Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso

<p>Abstract</p> <p>Background</p> <p>Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated.</p> <p>Methods</p> <p>A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria).</p> <p>The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level.</p> <p>The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season.</p> <p>Results</p> <p>A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%–22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%–71.5%), respectively in the intervention and control arms (p << 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32).</p> <p>The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs. 2,595), with malaria accounting for 87.4% of all disease episodes recorded in the intervention area and for 34.1% in the control area (P < 0.0001). Of all the malaria cases treated in the intervention arm, only 6.7% were treated at the health facility level.</p> <p>Conclusion</p> <p>These findings suggest that implementation of HMM, by reducing the workload in health facilities, might contributes to an overall increase of the performance of the peripheral health facilities.</p

Epilepsie et permis de conduire au Mali : connaissances, attitudes et pratiques des moniteurs d’auto-école et des candidats au permis de conduire

Introduction: L’un des sujets les plus controversés dans le domaine de l’épilepsie est la problématique de la conduite chez l’épileptique.Objectif: Nous avons initié une étude, en collaboration avec l’Agence Nationale de la Sécurité Routière au Mali (ANASER), ayant pour but de faire l’état des lieux sur les connaissances, attitudes et pratiques des conducteurs, moniteurs et inspecteurs d’auto-écoles en matière d’épilepsie.Methode: Il s’agissait d’une étude longitudinale, prospective, descriptive et analytique qui s’est déroulée de juin 2009 à juin 2010. Elle a porté sur 31 auto-écoles du district de Bamako. 568 personnes ont été interrogées (488 candidats au permis de conduire, 70 moniteurs d’auto-école et 10 inspecteurs).Resultats: Près de 60 % des personnes interrogées accordaient une origine surnaturelle à l’épilepsie ; plus de 85 % indiquaient que l’épilepsie était incompatible avec la conduite automobile. Plus de la moitié ignorait l’existence d’une réglementation. Près de 70 % pensaient que l’épilepsie était pourvoyeuse d’accident de la voie publique.Conclusion: A l’instar de nos précédentes études communautaires au Mali, ce travail a permis de mettre l’accent, d’une part, sur l’importance des connaissances erronées sur l’épilepsie et, d’autre part, sur la nécessité d’actualiser la réglementation en matière de conduite de véhicules motorisés pour ces patients.Mots clés: Attitudes, Épilepsie, Mali, Permis de conduire, Conduite automobileEnglish Title: Epilepsy and driving licence in Mali : knowledge, attitudes and practices of driving schools monitors and the candidates for the licenceEnglish AbstractBackground: One of the most controversial topics in the field of epilepsy remains the issue of driving license for epileptic patients.Purpose: We initiated a study in collaboration with ANASER (National Agency for Road Safety in Mali) with the goal, on one hand, of assessing the knowledge, attitudes and practices of drivers and driving school authorities on epilepsy and, on the other hand, to analyze the current regulations on issuance of license to epileptic patients.Methods: Il s’agissait d’une étude longitudinale, prospective, descriptive et analytique qui s’est déroulée de juin 2009 à juin 2010. We interviewed 568 sujects, including 488 candidates for driver’s license, 70 driving school monitors and 10 inspectors.Results: About 60% gave a supernatural origin of the disease, and more than 85% believed that epilepsy was incompatible with driving. More than half were unaware of regulations. Approximately, 70% of respondents believed that epilepsy was a contributory factor to road accident.Conclusion: As in our previous community studies in Mali, this study emphasizes the importance of misconceptions about epilepsy, and has shown the need to update the regulations regarding the driving of motorized vehicles for these patients.Keywords: Epilepsy, Attitudes, Driving , Driving License, Mal

L’appendagite aiguë : une étiologie rare à ne pas méconnaître dans les douleurs abdominales: Acute appendagitis: a rare etiology not to be overlooked in abdominal pain

Acute appendagitis is a rare cause of abdominal pain. Its diagnosis is based on medical imaging and its treatment is medical. We report a case of acute appendagitis diagnosed on the abdominal CT scan in the context of epigastralgia. L’appendagite aiguë est une cause rare de douleurs abdominales. Son diagnostic repose sur l’imagerie médicale et son traitement est médical. Nous rapportons un cas d’appendagite aiguë diagnostiquée au scanner abdominal au décours d’une mise au point d’épigastralgies

Extent and Dynamics of Polymorphism in the Malaria Vaccine Candidate Plasmodium falciparum Reticulocyte-Binding Protein Homologue-5 in Kalifabougou, Mali

Reticulocyte-binding homologues (RH) are a ligand family that mediates merozoite invasion of erythrocytes in Plasmodium falciparum. Among the five members of this family identified so far, only P. falciparum reticulocyte-binding homologue-5 (PfRH5) has been found to be essential for parasite survival across strains that differ in virulence and route of host-cell invasion. Based on its essential role in invasion and early evidence of sequence conservation, PfRH5 has been prioritized for development as a vaccine candidate. However, little is known about the extent of genetic variability of RH5 in the field and the potential impact of such diversity on clinical outcomes or on vaccine evasion. Samples collected during a prospective cohort study of malaria incidence conducted in Kalifabougou, in southwestern Mali, were used to estimate genetic diversity, measure haplotype prevalence, and assess the within-host dynamics of PfRH5 variants over time and in relation to clinical malaria. A total of 10 nonsynonymous polymorphic sites were identified in the Pfrh5 gene, resulting in 13 haplotypes encoding unique protein variants. Four of these variants have not been previously observed. Plasmodium falciparum reticulocyte-binding homologue-5 had low amino acid haplotype (h = 0.58) and nucleotide (π = 0.00061) diversity. By contrast to other leading blood-stage malaria vaccine candidate antigens, amino acid differences were not associated with changes in the risk of febrile malaria in consecutive infections. Conserved B- and T-cell epitopes were identified. These results support the prioritization of PfRH5 for possible inclusion in a broadly cross-protective vaccine

African Linguistics in Central and Eastern Europe, and in the Nordic Countries

Non peer reviewe

Application of multi-perspective modeling and holistic simulation to Urban Transportation Systems

International audienceAs Urban Transportation Systems (UTS) are becoming central in our daily lives, they are also gaining in complexity due to their ever-increasing interdependence with other socioeconomic dimensions (such as climate, demography and environmental policies, to name a few). This paper presents a multi-perspective modeling and holistic simulation framework that can address such a complexity. It is based on the holistic integration of models that have independently been built from the respective perspectives of various but interdependent dimensions. The resulting model can answer questions that any of the perspective-specific models cannot in isolation

Epidemiologie du prolapsus genital

La genèse du prolapsus génital est multifactorielle et des évènements individuels vont influencer l’apparition du prolapsus chez la femme. L’étude du profil épidémiologique des femmes victimes de prolapsus génital permet d’étudier tous les facteurs pour mieux conseiller et rassurer les femmes dans la prévention et la prise en charge de cette pathologie.Objectifs. Déterminer le profil épidémiologique des patientes victimes de prolapsus au service de gynécologie de l’hôpital du Mali.Matériel et méthode. Il s’agissait d’une étude transversale à visée descriptive à collecte prospective du 1er janvier au 31 décembre 2019. Nous avons inclus tous les cas de prolapsus génital diagnostiqué en dehors de la grossesse et dans les trois premiers mois du post-partum. L’interrogatoire a permis de préciser le moment d’apparition et l’examen physique d’identifier le type du prolapsus.Résultats : Nous avons enregistré 35 cas de prolapsus sur 267 interventions chirurgicales soit 13,10%. Les patientes en âge de procréer étaient de 21 (60%) versus patientes en ménopause 14 (40%). L’âge moyen était de 44,74 ans avec des extrêmes de 17 et 80 ans, La majorité des patientes était des femmes au foyer 29 cas (82,86%). Le milieu de résidence était rural ou urbain dans respectivement 20 cas (57,14%) et 15 cas (42,86%). La parité moyenne était de 5,22 % avec 45,71% de grandes multipares, 25,71% de paucipares et 20% de multipares. Les femmes mariées ont représenté 65% des cas. La durée d’apparition du prolapsus était en moyenne de trois ans. Les principaux antécédents retrouvés étaient la macrosomie 2 cas (5,71%), la déchirure du périnée 2 cas (5,71%) et la césarienne 1 cas (2,86%). Selon la classification de Baden, 23 patientes avaient un prolapsus de grade 3 (65,71%). Les organes participant au prolapsus étaient l’utérus et la vessie simultanément dans 19 cas (54,29%), la vessie seule dans 6 cas (17,14%), la vessie et le rectum 4 cas (11,43%).Conclusion : le prolapsus génital est fréquent chez la multipare avec une prédominance du grade 3 English title: Epidemiology of genital prolapse The genesis of genital prolapse is multifactorial and individual events will influence the onset of prolapse in women. The study of the epidemiological profile of women victims of genital prolapse makes it possible to study all the factors to better advise and reassure women in the prevention and management of this pathology.Goals. To determine the epidemiological profile of patients suffering from prolapse in the gynecology department of the hospital in Mali.Material and method. This was a descriptive cross-sectional study with prospective collection from January 1 to December 31, 2019. We included all cases of genital prolapse diagnosed outside pregnancy and in the first three months postpartum. The questioning clarified the time of onset and the physical examination identified the type of prolapse.Results: We recorded 35 cases of prolapse out of 267 surgical procedures, (13.10%). Patients of childbearing age were 21 (60%) versus menopausal 14 (40%). The mean age was 44.74 years with extremes of 17 and 80 years. The majority of patients were housewives in 29 cases (82.86%). The place of residence was rural or urban in respectively 20 cases (57.14%) and 15 cases (42.86%). The average parity was 5.22% with 45.71% large multiparas, 25.71% pauciparas and 20% multiparas. Married women accounted for 65% of cases. The duration of the onset of prolapse was on average three years. The main antecedents found were macrosomia 2 cases (5.71%), perineum tear 2 cases (5.71%) and cesarean section 1 case (2.86%). According to Baden's classification, 23 patients had grade 3 prolapse (65.71%). The organs participating in the prolapse were the uterus and bladder simultaneously in 19 cases (54.29%), the bladder alone in 6 cases (17.14%), and the bladder and rectum in 4 cases (11.43%).Conclusion: genital prolapse is frequent in multipara with a predominance of grade

Contribution A L’amélioration De L’accès A L’eau, L’hygiène Et L’assainissement Dans La Commune Rurale De Zan Coulibaly Au Mali

Dans la perspective d’améliorer l’accès aux services de base en eau potable, hygiène et assainissement (EHA), le Mali a fait de ce secteur une priorité depuis 2006. Cette étude avait pour objectif de mener une analyse critique du diagnostic de l’accès aux services de base EHA et l’impact des déplacés internes de la crise politique et sécuritaire de 2012 sur ces services dans la commune de Zan Coulibaly afin de proposer des stratégies locales pérennes. Les données ont été collectées à travers une fiche de questionnaire semi-structurée, des observations directes sur le terrain et la consultation des documents administratifs. L’enquête a révélé que les forages (40%) et les puits traditionnels (28%) étaient les principales sources d’approvisionnement en eau. La collecte de l’eau est une activité exclusivement féminine. Pour traiter l’eau de boisson à domicile, la filtration sur linge était la technique la plus utilisée (71%). Malgré un contexte pandémique à COVID-19, seulement 24 % des personnes interrogées lavaient les mains au sortir des toilettes et 22% avant de manger. Aussi, 16% des enquêtés pratiquaient toujours la défécation à l’air libre. De 2016 à 2020, on note une persistance des maladies diarrhéiques et une réapparition des maladies dues aux vers intestinaux. Par ailleurs une éradication du trachome et du choléra a été observée. Néanmoins, les résultats relatifs au site des déplacés internes de la crise, sont alarmantes. Ces données constitueraient une base pour mieux orienter les politiques et les actions futures relatives aux services EHA dans la commune de Zan Coulibaly. To improve the access to the basic water, sanitation and hygiene (WASH) services, Mali has made this sector a priority since 2006. This study aimed to conduct a critical analysis of the diagnosis of access to WASH basic services and the impact of internally displaced people from the political and security crisis of 2012 on these services in the rural commune of Zan Coulibaly in order to propose sustainable local strategies. The data were collected throughout a semi-structured questionnaire form, direct observations on the sites in the nine villages, and the consultation of executive documents. The survey revealed that the drilling (40%) and the traditional wells (28%) were the main sources of water supply. The water collection is an exclusively female activity. To treat drinking water at home, the filtration was the most commonly used technique (71%). Despite a pandemic context of COVID-19, only 24% of respondents washed their hands after leaving the toilet and 22% before eating. Also, 16% of respondents have always defecated in the free air. From 2016 to 2020, we note the persistence of diarrheal diseases and the reappearance of intestinal worm diseases. Otherwise, the trachoma and the cholera were eradicated. Nevertheless, the results relating to the internally displaced people from the crisis are alarming. These data could provide a basis for better guiding the future policies and actions in the provision of WASH services in the rural commune of Zan Coulibaly

Indium recovery by coupling liquid-liquid extraction and electrodeposition in ionic liquids

International audienceThe development of water immiscible room temperature ionic liquids (RTILs) naturally suggested their use for biphasic extraction as an alternative to molecular organic solvents most notably for their low vapor pressure . However, although liquid-liquid extraction processes using RTILs often reach high efficiency and selectivity, the difficult de-extraction of metallic species is to date as a major technical lock. In this context, in situ electrodeposition in the ionic liquid phase after liquid-liquid extraction could allow species recovery in their metallic form. In this work, we studied the possibility to recover indium by coupling liquid-liquid extraction followed by in situ electrodeposition in the ionic liquid phase. Indium was classified in June 2010 as a critical raw material by the European Commission, due to its high relative economic importance and to high relative supply risk . We first investigated the electrodeposition of In in 1-butyl-1-ethylpiperidinium bis(trifluoromethylsulfonyl)imide (BEPipNTf2) in ambient atmosphere, after its synthesis and its purification . This RTIL, characterized by a wide electrochemical window, a low viscosity and an ultra-low hygroscopic character presents good properties for liquid-liquid extraction and consecutive electrodeposition. Then, based on the works of F. Kubota et al. [4] who showed that In(III) can be quantitatively and selectively extracted in an ionic liquid using trimethylphosphine oxide (TOPO) as extractant, we studied the electrochemical behavior of In(III)-TOPO complex. Voltammetric studies revealed that TOPO is non electroactive and that the In-TOPO complex can be reduced within the electrochemical window of the ionic liquid. The influence of the extractant on the electrodeposition of metallic indium was studied and it appears that indium can be quantitatively electrodeposited in the presence of TOPO. Finally, the feasibility of In electrodeposition in ambient atmosphere after liquid-liquid extraction was then demonstrated