Health facility-based prevalence and potential risk factors of autism spectrum disorders in Mali

Background: The prevalence of autism spectrum disorders (ASD) is 1-2% worldwide, 1 in 68 in the U.S, and unknown in Africa. ASD is under-diagnosed in Mali due to stigma and the lack of appropriate human resources and infrastructure.Objective: To determine the ASD frequency and potential risk factors in Mali.Methods: We identified all the health facilities and community-based organizations involved in the ASD diagnosis and management in Bamako. We established an ASD research and awareness platform in Mali, which encompasses community-based organizations and a multidisciplinary team including psychiatrists, psychologists, pediatricians, geneticists, and public health and social science specialists. Through this platform, we performed a survey in health facilities and organizations where patients with ASD are likely to seek care in Bamako. We reviewed the psychiatric patient registry to obtain basic epidemiological profiles of children with ASD, epilepsy and other psychiatric disorders.Results: We found a health facility-based prevalence of ASD of 4.5% (105/2,343) in Bamako. The mean age at the first outpatient visit was 7.64 ± 3.85 years old. First degree consanguinity of 29.5% (31/105) was more frequent in parents of ASD children versus age and sex matched controls OR= 4.37 [1.96-9.76] p=0.0001.Conclusion: Our data suggest that ASD is more common than expected in Mali. The established ASD awareness and research platform may improve the diagnosis and management of ASD by raising ASD awareness, training of Malian clinicians and researchers in early ASD screening and diagnosis, and strengthening research capacity in genomics of ASD and other mental disorders.Keywords: ASD, prevalence, consanguinity, health facilit

Agricultural intensification and policy interventions: Exploring plausible futures for smallholder farmers in Southern Mali

Assessing how livelihoods in rural sub-Saharan Africa might change given future trends in socio-economic and biophysical conditions helps to identify and direct effective efforts towards poverty reduction. Based on existing literature, hypothetical changes in farmer practices and policy interventions were described and used to build five contrasting scenarios towards the year 2027. A simulation framework was developed to assess food self-sufficiency and income per capita now and in the future for a representative village of 99 households in Southern Mali. In the current situation, 26% of the farms were food self-sufficient and above the 1.9 US$ day−1 poverty line. This percentage would fall to 13% in the “Business as usual” scenario. In the “Dairy development” scenario, with intensification of livestock production and support to the milk sector, 27% of farms would be food self-sufficient and non-poor. Additional policy interventions targeting family planning and job creation outside agriculture would be needed to improve both household food self-sufficiency and income per capita. In this optimistic scenario, 77% of the farms would be non-poor and food self-sufficient in 2027. Additional programs to promote Integrated Pest Management, small-scale mechanization and mineral fertilizer on traditional cereals could allow a drastic increase in productivity and would lift 94% of the farm population out of poverty. Considering the entire heterogeneous farm population was crucial to accurately assess pathways out of poverty. Our study stresses the need for a strategic and multi-sectoral combination of interventions to improve livelihoods

Correction: A Seroepidemiological Study of Serogroup A Meningococcal Infection in the African Meningitis Belt.

[This corrects the article DOI: 10.1371/journal.pone.0147928.]

Consommation d’alcool chez les travailleurs à Ouagadougou (Burkina Faso)

Dans le monde du travail, l’alcoolisation de certains travailleurs est une préoccupation aussi bien de l’employeur que des autres salariés. En effet, l’alcool est un facteur démultiplicateur du risque professionnel. Cependant très peu de données sont disponibles dans les pays de la sous-région. L’objectif était d’étudier l’ampleur de la consommation d’alcool chez les travailleurs à Ouagadougou. Nous avons procédé à un échantillonnage stratifié simple. Le questionnaire AUDIT a été administré aux travailleurs ayant donné leur consentement. Les résultats ont été présentés sous formes univariées. L’échantillon était constitué de 350 travailleurs avec un taux de participation de 100 %. La prévalence de la consommation d’alcool était de 65,14 % avec une fréquence de consommation inférieure ou égale à 4 fois par mois chez 50 % des travailleurs. La quantité d’alcool consommée un jour typique de consommation était inférieure ou égale à 4 verres chez 57,02 %. Les travailleurs qui avaient une consommation à faible risque étaient les plus représentés avec 39,43 %. Le sexe masculin, la confession religieuse non musulmane et le niveau d’instruction supérieur étaient les facteurs associés à la consommation d’alcool chez les travailleurs. La consommation d’alcool chez les travailleurs dans la ville de Ouagadougou est importante. Cela interpelle les acteurs de la prévention quant à la nécessité d’en tenir compte dans la politique santé et sécurité au travail en entreprise.Mots-clés: consommation d’alcool, travailleurs, OuagadougouEnglish Title: Alcohol consumption among workers in Ouagadougou (Burkina Faso)English AbstractIn the world of work, the alcoholism of certain workers is a concern for both the employer and other employees. Indeed, alcohol is a factor multiplying the occupational risk. However, very little data is available in the countries of the subregion. The objective was to study the extent of alcohol consumption among workers in Ouagadougou. We proceeded to a simple stratified sampling. The AUDIT questionnaire was administered to the workers who gave their consent. The results were presented in univariate. The sample consisted of 350 workers with a participation rate of 100%. The prevalence of alcohol consumption was 65.14% with a consumption frequency less than or equal to 4 times per month for 50% of workers. The amount of alcohol consumed on a typical day of consumption was less than or equal to 4 glasses in 57.02%. Workers with low risk consumption were the most represented at 39.43%. Male, non-Muslim, and higher education  were the factors associated with alcohol consumption among workers. Alcohol consumption among workers in the city of Ouagadougou is important and already requires the implementation of a policy to fight against the use of alcohol.Keywords: alcohol consumption, workers, Ouagadougo

Prise en charge de la COVID-19 à domicile à Ouagadougou au Burkina Faso au début de la pandémie (Résultats préliminaires)

Introduction : Face au nombre croissant de cas de refus d’hospitalisation d’une part et à la faiblesse des capacités d’hospitalisation d’autre part, le Burkina Faso a opté pour un programme de suivi des patients à domicile que nous étudions.Méthodologie : Il s’est agi d’une étude transversale descriptive du 16 avril au 20 mai 2020, à Ouagadougou des patients COVID-19 confirmés par PCR et pris en charge à domicile.Résultats : Au total 222 patients avec une COVID-19 ont été recensés dont 30 patients (13,5%) pris en charge à domicile. Le nombre moyen de suivi était de 3,45 visites, l’âge moyen était de 36,1 ± 16,7 ans et les enfants ainsi que les sujets de plus de 60 ans représentaient chacun 10% des cas. Parmi les patients, 60% étaient des célibataires et 22% avaient une comorbidité dont les plus fréquentes étaient le diabète (13,2%) et l’hypertension artérielle (6,7%). Les principaux symptômes étaient la toux (30,0%), l’asthénie physique (26,7%) et les céphalées (16,7%). Au cours du suivi, 33% des patients n’ont pas respecté le confinement à domicile : certains étaient absents et d’autres à leurs occupations sans port de masque ; Dans 10% des cas, les patients ont été hospitalisés et un décès a été constaté.Conclusion : Cette nouvelle pratique de prise en charge, si elle respecte certains critères d’éligibilité permettra de désengorger les structures sanitaires et offrirait plus de confort et de sérénité aux patients.   English title: Home Care of COVID-19 in Burkina Faso at the Start of the pandemic (Preliminary Results)Background : Faced with the growing number of cases of refusal of hospitalization on the one hand and the weakness of hospitalization capacity on the other hand, Burkina Faso has opted for a home patient monitoring program, which we study.Methodology : This was a descriptive cross-sectional study carried out on COVID-19 patients confirmed by polymerase chain reaction and cared for at home from April 16 to May 20, 2020, in the city of Ouagadougou. Results : A total of 223 patients were identified in Ouagadougou, including 30 patients (13.5%) who were cared for at home. The mean number of follow-ups was 3.45 visits, average age was 36.1±16.7 years, children and people over 60 years in 10.0% of each. Of the patients, 60.0% were single and 22.0% had a comorbidity; the most common of which were diabetes (13.2%) and hypertension (6.7%). The main symptoms were cough (30.0%), physical asthenia (26.7%), and headache (16.7%). During follow-up, 33.0% did not adhere to containment at home: some of them were absents or doing theirs work without masque. Ten percent of patients takecare at home were hospitalized, and one death was recorded.Conclusion : If this new practice of home care meets certain eligibility criteria, it will relieve congestion at healthcare facilities and offer more comfort and serenity to patients

Validation of two parent-reported autism spectrum disorders screening tools M-CHAT-R and SCQ in Bamako, Mali.

BackgroundEarly screening is crucial for early autism spectrum disorders (ASD) diagnosis and intervention. ASD screening tools have mostly been constructed based on the Western cultural context. We hypothesized that their use in Mali may require a prior validation.ObjectiveTo validate the modified checklist for autism in toddlers-Revised (M-CHAT-R) and the social communication questionnaire (SCQ) in the Malian sociocultural context for ASD screening.Study designWe administered M-CHAT-R and SCQ in 947 toddlers aged 16-30 months old at the district and community health centers in Bamako and 120 patients (60 autistic and 60 age and sex matched controls) aged ≥4 years old at the psychiatry department in Bamako. Toddlers at moderate to high risk of ASD underwent M-CHAT-R/F and clinical evaluation by an ASD multidisciplinary team. M-CHAT-R and SCQ were evaluated for cultural appropriateness by Malian anthropologists. The sensitivity, specificity, PPV, NPV were determined for both M-CHAT-R and SCQ. Health professionals have been trained during ASD seminary on how to use M-CHAT-R and SCQ for ASD screening in Bamako.ResultsWe found for the M-CHAT-R a sensitivity of 50%, a specificity of 100%, a PPV of 100% and a NPV of 87%. The SCQ had a sensitivity of 71%, a specificity of 72%, a PPV of 73% and a NPV of 70%. We have found four out of 20 items on the M-CHAT-R that were culturally inappropriate in the Malian context.DiscussionM-CHAT-R and SCQ can be used for early autism screening in Mali. In the future, we plan to train a descent number of Malian physicians in chief and pediatricians at the district hospitals across the country to integrate the early ASD screening into the national health system.ConclusionM-CHAT-R has a perfect specificity and SCQ a fair diagnostic accuracy for ASD in Mali