ENTRE INSTABILITÉ ET DÉVELOPPEMENT : Analyse de l'impact de l'endettement par le marché régional des titres publics et la stabilité politique sur la Croissance économique au Mali (2011-2023).

Khalid DEMBELE Cette étude explore la relation complexe entre l'endettement, la croissance économique et la stabilité politique au Mali à travers le marché régional des titres publics de l’UEMOA sur la période de 2011 à 2023. En se servant des bases de  l’UEMOA-Titres de la BCEAO et de la Banque mondiale en appliquant plusieurs méthodes d’estimations : méthode des variables instrumentales et ARDL en raison de la nature des données, pour évaluer les effets de l'endettement à travers les fonds mobilisés sur le marché des titres publics, sur la croissance au Mali. Les résultats indiquent que l'endettement via les titres obligataires peut stimuler la croissance économique, tandis que les instruments de dette à court terme, comme les bons du Trésor, ont tendance à avoir un impact négatif. De plus, la stabilité politique se révèle être un élément clé pour mobiliser des fonds sur le marché régional,  la gestion efficace de la dette et son influence sur la croissance. Ces résultats ont des implications significatifs pour la politique économique, suggérant la nécessité dans le choix de type d’endettement entre les titres obligataires ou bons du trésor et une gestion prudente de la dette  avec un environnement politique stable, et offrent des leçons importantes pour d'autres pays en développemen

Analyse des propositions des acteurs locaux en matière de résolution de la crise sécuritaire dans le delta intérieur du Niger et le Seeno

Résumé : La présente recherche s’inscrit dans la perspective de trouver une solution alternative à l’insécurité dans le Delta Intérieur du Niger et le Seeno au Centre du Mali. Son objectif est d’analyser les propositions de réponses endogènes à cette crise. La démarche méthodologique de type qualitatif, s’est appuyée sur la revue documentaire. Avec un échantillon de cinq cent dix (510) individus répartis entre les deux zones à travers des entretiens individuels et des focus-groupes, les données collectées ont fait l’objet d’une analyse de contenu des discours. Les résultats de l’étude montrent la volonté générale des populations locales à en finir avec le conflit. Il ressort qu’une sortie de crise définitive passe par un changement de paradigme dans le traitement de la question. Pour cela, certains acteurs négligés par l’Etat sont mieux désignés pour faire aboutir la paix dans le Delta Intérieur du Niger et le Seeno. Mots clés : Acteurs locaux, Delta Intérieur du Niger, Insécurité, Propositions, Seeno

Évaluation de la Satisfaction des Usagers du Service des Urgences de l'Hôpital Mère-Enfant le Luxembourg de Bamako au Mali, en 2019

Introduction : L’évaluation de lasatisfaction des usagers est un élément essentiel de la qualité des soins et prestation d’un hôpital. Cette étude visait à évaluer la satisfaction des usagers du service des urgences au Centre Hospitalier Universitaire le Luxembourg de Bamako, Mali, en 2019 en vue d’améliorer la qualité de la prise en charge. Méthodes : Il s’agissait d’une étude descriptive, transversaleayant ciblé les patients ou accompagnants en consultation ouhospitalisé dans ledit service. La collecte des données, réalisée du 02 mai au 23 août 2019, a utilisé un questionnaire administré auxusagers dans le service ou à la sortie, en mode face à face, après leur consentement éclairé. Résultats : Sur les 138 usagers enquêtés, 68,84 était de sexe féminin, 73,19% avait plus de 50 ans, 96,38% scolarisés et 35,51% étaient des ménagères. Ils étaient satisfaits à 72,97% des prestations reçues.Le principal motif de satisfaction était la rapidité de la prise en charge(p=0,037). Chez les non satisfaits (27,03%), les motifs incriminés étaient le long temps d’attente (63,37%), la non disponibilité des médicaments (30,43%), le coût élevé des prestations (28,99%) et l’exiguïté des locaux (26,21%).  Conclusion : Malgré certaines insuffisances du service des urgences du CHU le Luxembourg, le bon accueil et la prise en charge rapide sont les éléments clés associés à la satisfaction du patient.   Introduction:The evaluation of user satisfaction is an essential element of the quality of care and delivery of a hospital. This study aimed to assess the satisfaction of users of the emergency department at the Center Hospitalier Universitaire le Luxembourg in Bamako, Mali, in 2019 with a view to improving the quality of care. Methods:This was a descriptive, cross-sectional study that targeted patients or caregivers in consultation or hospitalized in the said service. Data collection, carried out from May 2 to August 23, 2019, used a questionnaire administered to users in the service or at the exit, in face-to-face mode, after their informed consent. Results:Of the 138 users surveyed, 68.84 were female, 73.19% were over 50 years old, 96.38% were educated and 35.51% were housewives. They were 72.97% satisfied with the services received. The main reason for satisfaction was the speed of treatment (p=0.037). Among those not satisfied (27.03%), the reasons incriminated were the long waiting time (63.37%), the unavailability of drugs (30.43%), the high cost of services (28.99%) and the small size of the premises (26.21%). Conclusion:Despite certain shortcomings of the emergency department of the CHU Luxembourg, good reception and rapid treatment are the key elements associated with patient satisfaction

Évaluation de la Satisfaction des Usagers du Service des Urgences de l'Hôpital Mère-Enfant le Luxembourg de Bamako au Mali, en 2019

Introduction : L’évaluation de lasatisfaction des usagers est un élément essentiel de la qualité des soins et prestation d’un hôpital. Cette étude visait à évaluer la satisfaction des usagers du service des urgences au Centre Hospitalier Universitaire le Luxembourg de Bamako, Mali, en 2019 en vue d’améliorer la qualité de la prise en charge. Méthodes : Il s’agissait d’une étude descriptive, transversaleayant ciblé les patients ou accompagnants en consultation ouhospitalisé dans ledit service. La collecte des données, réalisée du 02 mai au 23 août 2019, a utilisé un questionnaire administré auxusagers dans le service ou à la sortie, en mode face à face, après leur consentement éclairé. Résultats : Sur les 138 usagers enquêtés, 68,84 était de sexe féminin, 73,19% avait plus de 50 ans, 96,38% scolarisés et 35,51% étaient des ménagères. Ils étaient satisfaits à 72,97% des prestations reçues.Le principal motif de satisfaction était la rapidité de la prise en charge(p=0,037). Chez les non satisfaits (27,03%), les motifs incriminés étaient le long temps d’attente (63,37%), la non disponibilité des médicaments (30,43%), le coût élevé des prestations (28,99%) et l’exiguïté des locaux (26,21%).  Conclusion : Malgré certaines insuffisances du service des urgences du CHU le Luxembourg, le bon accueil et la prise en charge rapide sont les éléments clés associés à la satisfaction du patient.   Introduction:The evaluation of user satisfaction is an essential element of the quality of care and delivery of a hospital. This study aimed to assess the satisfaction of users of the emergency department at the Center Hospitalier Universitaire le Luxembourg in Bamako, Mali, in 2019 with a view to improving the quality of care. Methods:This was a descriptive, cross-sectional study that targeted patients or caregivers in consultation or hospitalized in the said service. Data collection, carried out from May 2 to August 23, 2019, used a questionnaire administered to users in the service or at the exit, in face-to-face mode, after their informed consent. Results:Of the 138 users surveyed, 68.84 were female, 73.19% were over 50 years old, 96.38% were educated and 35.51% were housewives. They were 72.97% satisfied with the services received. The main reason for satisfaction was the speed of treatment (p=0.037). Among those not satisfied (27.03%), the reasons incriminated were the long waiting time (63.37%), the unavailability of drugs (30.43%), the high cost of services (28.99%) and the small size of the premises (26.21%). Conclusion:Despite certain shortcomings of the emergency department of the CHU Luxembourg, good reception and rapid treatment are the key elements associated with patient satisfaction

Operational Issues and Trends Associated with the Pilot Introduction of Zinc for Childhood Diarrhoea in Bougouni District, Mali

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas

Operational Issues and Trends Associated with the Pilot Introduction of Zinc for Childhood Diarrhoea in Bougouni District, Mali

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas

Pyronaridine-artesunate or dihydroartemisinin-piperaquine combined with single low-dose primaquine to prevent Plasmodium falciparum malaria transmission in Ouélessébougou, Mali: a four-arm, single-blind, phase 2/3, randomised trial.

BACKGROUND: Pyronaridine-artesunate is the most recently licensed artemisinin-based combination therapy. WHO has recommended that a single low dose of primaquine could be added to artemisinin-based combination therapies to reduce Plasmodium falciparum transmission in areas aiming for elimination of malaria or areas facing artemisinin resistance. We aimed to determine the efficacy of pyronaridine-artesunate and dihydroartemisinin-piperaquine with and without single low-dose primaquine for reducing gametocyte density and transmission to mosquitoes. METHODS: We conducted a four-arm, single-blind, phase 2/3, randomised trial at the Ouélessébougou Clinical Research Unit of the Malaria Research and Training Centre of the University of Bamako (Bamako, Mali). Participants were aged 5-50 years, with asymptomatic P falciparum malaria mono-infection and gametocyte carriage on microscopy, haemoglobin density of 9·5 g/dL or higher, bodyweight less than 80 kg, and no use of antimalarial drugs over the past week. Participants were randomly assigned (1:1:1:1) to one of four treatment groups: pyronaridine-artesunate, pyronaridine-artesunate plus primaquine, dihydroartemisinin-piperaquine, or dihydroartemisinin-piperaquine plus primaquine. Treatment allocation was concealed to all study staff other than the trial pharmacist and treating physician. Dihydroartemisinin-piperaquine and pyronaridine-artesunate were administered as per manufacturer guidelines over 3 days; primaquine was administered as a single dose in oral solution according to bodyweight (0·25 mg/kg; in 1 kg bands). The primary endpoint was percentage reduction in mosquito infection rate (percentage of mosquitoes surviving to dissection that were infected with P falciparum) at 48 h after treatment compared with baseline (before treatment) in all treatment groups. Data were analysed per protocol. This trial is now complete, and is registered with ClinicalTrials.gov, NCT04049916. FINDINGS: Between Sept 10 and Nov 19, 2019, 1044 patients were assessed for eligibility and 100 were enrolled and randomly assigned to one of the four treatment groups (n=25 per group). Before treatment, 66 (66%) of 100 participants were infectious to mosquitoes, with a median of 15·8% (IQR 5·4-31·9) of mosquitoes becoming infected. In individuals who were infectious before treatment, the median percentage reduction in mosquito infection rate 48 h after treatment was 100·0% (IQR 100·0 to 100·0) for individuals treated with pyronaridine-artesunate plus primaquine (n=18; p<0·0001) and dihydroartemisinin-piperaquine plus primaquine (n=15; p=0·0001), compared with -8·7% (-54·8 to 93·2) with pyronaridine-artesunate (n=17; p=0·88) and 50·4% (13·8 to 70·9) with dihydroartemisinin-piperaquine (n=16; p=0·13). There were no serious adverse events, and there were no significant differences between treatment groups at any point in the frequency of any adverse events (Fisher's exact test p=0·96) or adverse events related to study drugs (p=0·64). The most common adverse events were headaches (40 events in 32 [32%] of 100 participants), rhinitis (31 events in 30 [30%]), and respiratory infection (20 events in 20 [20%]). INTERPRETATION: These data support the use of single low-dose primaquine as an effective supplement to dihydroartemisinin-piperaquine and pyronaridine-artesunate for blocking P falciparum transmission. The new pyronaridine-artesunate plus single low-dose primaquine combination is of immediate relevance to regions in which the containment of partial artemisinin and partner-drug resistance is a growing concern and in regions aiming to eliminate malaria. FUNDING: The Bill & Melinda Gates Foundation. TRANSLATIONS: For the French, Spanish and Swahilil translations of the abstract see Supplementary Materials section

Echanges d'energie et de masse a l'interieur et au-dessus d'une foret de pins des Landes

SIGLEINIST T 73793 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Influence of initial soil moisture in a regional climate model study over West Africa - Part 1: Impact on the climate mean

International audienceThe impact of soil moisture initial conditions on the mean climate over West Africa was examined using the latest version of the regional climate model of the International Centre for Theoretical Physics (RegCM4) at a 25 km horizontal resolution. The soil moisture reanalysis of the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis of the 20th century (ERA-20C) was used to initialize the control experiment, while its minimum and maximum values over the entire domain were used to establish the respective initial dry and wet soil moisture conditions (hereafter referred to as dry and wet experiments, respectively). For the respective control, wet and dry experiments, an ensemble of five runs from June to September was performed. In each experiment, we analyzed the two idealized simulations most sensitive to the dry and wet soil moisture initial conditions. The impact of soil moisture initial conditions on precipitation in West Africa is linear over the Central and West Sahel regions, where dry (wet) experiments lead to a rainfall decrease (increase). The strongest precipitation increase is found over the West Sahel for wet experiments, with a maximum change value of approximately 40 %, whereas the strongest precipitation decrease is found for dry experiments over the Central Sahel, with a peak change of approximately −4 %. The sensitivity of soil moisture initial conditions can persist for 3-4 months (90-120 d) depending on the region. However, the influence on precipitation is no longer than 1 month (between 15 and 30 d). The strongest temperature decrease is located over the Central and West Sahel, with a maximum change of approximately −1.5 °C in wet experiments, whereas the strongest temperature increase is found over the Guinea coast and Central Sahel for the dry experiments, with a maximum change of around 0.6 °C. A significant impact of soil moisture initial conditions on the surface energy fluxes is noted: in the wet (dry) experiments, a cooling (warming) of the surface temperature is associated with a decrease (increase) in sensible heat flux, an increase (decrease) in latent heat flux and a decrease (increase) in the boundary layer depth. Part 2 of this study (Koné et al., 2022) investigates the influence of soil moisture initial conditions on climate extremes

Influence of initial soil moisture in a regional climate model study over West Africa - Part 2: Impact on the climate extremes

International audienceThe influence of soil moisture initial conditions on the climate extreme indices over West Africa was investigated using the fourth generation of the International Centre for Theoretical Physics regional climate model (non-hydrostatic) coupled with version 4.5 of the Community Land Model (RegCM4-CLM4.5) at a 25 km spatial resolution. We initialized the control experiments with the reanalysis soil moisture data from the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis of the 20th century (ERA-20C), while we initialized the dry and wet experiments with the maximum and minimum soil moisture values over the West Africa domain, respectively. For each experiment, an ensemble of five runs was performed for 5 years (2001-2005) with soil moisture initial conditions for the runs prescribed on 1 June and the simulations being performed over 4 months (122 d) from June to September. The performance of RegCM4-CLM4.5 with respect to simulating the 10 extreme rainfall and temperature indices used in this study is presented. The results are then discussed for the two idealized simulations that are most sensitive to the dry and wet soil moisture initial conditions in order to highlight the impacts beyond the limits of soil moisture internal forcing in the model. Over the Central Sahel, dry (wet) experiments lead to a decrease (increase) in precipitation extreme indices related to the number of events, but this was not seen for indices related to the intensity of the events. Soil moisture initial conditions unequally affect the daily minimum and maximum temperatures. The strongest impact is found on the maximum temperature: wet (dry) experiments decrease (increase) the maximum temperature over the whole region. Over the Central Sahel, wet (dry) experiments lead to a decrease (increase) in the maximum values of the minimum temperature