Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: Policy and public-health implications

A classic way of delaying drug resistance is to use an alternative when possible. We tested the malaria treatment Argemone mexicana decoction (AM), a validated self-prepared traditional medicine made with one widely available plant and safe across wide dose variations. In an attempt to reflect the real situation in the home-based management of malaria in a remote Malian village, 301 patients with presumed uncomplicated malaria (median age 5 years) were randomly assigned to receive AM or artesunate-amodiaquine [artemisinin combination therapy (ACT)] as first-line treatment. Both treatments were well tolerated. Over 28 days, second-line treatment was not required for 89% (95% CI 84.1-93.2) of patients on AM, versus 95% (95% CI 88.8-98.3) on ACT. Deterioration to severe malaria was 1.9% in both groups in children aged ≤5 years (there were no cases in patients aged >5 years) and 0% had coma/convulsions. AM, now government-approved in Mali, could be tested as a first-line complement to standard modern drugs in high-transmission areas, in order to reduce the drug pressure for development of resistance to ACT, in the management of malaria. In view of the low rate of severe malaria and good tolerability, AM may also constitute a first-aid treatment when access to other antimalarials is delaye

Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT

Argemone mexicana (AM), a validated herbal medicine for uncomplicated malaria, seems to prevent severe malaria without completely clearing parasites in most patients. This study, in a high transmission area of South Mali, explores whether residual parasitaemia at day 28 was associated with subsequent malaria episodes and/or anaemia. Three hundred and one patients were randomly assigned to AM or artesunate/amodiaquine as first line treatment, of whom 294 were followed up beyond the standard 28 days, to 84 days. From day 29 to day 84, there were no significant differences between treatment groups in new clinical episodes of uncomplicated malaria (0.33 vs 0.31 episodes/patient), severe malaria (<6% per month of patients aged ≤5 years) or moderate anaemia (hematocrit <24%: 1.1% in both groups at day 84). Total parasite clearance at day 28 was not correlated with incidence of uncomplicated or severe malaria or of moderate anaemia over the subsequent two months. Total parasite clearance at day 28 was not clinically important in the context of high transmission. If this finding can be confirmed, some antimalarials which are clinically effective but do not completely clear parasites could nevertheless be appropriate in high transmission areas. Such a policy could be tested as a way to delay resistance to artemisinin combination therapie

Déterminants de l’adoption des Variétés Améliorées de Maïs dans la Région de Sikasso Mali

Le maïs à cause de sa forte productivité est parmi les céréales sèches qui occupent une place importante dans la stratégie de la sécurité Alimentaire au Mali. Vue cette place de ce produit dans l’économie des pays de l’Union Economique et Monétaire Ouest Africaine (UEMOA) en général et dans celle du Mali en particulier, le Conseil Ouest et Centre pour la Recherche et le Développement Agricoles (CORAF) a signé en 2014 avec ces pays, une convention pour la mise en œuvre d’un programme collaboratif sur la filière maïs. Il s’agit pour cette étude d’analyser les déterminants de l’adoption des variétés améliorées de maïs dans la région de Sikasso Mali. Ainsi, des données ont été collectées auprès de 200 producteurs de maïs dans deux cercles (Yanfolila et Koutiala) de la région de Sikasso. Les méthodes économétriques Probit, Logit avec l’approche contrefactuelle basée sur basée sur l’effet moyen de traitement (ATE) ont été utilisés. Il ressort des résultats que les facteurs déterminants dans l’adoption de la variété DEMBAYUNA sont le prix de vente et la participation à une formation. Par contre pour la variété SOTUBAKA, ce sont le nombre d’actif dans le ménage, l’appartenance à un groupement, le contact avec au moins un projet, le prix de vente et la participation à une formation qui sont déterminants. Le Taux commun d’adoption et d’exposition (JEA) est de 39% pour la variété DEMBAYUMA et 64% pour la variété SOTUBAKA. L’amélioration des conditions des producteurs passe par une vulgarisation poussée des variétés performantes. &nbsp; Maize, due to its high productivity among dry cereals, occupies an important place in the food security strategy in Mali. Considering the importance of the product in the economy of West African Economics and Monetary Union (UEMOA) countries in general and in Mali in particular, the West and Central African Concil for Agricultural Research and Development (CORAF) in 2014 signed an agreement with these countries for the implementation of a collaborative program in the maize sector. This paper, therefore, focuses on assessing its impact on income, poverty, food and nutritional security, and on the education of children. Data were collected from 200 maize producers in two circles (Yanfolila and Koutiala) in the Sikasso region. The Probit and Logit econometric methods with the counterfactual approach based on the mean treatment effect (ATE) were used. The econometric results showed that the selling price and participation in training determined the adoption of DEMBAYUNA variety. The number of workers in the household, membership group, contact with at least one project, selling price, and participation in training influenced the uptake of SOTUBAKA variety. The Common Adoption and Exposure Rate (JEA) were 39% for the DEMBAYUMA variety and 64% for the SOTUBAKA variety. The improvement of the livelihood of maize producers should be based on the strengthening of the extension services, i.e., high yielding varieties

Anesthesie au cours des ventriculocisternostomies au Mali : Une serie de 31 cas

Introduction La ventriculocisternostomie est une technique moderne du traitement des hydrocéphalies. Elle est peu fréquente en Afrique. Objectif:&nbsp; Décrire la prise en charge anesthésique et l’évolution des patients opérés par ventriculocisternostomie. Patients et Méthode: Etude de cohorte prospective de 15 mois de janvier 2014 au 31 mars 2015. La saisie et l’analyse des données ont été effectuées par Microsoft word 2010 Epi info 3.5.3.fr. Résultats:&nbsp; Les nourrissons prédominaient avec un sexe ratio de 1,81 en faveur du sexe masculin. Un antécédent de méningite ou d’infection respiratoire à répétition a été retrouvé chez 10 patients (32,2%). L’indication de la ventriculocisternostomie était une hydrocéphalie chez 30 patients (96, 8%). La classe ASA était II chez 19 patients (61,3%). L’intubation était prévue difficile chez 28 patients (90,3%).Tous les patients ont été opérés sous anesthésie générale. Une antibioprophylaxie a été faite chez tous les patients. La tachycardie isolée a été le seul évènement indésirable per opératoire observé chez 13 patients (41,9%). La durée de la chirurgie était de 62, 25 ± 20,9 minutes celle de l’anesthésie était de 93,5 ± 25,4 minutes. En postopératoire, une complication a été observée chez 7 patients (22,6%). Il s’agissait d’une méningite chez 3 patients (42,9%), d’une souffrance cérébrale, d’une obstruction de la stomie, d’un abcès cérébral et une paralysie du nerf III dans 14,3% chacune (1 patient). L’évolution était favorable chez 29 patients (93,5%). La durée médiane d’hospitalisation était de 3 jours. Conclusion:&nbsp; Au Mali, la prise en charge anesthésique au cours de la ventriculocisternostomie s’adresse à une population pédiatrique avec un terrain précaire. &nbsp; English title: Anesthesia during endoscopic third ventriculostomy in Mali: A series of 31 cases Introduction: Endoscopic Third Ventriculostomy (ETV) is a modern technique for the treatment of hydrocephalus. It is uncommon in Africa. Objective To describe ananesthesic management and the outcome of patients operated on by ETV. Patients and Methods Prospective cohort study over 15 months to January 2014 at 31 march 2015. The data entry and analysis were done by word office, Epi info 3.5.3.fr. Results: Infants predominated with a sex ratio of 1.81 in favor of men. A history of meningitis or recurrent respiratory infection was found in 10 patients (32.2%). The indication of ETV was hydrocephalus in 30 patients (96.8%). The ASA class was II in 19 patients (61.3%).&nbsp; Intubation was expected to be difficult in 28 patients (90.3%). All patients were operated on under general anesthesia. Antibiotic&nbsp; prophylaxis was done in all patients. Isolated tachycardia was the only peroperative adverse event observed in 13 patients (41.9%). The duration of the surgery was 62.25 ± 20.9 minutes that of the anesthesia was 93.5 ± 25.4 minutes. Postoperatively, a complication was observed in 7 patients (22.6%). It was meningitis in 3 patients (42.9%), brain pain, obstruction of the stoma, brain abscess and nerve III paralysis in 14.3% each (1 patient). The outcome was favorable in 29 patients (93.5%). The median hospital stay was 3 days. Conclusion:&nbsp; In Mali, anesthetic management during ETV is aimed at a pediatric population with precarious terrain

Valeur diagnostique de deux tests rapides utilisés dans le diagnostic du VIH-2 au Mali : Diagnosis value of two HIV-2 rapid diagnostic tests used in Mali

Context and objective. In sub-Saharan Africa, the epicenter of HIV infection, rapid tests are proposed in first line, but diagnosis value of these tests is rarely performed. The goal of the present study was to evaluate the performance of 2 rapid tests used for the diagnosis of HIV-2 infection compared to a baseline test in order to propose in algorithm for HIV infection diagnosis in health care system. Methods. A cross-sectional study was carried out in three treatment centers in Mali (Bamako, Segou and Sikasso). The tests evaluated were: Genie® II HIV-1/HIV-2 (Sanofi Diagnostic Pasteur, France) and ImmunoComb® II HIV 1&amp;2 BiSpot (Organics, Strasbourg, France). The study involved 34 sera collected consecutively. The l’INNO-LIA HIV I/II Score confirmatory test was used as a reference test in Belgium. Performance of tests were assessed using sensibility, specificity, positive predictive value, negative predictive value and kappa concordance. Results. Patients’ ages ranged from 12 years to 78 years, 19 patients were women (55.8%) and 28 patients had HIV-2 infection. The sensitivity of the rapid tests was 96.4%. The kappa concordance coefficient was 0.85. We found 28 HIV-2 positive patients out of 34 patients. Conclusions. The two rapid tests used in Mali yielded satisfactory results, but the quality of HIV-1 and 2 discrimination serology could be improved. Contexte et objectif. Dans les pays d’Afrique subsaharienne épicentre de l’infection à VIH, les tests rapides sont proposés en première intention, mais la valeur diagnostique de ces tests est rarement réalisée. L’objectif du présent travail était d’évaluer la performance de 2 tests rapides utilisés pour le diagnostic de l’infection à VIH-2 par rapport un test de référence afin de proposer des algorithmes de tests simples et rapides utilisables dans les structures sanitaires. Méthodes.Une étude transversale a été réalisée, dans trois centres de prise en charge au Mali (Bamako, Ségou et Sikasso). Les tests évalués étaient le Genie® II HIV-1/HIV-2 (Sanofi Diagnostic Pasteur, France) et l’ImmunoComb® II HIV 1&amp;2 BiSpot (Organics, Strasbourg, France). L’étude a porté sur 34 sérums collectés consécutivement. Le test de confirmation l’INNO-LIA HIV I/II Score a été utilisé comme test de référence en Belgique. La performance de deux tests précités a été évaluée en recherchant la sensibilité, la spécificité, la valeur prédictive positive (VPP), la valeur prédictive négative (VPN) et la concordance. Résultats. L’âge des patients variait de 12 ans à 78 ans, 19 patients étaient des femmes (55,8%) et 28 patients avaient le VIH-2. La sensibilité des tests rapides était de 96,4%. Le coefficient de concordance kappa était de 0,85. Conclusions. Les deux tests rapides utilisés au Mali ont donné des résultats satisfaisants, et peuvent être proposés en première intention dans l’algorithme national du diagnostic de l’infection à VIH-2 au Mali

The 2D Spectral Intrinsic Decomposition Method Applied to Image Analysis

We propose a new method for autoadaptive image decomposition and recomposition based on the two-dimensional version of the Spectral Intrinsic Decomposition (SID). We introduce a faster diffusivity function for the computation of the mean envelope operator which provides the components of the SID algorithm for any signal. The 2D version of SID algorithm is implemented and applied to some very known images test. We extracted relevant components and obtained promising results in images analysis applications

Annual population dynamics of mango fruit flies (Diptera: Tephritidae) in West Africa: Socio-economic aspects, host phenology and implications for management

Losses in West African commercial mango orchards due to fruit fly infestations have exceeded 50% by the middle of the crop season since 2005, resulting in considerable income loss for the growers. Materials and methods. In 2009, weekly monitoring of adult fruit fly species of economic significance was carried out in eight West African countries at 12 sites across five agro-ecological zones: (i) Humid Forest, (ii) Guinean savanna, (iii) Southern Sudan, (iv) Northern Sudan, and (v) Sahelian. Trapping was performed using methyl eugenol and terpinyl acetate in 288 Tephritraps, targeting Bactrocera invadens and Ceratitis cosyra. Results. The data showed that B. Invadens was present throughout the year in the Forest zone, abundant for 7 months, with a peak in May at the end of the mango season, C. cosyra being totally absent. In the Guinean savanna zone, B. invadens was abundant for 6-7 months, with a peak at the beginning of June coinciding with the season, with a few C. cosyra. In the Southern Sudan zone, B. invadens was abundant for 6 months, with a peak in mid-June during the season, C. cosyra peaking in April. In the Northern Sudan zone, B. invadens was abundant for 5 months, with a peak at the end of June at the end of the season, C. cosyra peaking in May. In the Sahelian zone, B. invadens was abundant for 4 months, peaking in August during the sea-son, C. cosyra peaking just before. These preliminary results showed that the exotic species, B. invadens, was present at high levels [mean peak of 378 flies per trap per day (FTD)] in all agro-eco-logical zones, while the native species, C. cosyra, preferred the drier zones of West Africa, with lower population levels (mean peak of 77 FTD).Conclusion. Detection trapping of male flies with parapheromones is a useful indicator of field population levels and could be used to deploy control measures (IPM package) in a timely manner when the Economic Injury Level is reached. Control strategies for these quarantine mango fruit fly species are discussed with respect to agro-ecological zones and the phenological stages of the mango tree. (Résumé d'auteur

Mistreatment in the gynaecology and obstetrics units of health facilities: community women's experiences in Guinea

Background: Improving maternal and child health helps to ensure women's well-being. However, despite many efforts, women are still subjected to mistreatment and abuse in health facilities such as gynaecology and obstetrics units. Data on women's mistreatment in gynaecology are scarce and insufficient in obstetrics departments. This study therefore analyses women's experiences of mistreatment in these services in Guinea. Methods: This study is based on a qualitative approach using in-depth individual interviews and group discussions with community women. The data was subjected to thematic analysis. Results: This study revealed a high prevalence of mistreatment of women in health facilities, both during provision of gynaecological services and in obstetric units (pregnancy, prenatal consultations and childbirth). They are mainly victims of verbal abuse, negligence and informal payment, and to a lesser extent physical violence. Victims generally have few means of redress. This mistreatment is encouraged above all by the lack of training for health care providers, the inadequacy of services and the absence of sanctions. To prevent and combat this phenomenon, it is necessary to organise training courses on respectful maternal care for healthcare providers, make patients aware of their rights and the culture of consent, and apply disciplinary sanctions. Conclusions: This study has enabled us to understand the types and extent of mistreatment suffered by women in obstetrics and gynaecology units.  It identified measures to be taken to prevent and combat mistreatment in these units in order to ensure respectful healthcare and improve relations between healthcare providers and their clients

Factors associated with decision-making on family planning use among women aged 15-49 in Guinea

Background: In Guinea, several factors affect women's ability to make decisions about contraceptive use. The objective of this study was to identify factors associated with married women's decision-making power regarding family planning use in Guinea. Methods: Data from the 2018 Guinea Demographic and Health Survey were used. A sample of 752 women was included in the study. Multivariate logistic regression was performed to determine the factors associated with women's decision-making power regarding the use of family planning in Guinea. The Odd ratio with 95% confidence interval was calculated for the variables in the final model. Results: The overall prevalence of women deciding to use family planning was 65.47% [95%CI: 62.18 68.61]. Urban women had a 49% lower chance of deciding to use family planning than rural women (adjusted OR=0.61; 95% CI [0.238 0.92]). Similarly, women with secondary education were 3.53 times more likely to use family planning than those with no formal education (adjusted OR=3.53; 95% CI [1.27 9.78]). Conclusions: This study shows the importance of several factors in women's decision-making power regarding family planning use in Guinea. Women with secondary education, those in the Kindia and Kankan regions, and those with a job had higher probability of deciding to use family planning. Findings from this study could help guide public health policies, emphasising the importance of education, employment and access to health services in improving women's decision-making power when it comes to family planning in the Republic of Guinea