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

Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded. It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses

Socio-cultural representation of pain in Mali : study of management networks : the importance of developing a prototype center for pain management adapted to Africa

L’Afrique Subsaharienne (ASS) est confrontée à des problèmes de santé complexes qui impliquent un large éventail des facteurs sociopolitiques, économiques, structurel, culturel Dans ce contexte, les spécificités et les difficultés de la prise en charge de la douleur en Afrique subsaharienne sont multiples (structurel et socioculturel). Par ailleurs, sur le plan anthropologique et médical les modèles cliniques et les modèles explicatifs de la douleur ne sont pas identiques à ceux des sociétés occidentales. Les systèmes de représentation de la maladie dans certaines communautés africaines défendent que les « états » pathologiques ne soient pas seulement dus à des causes naturelles, mais peuvent aussi être provoqués par des forces occultes. Le traitement de la maladie est alors bidirectionnel en touchant, d’abord, le trouble organique par des plantes et ensuite, en rétablissant l’équilibre des forces vitales par des prières et des rites. Dans cette dynamique il devient urgent compte du fardeau de la douleur à l’échelle individuel et communautaire de réfléchir sur une filière de soins de prise en charge de la douleur adapté aux réalités locales. D’où notre problématique de recherche à savoir, quels sont les systèmes de représentation et de pratiques traditionnelles de prise en charge de la douleur au Mali ? Quels impacts sur la mise en place d'un centre de suivi de la douleur au Mali ? Ce travail avait pour objectif d’étudier les systèmes de représentation Maliens et les déterminants socio-culturels de la douleur, afin de contextualiser les modèles cliniques d’une part et d’autre part de construire un modèle adapté de centre de la douleur. Le but ultime de ce travail était de mettre à la disposition de la communauté (neurologues, politiques, chercheurs, patients, tradithérapeutes) des soins efficaces, adaptés aux réalités socioculturelles afin de réduire le fardeau des pathologies Neurologique en ASS. Nous avons confirmé dans ce travail l’importance de la douleur et surtout celle neuropathique dans notre pratique. Ce travail a permis aussi d’appréhender le rôle primordial de la Médecine Traditionnelle dans l’offre de soins. Nous attirons l’attention des chercheurs et les décideurs politiques pour trouver des stratégies afin d’améliorer la prise en charge de la douleur par la mise en place de programmes innovants visant à favoriser la collaboration entre la Médecine Traditionnelle et Médecine Conventionnelle.Sub-Saharan Africa (SSA) is facing complex health problems involving a broad range of sociopolitical, economic, systemic, and cultural factors. In this context, the specificities and the difficulties of treating pain in sub-Saharan Africa are multiple (systemic and sociocultural). Furthermore, at the anthropological and medical levels, the clinical models and the explanatory models of pain are not identical to those of Western societies. The systems of representation of disease in certain African communities assert that pathological “states” are not only due to natural causes but that they can also be triggered by occult forces. Treatment of disease then becomes bidirectional by, firstly addressing the physical disorder with plants, and then by reestablishing the balance of life forces by prayers and rites. In light of the burden of pain at the individual and the community level, with this approach, there is a need to consider a range of care to treat pain tailored to the local realities. Whence our research topic, namely, what are the systems of representation and traditional practices for treating pain in Mali? What might the impacts be on the implementation of a center to monitor pain in Mali? The objective of this work was to study the Malian systems of representation and the sociocultural determinants of pain, so as to, on the one hand, contextualize the clinical models and, on the other hand, to devise a customized model of a pain center. The ultimate aim of this work was to make effective care, tailored to the sociocultural realities, available to the community (neurologists, politicians, researchers, patients, and traditional therapists) in order to reduce the burden of neurological pathologies in SSA. In this work, we have confirmed the prevalence of pain, and particularly neuropathic pain, in our practice. This work has also allowed us to appreciate the key role of traditional medicine in the provision of care. We call on researchers and policy decision-makers to find new strategies aimed at improvement of the treatment of pain by the implementation of novel programs geared toward promoting collaboration between traditional medicine and conventional medicine

Diabetic polyneuropathy with/out neuropathic pain in Mali: A cross-sectional study in two reference diabetes treatment centers in Bamako (Mali), Western Africa.

IntroductionDiabetic polyneuropathy (DPN) with or without neuropathic pain is a frequent complication of diabetes. This work aimed to determine the prevalence of diabetic polyneuropathy, to describe its epidemiological aspects, and to analyze the therapeutic itinerary of patients with DPN.MethodsThis was a cross-sectional, descriptive study performed synchronously over six months at two major follow-up sites for patients with diabetes in Mali. DPN was diagnosed based on the Michigan Neuropathy Screening Instrument (MNSI). The neuropathic nature of the pain and the quality of life of patients were evaluated by the DN4 and the ED-5D scale, respectively. We used three (3) different questionnaires to collect data from patients (one at inclusion and another during the follow-up consultation) and from the caregivers of patients with DPN.ResultsWe included 252 patients with diabetes, and DPN was found to have a healthcare facility-based prevalence of 69.8% (176/252). The sex ratio was approximately three females for every male patient. The patients were mostly 31 to 60 years of age, 83% had type 2 diabetes, and 86.9% had neuropathic pain Approximately half of the patients (48.3%) had autonomic neuropathy and they reported moderate to intense pain, which was mainly described as a burning sensation. The patients exhibited impaired exteroceptive and proprioceptive sensations in 51.7% of cases. The patients smoked tobacco in 3.4% of cases, while 36.6% of the patients were obese and had dyslipidemia. The caregivers clearly indicated that appropriate medications were not readily accessible or available for their patients with DPN.ConclusionThe healthcare facility-based prevalence of DPN with or without neuropathic pain was high in our cohort. These inexpensive and easy-to-use tools (MNSI, DN4) can be used to adequately diagnose DPN in the African context. In Mali, screening and early treatment of patients at risk of DPN should allow for a reduction of the burden of the disease, while caregivers need to be adequately trained to manage DPN

Structured Q1 headache services as the solution to the ill-health burden of headache: 1. Rationale and description

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded