Concordance of vaccination status and associated factors with incomplete vaccination: a household survey in the health district of Segou, Mali, 2019

Introduction: the region of Segou recorded 36.8% of children were incompletely vaccinated in 2018. In 2019, the district of Segou was one of the districts with the lowest vaccination coverage in the region, with 85.1% coverage for the three doses of the pentavalent vaccine and 85.4% for the measles vaccine. This study was initiated to better understand this low vaccination coverage, in the absence of specific studies on vaccination coverage in the district of Segou. Methods: a prospective cross-sectional study was conducted from May to August 2020 with 30 clusters. We performed Kappa coefficient, bivariate, and multiple logistic regression analysis. Results: findings showed that 18.46% (101/547) [15.44-21.93] of children were incompletely vaccinated. Mothers correctly reported the vaccination status of their children in 67.30% of cases (Kappa coefficient). Uneducated (OR[IC95%]=2.13[1.30-3.50]), living in rural area (OR[IC95%]=2.07[1.23-3.47]), lack of knowledge of Expanded Program on Immunization (EPI) target diseases (OR[IC95%]=2.37[1.52-3.68]), lack of knowledge of vaccination schedule (OR[IC95%]=3.33[1.90-5.81]) and lack of knowledge of the importance of vaccination (OR[IC95%]=3.6[2.35-6.32]) were associated with incomplete vaccination. In multivariate analysis, uneducated (ORa[IC95%>]=1.68[1.004-2.810]) and lack of knowledge of the importance of vaccination were associated with incomplete vaccination (ORa[IC95%]=3.40[2.049-5.649]). Conclusion: findings showed a good concordance of the vaccination status. Living in a rural area, no education, lack of the knowledge of EPI target diseases, lack of the knowledge of vaccination schedule and lack of knowledge of the importance of vaccination were associated with incomplete vaccination

Antiretrovirall drugs accessibility to HIV/AIDS patients in Bamako, Mali (West Africa)

ABSTRACT OF THESIS ANTIRETROVIRAL DRUG ACCESSIBILITY TO HIV/AIDS PATIENTS IN BAMAKO, MALI (West Africa) Background The republic of Mali is a landlocked country located in West Africa. The national HIV infection prevalence rate was 1.7% in 2001 and still below 2% in 2004. In Mali, ARV drugs are free of charge for HIV/AIDS patients. By the end of 2005 there were 6 000 HIV-infected patients receiving ART out of 22 000 in need (32% coverage). By 2006, it was 37% of coverage. Do these patients under ART have regular access to ARV? Objective The main objective of the study was to assess patients' perception of difficulties in access to ARV drugs for patients on ART Methods: A quantitative cross-sectional study was conducted among HIV/AIDS patients and dispensers at the three ARV sites in Bamako, the capital city of Mali. Data were collected with questionnaire by using a face-to-face interview with 210 patients under ART at least one month and 16 dispensers. Findings Our findings showed that ARV was perceived accessible in patients and dispensers opinions even though dependant variables. But some main difficulties have been cited related to the lack of money for transportation fee, long waiting time, stigma etc. 138 patients (66%) were female. The mean age for patients was 35.17 ¡À 9.23 years. 183 patients (87%) were residing in Bamako. 169 patients (80%) had low or no income. During this study, we estimated the median distance to reach the ARV site to be 9km, the median cost of transportation 500 Francs CFA (¡Ö1 US dollar), the mean time to reach ARV site was 100.64 ¡À 225.80 minutes, the mean waiting time to get ARV at the treatment site (medical prescription plus ARV dispensing) was 3.80 ¡À 2.65 hours. 166 patients (79%) used public transportation to reach ARV sites. The advices given by dispensers and received by patients were not consistent. The findings showed existence of differences between the three ARV sites and also between genders in some variables. Conclusion: Generally, ARV was accessible to the majority of HIV/AIDS patients but some difficulties still existed. However another study would enable the possibility of finding out patients who still have no access to ARV

C50 - Evaluation de l’utilisation de la liste nationale des médicaments essentiels au Mali

Introduction : La liste nationale des médicaments essentiels (LNME), version de 2019, est un outil privilégié pour la mise en œuvre de la politique pharmaceutique nationale (PPN) au Mali. Elle participe à la rationalisation de la prescription. Elle est mise à jour tous les 2 ans. L’objectif était d’évaluer l’utilisation de la LNME par les prestataires avant sa révision. Méthodologie : Il s’agissait d’une étude transversale, réalisée du 1er février au 31 mars 2023 dans les structures sanitaires. La taille de l’échantillon a été déterminée par la formule de Schwartz qui a permis de sélectionner en fonction de leurs poids les régions de Sikasso, Ségou et le district de Bamako. Les données ont été collectées avec l’application KoboCollect. Les logiciels Excel®-2019 et SPSS®-22.0 ont servi à l’analyse des données. Résultats : Au total 457 agents de santé ont été enquêtés dont 380 prescripteurs et 77 gestionnaires de médicaments dans 61 structures visitées. La LNME était disponible dans 49% des structures. Environ 65% des gestionnaires et 6% des prescripteurs disposaient de la LNME. En somme, 50% des gestionnaires et 3% des prescripteurs l’utilisaient régulièrement pour l’approvisionnement en médicaments et la prescription. Les raisons de la faible utilisation de la LNME étaient diverses. Le délai moyen entre la révision de la LNME 2019 et la réception par les structures était de 1,8 an. Sur une liste de 30 médicaments évalués, la disponibilité moyenne le jour de la visité était de 19,75%. Par ailleurs, 27% des prescripteurs et 87% des gestionnaires inclus avaient respectivement reçu une formation en prescription rationnelle et en gestion logistique. Conclusion : La mise à disposition rapide de la LNME et la disponibilité continue de tous les médicaments y figurant pourrait renforcer son appropriation et son utilisation par les acteur

Le role de l’activite physique dans l’equilibre du diabete de type 2: The roles of physical activity in the stability of type 2 diabetes

Le diabète est une affection métabolique, caractérisée par une hyperglycémie chronique (taux de sucre trop élevé dans le sang) lié à une déficience, soit de la sécrétion de l’insuline, soit de l’action de l’insuline, soit les deux. L’activité physique régulière est aujourd’hui reconnue comme un des piliers du traitement du diabète de type 2, avec la prise de médicaments et une alimentation équilibrée. L’objectif de ce travail était d’étudier le rôle de l’activité physique dans l’équilibre du diabète de type 2 dans la ville de Fès au Maroc. Il s’agissait d’une étude observationnelle transversale, réalisée entre Janvier 2014 et Février 2015. Au total 1017 diabétiques de type 2 ont été inclus dans l’étude. L’âge moyen des patients était de 57,6±10,3 ans. La durée d’évolution moyenne du diabète était de 7,8±6,4 ans avec comme minimale 1an et une maximale de 54ans. Le sexe féminin était le plus représenté soit 78,3%, Les femmes de ménage représentaient 71%. Les patients non scolarisés étaient les plus fréquents avec 75,8% suivi du niveau primaire 15,6% avec un niveau socioéconomique bas dans 60,7%. Ils étaient du milieu urbain dans 94,1% et 67,8% des patients n’avaient pas de couverture sociale. L’activité physique modérée était pratiquée par 18,9% des sujets et 12,6% pratiquaient une activité physique intense. Les diabétiques qui pratiquaient une activité physique avaient moins de risque d’être déséquilibrés par rapport aux diabétiques qui pratiquaient une activité physique légère, OR [IC95%] = 0,14 [0,08- 0,25]. Diabetes is a metabolic disorder, characterized by chronic hyperglycemia due to a deficiency of insulin secretion or a deficiency of insulin action, or both. Regular physical activity is now recognized as a pillar in the treatment of type 2 diabetes in addition to medication and balanced diet. The objective of this work was to study the role of physical activity in the control of type 2 diabetes in Fez, Morocco. This was an observational cross-sectional study, conducted between January 2014 and February 2015. Overall, 1017 type 2 diabetics were included. The mean age of patients was 57.6 ± 10.3 years. The average duration of diabetes was 7.8 ± 6.4 years. Female represented 78.3% among which 71% were housewives. The majority of patients (75,8%) were not educated, and 15.6% reached primary level. More than the half of patients (60.7%) had a low socio-economic level. Almost all the patients (94.1%) lived in the urban area, and 67.8 had no social security. Moderate physical activity was practiced by 18.9% of subjects, and 12.6% practiced intense physical activity. Diabetics patients who practiced physical activity had better control over their diabetes condition compared to sedentary (OR 0.14 [0.08-0.25]

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

Adverse Drug Reactions to Antiretroviral Therapy (ART): Prospective Study in HIV Infected Adults in Sikasso (Mali)

Objective: The purpose of this study was to evaluate the adverse effects of Antiretroviral Therapy (ART) in adult HIV-infected patients in decentralized setting of Sikasso, in Mali. Methods: This is a proactive study that took place from 2 January 2011 to 30 December 2012 at the Hospital of Sikasso (Department of Medicine). HIV-infected adult patients who have started ART at least 3 months before were included in this study to monitor the laboratory and clinical Adverse Drug Reactions (ADR) for at least 6 months. The WHO classification of adverse drug reactions has been used to investigate the causality of antiretrovirals. Results: Women were the most represented with 58% of the cases. The most represented age range was 26-47 years with 73.6%. Of the 178 patients enrolled, 61.2% had an ADR. ADR were neurological (40.4%), digestive (35.8%), cutaneous (18.3%) and hematological (5.5%). Stavudine was the most incriminated molecule, in 24.8% of the cases. The WHO grade 4 classification of ART toxicity was represented in 3.4% of the cases. The WHO causality score of “certain” was found in 29.8% of the cases. Conclusion: Adverse effects of Antiretrovirals are frequent and could be life-threatening in short and long terms. Regular follow-up of patients receiving these triple therapies, and the associated complications, is essential. We recommend active surveillance of antiretroviral therapy to strengthen Pharmacovigilance in Mali

Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices