by IDPs to adjust to these new policies. METHODS: An exploratory qualitative research was conducted in Bamako and Ségou, two of the ten regions of Mali. The study counted 68 participants including 50 IDPs, seven administrative and health authorities, and 11 humanitarian actors. Sampling was guided by the principle of saturation and diversification, and data was collected through semi-structured individual interviews (n = 36) and focus groups (n = eight). Analysis was based on thematic content analysis through NVivo software. RESULTS: The main challenges identified concerning the implementation and adoption of physical distancing measures include the proximity in which IDPs live, their beliefs and values, the lack of toilets and safe water on sites, IDPs habits and economic situation, humanitarian actors' lack of financial resources and authority, and social pressure from religious leaders. Implemented mitigation measures include the building of new shelters or their compartmentalization, the creation of income-generating activities and food banks, psychosocial support, promoting awareness of IDPs, and nightly police patrols and surveillance to discourage IDPs from going out. Finally, a call for action is suggested for the actors involved in IDPs support and management. CONCLUSIONS: The study demonstrates the difficulty for IDPs to follow most of the physical distancing measures and informs about the risk of disease spreading among IDPs with its potential consequences. It also shows the inability of mitigation measures to control the outbreak and suggests actions to be considered.