Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial.

BACKGROUND: School-aged children are rarely targeted by malaria control programmes, yet the prevalence of Plasmodium infection in primary school children often exceeds that seen in younger children and could affect haemoglobin concentration and school performance. METHODS: A cluster-randomised trial was carried out in 80 primary schools in southern Mali to evaluate the impact of a school-based malaria intervention package. Intervention schools received two interventions sequentially: (1) teacher-led participatory malaria prevention education, combined with distribution of long-lasting insecticidal nets (LLINs), followed 7 months later at the end of the transmission season by (2) mass delivery of artesunate and sulfadoxine-pyrimethamine administered by teachers, termed intermittent parasite clearance in schools (IPCs). Control schools received LLINs as part of the national universal net distribution programme. The impact of the interventions on malaria and anaemia was evaluated over 20 months using cross-sectional surveys in a random subset of 38 schools(all classes), with a range of cognitive measures (sustained attention, visual search, numeracy, vocabulary and writing) assessed in a longitudinal cohort of children aged 9-12 years in all 80 schools. RESULTS: Delivery of a single round of IPCs was associated with dramatic reductions in malaria parasitaemia (OR 0.005, 95% CI 0.002 to 0.011, p<0.001) and gametocyte carriage (OR 0.02, 95% CI 0.00 to 0.17, p<0.001) in intervention compared with control schools. This effect was sustained for 6 months until the beginning of the next transmission season. IPCs was also associated with a significant decrease in anaemia (OR 0.56, 95% CI 0.40 to 0.78, p=0.001), and increase in sustained attention (difference +0.23, 95% CI 0.10 to 0.36, p<0.001). There was no evidence of impact on other cognitive measures. CONCLUSION: The combination of malaria prevention education, LLINs and IPCs can reduce anaemia and improve sustained attention of school children in areas of highly seasonal transmission. These findings highlight the impact of asymptomatic malaria infection on cognitive performance in schoolchildren and the benefit of IPCs in reducing this burden. Additionally, malaria control in schools can help diminish the infectious reservoir that sustains Plasmodium transmission

The scope of coverage under the Rotterdam Rules - Unimodal and multimodal aspects

U radu se proučavaju, raščlanjuju i interpretiraju sve relevantne odredbe o polju primjene Roterdamskih pravila. Analizira se njihovo opće polje primjene, govori se o ugovorima, prijevozima te subjektima prijevoznih poslova na koje se Roterdamska pravila primjenjuju. Proučavaju se i specifične odredbe o posebnim isključenjima. Tumači se u kojem opsegu Roterdamska pravila pokrivaju multimodalni prijevoz te se govori o multimodalnosti kao obilježju suvremenog prijevoza i unifikaciji multimodalnog prijevoza. Pomno se ulazi u sadržaj i doseg odredbi kojima se propisuju uvjeti koji moraju biti ispunjeni da bi odredbe druge međunarodne prijevozne konvencije imale prednost u odnosu na odredbe Roterdamskih pravila. Nastoji se ukazati i na razlike u pogledu njezinog polja primjene i polja primjene međunarodnih konvencija koje su na snazi, a kojima se uređuje prijevoz stvari morem. Odredbe o polju primjene iznimno su važne i zadiru u bit nove konvencije, njezinu koncepciju, temeljna načela i ciljeve novog pravnog uređenja koje Konvencija propisuje. Najvažnije novine polja primjene Roterdamskih pravila u odnosu na međunarodne konvencije koje su na snazi, a koje uređuju prijevoz stvari morem jesu proširenje polja primjene na prijevoze “od vrata do vrata” i novo uređenje prijevoznih isprava. Cilj rada je skrenuti pažnju na polje primjene kao važno pitanje koje utječe na recepciju Roterdamskih pravila i istaknuti ona rješenja koja se najviše kritiziraju i za koja se osnovano može pretpostaviti da predstavljaju zapreku za njihovu recepciju.This paper considers the application of provisions of the United Nations Convention on Contracts for the International Carriage of Goods Wholly or Partly by Sea (the Rotterdam Rules). The scope of coverage issues go to the heart of the new Convention. This article highlights the major topics relating to the scope of coverage. All aspects of this key issue are examined here: the general scope of application; criteria that must be satisfied for the Convention to be applied; types of transactions that the Convention might govern; application to certain parties. Some of these questions have been particularly controversial. Moreover, this paper addresses the circumstances under which the Rotterdam Rules give way to other conventions. The author discusses issues that may arise from the fact that the Convention will cover both the inward and the outward carriage. It further considers specific exclusions from the Convention. Differences between the Rotterdam Rules and the international legislation in force are pointed out. One of the most significant changes introduced by the Rotterdam Rules to the existing law is the expansion of its scope of coverage to include the door-to-door transport. The Convention covers both the inbound and the outbound international shipments to or from a Contracting State. The Convention applies to contracts in both the liner and the non-liner trades, but not to charterparties and other contracts for the use of a ship or of any space thereon. Volume contract, to which the Convention applies, may provide for greater or lesser obligations and liabilities than those imposed by the Rotterdam Rules

Evolution of Malaria Incidence in Five Health Districts, in the Context of the Scaling up of Seasonal Malaria Chemoprevention, 2016 to 2018, in Mali

International audienceContext: In Mali, malaria transmission is seasonal, exposing children to high morbidity and mortality. A preventative strategy called Seasonal Malaria Chemoprevention (SMC) is being implemented, consisting of the distribution of drugs at monthly intervals for up to 4 months to children between 3 and 59 months of age during the period of the year when malaria is most prevalent. This study aimed to analyze the evolution of the incidence of malaria in the general population of the health districts of Kati, Kadiolo, Sikasso, Yorosso, and Tominian in the context of SMC implementation.Methods: This is a transversal study analyzing the routine malaria data and meteorological data of Nasa Giovanni from 2016 to 2018. General Additive Model (GAM) analysis was performed to investigate the relationship between malaria incidence and meteorological factors.Results: From 2016 to 2018, the evolution of the overall incidence in all the study districts was positively associated with the relative humidity, rainfall, and minimum temperature components. The average monthly incidence and the relative humidity varied according to the health district, and the average temperature and rainfall were similar. A decrease in incidence was observed in children under five years old in 2017 and 2018 compared to 2016.Conclusion: A decrease in the incidence of malaria was observed after the SMC rounds. SMC should be applied at optimal periods

Facteurs de risques de l’hemorragie du post partum au CSREF de Niono: Postpartum hemorrhage risk factors in Niono

Dans le district sanitaire de Niono l’hémorragie du post-partum (HPP) était définie comme toutes les hémorragies qui surviennent immédiatement après l’accouchement et dans les 42 jours du post-partum. En 2015, la fréquence de l’HPP s’y élevait à 1,34% avec un taux de décès de 8,5% contre 1,42% avec un de décès de 5,5% en 2016. L’objectif principal de ce thème était d’étudier les facteurs de risque de survenue des HPP. Méthode : il s’agissait d’une étude transversale réalisée à la maternité du Csréf de Niono du 1er janvier au 31 décembre 2018. Les données recueillies à travers l’exploitation des dossiers médicaux et transcrites sur un questionnaire ont été analysées sur SPSS version 20 pour déterminer les facteurs de risque d’HPP. La confidentialité et l’éthique ont été respectées. Résultats : Sur 1894 admissions, l’hémorragie du postpartum&nbsp;avait une fréquence de 2,16%. Les parturientes résidant hors de Niono représentaient 82,9%, non scolarisées à 82,9%, référées par Cscom à 46,3%. Chez nos patientes 78,1% avaient bénéficié d’une délivrance active. Au total 68,3% avait une rétention placentaire, 75,6% une inertie utérine, prises en charge par la Gestion Active de la Troisième Phase de l’Accouchement (GATPA). Le pronostic maternel était bon dans 97,6% des cas. Il s’agissait d’une hémorragie immédiate pour 92,7%. Conclusion : L’HPP est une urgence obstétricale fréquente et un accent particulier doit être mis sur la prévention en maîtrisant les facteurs de risques obstétricaux et en appliquant la GATPA. ABSTRACT: Introduction: In the Niono Health District, postpartum hemorrhage was defined as all hemorrhages that occur immediately after delivery and within 42 days postpartum. In 2015, the frequency of postpartum hemorrhage was 1.34% with a death rate of 8.5%, compared to 1.42% with a death rate of 5.5% in 2016. The main objective of this theme was to study the risk factors for the occurrence of postpartum hemorrhage. Method: This was a cross-sectional study carried out at the maternity ward of the Csréf de Niono from 1 January to 31 December 2018. Data collected through the use of medical records and transcribed to a questionnaire were analyzed on SPSS version 20 to determine risk factors for PPH. Results: Out of 1894 admissions, postpartum hemorrhage had a frequency of 2.16%. Patients residing outside Niono accounted for 82.9%, 82.9% were out of school and 46.3% were referred by Cscom. In our patients 78.1% had been actively delivered. A total of 68.3% had placental retention, 75.6% had uterine inertia, which was managed by Active Management of the Third Stage of Labor. The maternal prognosis was good in 97.6% of cases. It was an immediate hemorrhage for 92.7%. Conclusion: PPH is a frequent obstetric emergency and special emphasis must be placed on prevention by controlling obstetric risk factors and applying AMTSL

Two-Year Scale-Up of Seasonal Malaria Chemoprevention Reduced Malaria Morbidity among Children in the Health District of Koutiala, Mali

International audienceBackground: Previous controlled studies demonstrated seasonal malaria chemoprevention (SMC) reduces malaria morbidity by >80% in children aged 3-59 months. Here, we assessed malaria morbidity after large-scale SMC implementation during a pilot campaign in the health district of Koutiala, Mali.Methods: Starting in August 2012, children received three rounds of SMC with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). From July 2013 onward, children received four rounds of SMC. Prevalence of malaria infection, clinical malaria and anemia were assessed during two cross-sectional surveys conducted in August 2012 and June 2014. Investigations involved 20 randomly selected clusters in 2012 against 10 clusters in 2014.Results: Overall, 662 children were included in 2012, and 670 in 2014. Children in 2014 versus those surveyed in 2012 showed reduced proportions of malaria infection (12.4% in 2014 versus 28.7% in 2012 (p = 0.001)), clinical malaria (0.3% versus 4.2%, respectively (p < 0.001)), and anemia (50.1% versus 67.4%, respectively (p = 0.001)). A propensity score approach that accounts for environmental differences showed that SMC conveyed a significant protective effect against malaria infection (IR = 0.01, 95% CI (0.0001; 0.09), clinical malaria (OR = 0.25, 95% CI (0.06; 0.85)), and hemoglobin concentration (β = 1.3, 95% CI (0.69; 1.96)) in 2012 and 2014, respectively.Conclusion: SMC significantly reduced frequency of malaria infection, clinical malaria and anemia two years after SMC scale-up in Koutiala

Leprosy persistence in the health district of Kenieba despite its elimination as a public health problem at the national level in Mali

WHO defined leprosy elimination as reaching a prevalence &lt; 1 case of leprosy per 10,000 inhabitants. Mali eliminated the disease since 2001 but in 2011, it recorded 226 new cases. This has a serious involvement in term of disease spreading. Therefore, we undertook a cross sectional study in Kenieba health district, still above the WHO recommended elimination threshold to better understand the disease epidemiology and its associated potential factors. The study took place from October 2013 to September 2014. All consenting villagers, living in one of the selected villages were included and clinically examined for leprosy signs

Stratification at the health district level for targeting malaria control interventions in Mali

International audienceMalaria is the leading cause of morbidity and mortality in Mali. Between 2017 and 2020, the number of cases increased in the country, with 2,884,827 confirmed cases and 1454 reported deaths in 2020. We performed a malaria risk stratification at the health district level in Mali with a view to proposing targeted control interventions. Data on confirmed malaria cases were obtained from the District Health Information Software 2, data on malaria prevalence and mortality in children aged 6-59 months from the 2018 Demographic and Health Survey, entomological data from Malian research institutions working on malaria in the sentinel sites of the National Malaria Control Program (NMCP), and environmental data from the National Aeronautics and Space Administration. A stratification of malaria risk was performed. Targeted malaria control interventions were selected based on spatial heterogeneity of malaria incidence, malaria prevalence in children, vector resistance distribution, health facility usage, child mortality, and seasonality of transmission. These interventions were discussed with the NMCP and the different funding partners. In 2017-2019, median incidence across the 75 health districts was 129.34 cases per 1000 person-years (standard deviation = 86.48). Risk stratification identified 12 health districts in very low transmission areas, 19 in low transmission areas, 20 in moderate transmission areas, and 24 in high transmission areas. Low health facility usage and increased vector resistance were observed in high transmission areas. Eight intervention combinations were selected for implementation. Our work provides an updated risk stratification using advanced statistical methods to inform the targeting of malaria control interventions in Mali. This stratification can serve as a template for continuous malaria risk stratifications in Mali and other countries

Etude epidemio-clinique des traumatismes lies aux accidents de la voie publique a l’Hopital de Niono : Epidemiological and clinical study of injuries related to road traffic accidents at Niono Hospital

Introduction : L’accident de la voie publique (AVP), est une collusion non désirée, mal anticipée sur le réseau public entre un engin et tout autre chose ou personne, fixe ou mobile engendrant des blessures humaines et/ou des dégâts matériels. Selon l’Organisation Mondiale de la Santé (OMS) les AVP entrainent plus de 1,25 millions de décès chaque année et 20 à 50 millions de blessés. Au Mali, en 2013, 6059 cas d’AVP dont 529 tués et 8286 blessés ont été enregistrés. L’objectif de ce travail était d’étudier les aspects épidémio-cliniques des traumatismes liés aux accidents de la voie publique à l’hôpital de Niono. Matériel et méthodes : il s’agissait d’une étude transversale à l’hôpital de Niono du 01 avril au 30 septembre 2019. Les données ont été saisies et analysées sur PAWS Statistics. Le respect de la confidentialité était de rigueur et aucune information n’a été divulguée. Résultats : La fréquence des AVP était de 3,14% parmi les 4705 consultations. Le sexe masculin dominait (74,1%) et le sex-ratio était de 2,86. Les jeunes de 15 à 30 ans étaient les plus touchés (42,2%). Les plaies étaient les plus rencontrées (47,6%). L’évolution a été favorable chez 69,4 % et 8,8% ont été évacués, 2% d’amputation et 3,4% de décès. Conclusion : les AVP étaient assez fréquents et provoquaient de graves traumatismes avec des handicaps et la mort, d’où l’importance de la sensibilisation et de l’obligation du permis de conduire. Introduction: A road accident is an unwanted, poorly anticipated collusion on the public network between a vehicle and any other thing or person, fixed or mobile, causing human injury and/or property damage. According to Word Health Organization (WHO), road accidents cause more than 1.25 million deaths each year and 20 to 50 million injuries. In Mali, in 2013, 6059 cases of MVA including 529 killed and 8286 injured were recorded. The objective was to study the epidemiological and clinical aspects of injuries related to road traffic accidents at Niono hospital. Material and methods: It was a cross-sectional study in the Niono hospital from April 1 to September 30, 2019. The data was captured and analyzed on PAWS Statistics. Confidentiality was respected and no information was disclosed. Results: Frequency 3.14%, male dominated (74.1%) and the sex ratio of 2.86. Youth aged 15 to 30 were the most affected (42.2%). Wounds were the most common (47.6%). The evolution was favorable in 69.4% and 8.8% were referred, 2% amputation and 3.4% death. Conclusion: Road accident were quite frequent and caused severe trauma with disabilities and death, hence the importance of sensitization and the requirement of a driver's license