Hodgkin Lymphoma at the Paediatric Oncology Unit of Gabriel Touré Teaching Hospital, Bamako, Mali: 5-Year Experience

Introduction. The aim of this retrospective, unicentric study over 5 years is to describe the epidemiologic, pathologic, clinic and therapeutic aspects of children treated for Hodgkin lymphoma in our paediatric oncology unit. Patients and Methods. From January 2005 to December 2009, all children under 18 years of age, with Hodgkin lymphoma were included in this study. The treatment protocol was the GFAOP (Groupe Franco—Africain d'Oncologie Pédiatrique) Hodgkin lymphoma treatment protocol. Results. During the study period, 217 cancer cases were diagnosed in our centre. Of these cases, 7 were Hodgkin Lymphoma (LH) (0.04%). The mean age was 11.7 years. The sex-ratio was 6/1. 4% (5/7) of patients were stage IIB and 28.6% (2/7) stage IIIB of Ann-Arbor classification. There were 3 cases (42.8%) of sclero-nodular subtype, 2 cases (28.6%) of lymphocyte-rich classical HL subtype, 1 case (14.3%) of mixed cellularity and 1 case (14.3%) of lymphocyte depleted subtype. With a median followup of 37 months, 5 patients (71.4%) are alive, and 2 patients (28.6%) died. Conclusion. Broader multicentric studies are needed for more accurate data on this malignancy

Isolation and characterization of Bacillus thuringiensis (Ernst Berliner) strains indigenous to agricultural soils of Mali.

The objective of this work was to isolate and characterize Bacillus thuringiensis from agricultural and other insect breeding sites in Mali. A hundred soil samples were collected from Bamako district, Segou, Sikasso and Timbuktu regions. B. thuringiensis (Bt) was isolated from the samples using a heat-acetate method and the isolates were identified and classified using morphological and biochemical tests. The frequency of B. thuringiensis in soils was noted. The results showed that, 15 out of the 3111 bacterial isolates were putative Bt. thuringiensis. Most isolates produced parasporal crystals. The average Bt index for all the areas sampled was 5.1%; the highest frequency was recorded for Niono in Segou region (11.7) and the lowest for Bozola in Bamako district (0.5). Contrary the known information on the high content and distribution of B. in soils, the agricultural soils of Mali contain few Bt strains, confirmed by the low Bt index obtained

HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa

We assessed the effect of HIV status disclosure on retention in care from initiation of antiretroviral therapy (ART) among HIV-infected children aged 10 years or more in Cote d'Ivoire, Mali and Sénégal.Multi-centre cohort study within five paediatric clinics participating in the IeDEA West Africa collaboration. HIV-infected patients were included in this study if they met the following inclusion criteria: aged 10-21 years while on ART; having initiated ART ≥ 200 days before the closure date of the clinic database; followed ≥ 15 days from ART initiation in clinics with ≥ 10 adolescents enrolled. Routine follow-up data were merged with those collected through a standardized ad hoc questionnaire on awareness of HIV status. Probability of retention (no death or loss-to-follow-up) was estimated with Kaplan-Meier method. Cox proportional hazard model with date of ART initiation as origin and a delayed entry at date of 10th birthday was used to identify factors associated with death or loss-to-follow-up.650 adolescents were available for this analysis. Characteristics at ART initiation were: median age of 10.4 years; median CD4 count of 224 cells/mm³ (47% with severe immunosuppression), 48% CDC stage C/WHO stage 3/4. The median follow-up on ART after the age of 10 was 23.3 months; 187 adolescents (28.8%) knew their HIV status. The overall probability of retention at 36 months after ART initiation was 74.6% (95% confidence interval [CI]: 70.5-79.0) and was higher for those disclosed compared to those not: adjusted hazard ratio for the risk of being death or loss-to-follow-up = 0.23 (95% CI: 0.13-0.39).About 2/3 of HIV-infected adolescents on ART were not aware of their HIV status in these ART clinics in West Africa but disclosed HIV status improved retention in care. The disclosure process should be thus systematically encouraged and organized in adolescent populations

Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006

<p>Abstract</p> <p>Background</p> <p>In Mali, malaria is the leading cause of death and the primary cause of outpatient visits for children under five. The twin towns of Mopti and Sévaré have historically had high under-five mortality. This paper investigates the changing malaria burden in children under five in these two towns for the years 1998-2006, and the likely contribution of previous interventions aimed at reducing malaria.</p> <p>Methods</p> <p>A retrospective analysis of daily outpatient consultation records from urban community health centres (CSCOMs) located in Mopti and Sévaré for the years 1998-2006 was conducted. Risk factors for a diagnosis of presumptive malaria, using logistic regression and trends in presumptive malaria diagnostic rates, were assessed using multilevel analysis.</p> <p>Results</p> <p>Between 1998-2006, presumptive malaria accounted for 33.8% of all recorded consultation diagnoses (10,123 out of 29,915). The monthly presumptive malaria diagnostic rate for children under five decreased by 66% (average of 8 diagnoses per month per 1,000 children in 1998 to 2.7 diagnoses per month in 2006). The multi-level analysis related 37% of this decrease to the distribution of bed net treatment kits initiated in May of 2001. Children of the Fulani (Peuhl) ethnicity had significantly lower odds of a presumptive malaria diagnosis when compared to children of other ethnic groups.</p> <p>Conclusions</p> <p>Presumptive malaria diagnostic rates have decreased between 1998-2006 among health care-seeking children under five in Mopti and Sévaré. A bed net treatment kit intervention conducted in 2001 is likely to have contributed to this decline. The results corroborate previous findings that suggest that the Fulani ethnicity is protective against malaria. The findings are useful to encourage dialogue around the urban malaria situation in Mali, particularly in the context of achieving the target of reducing malaria morbidity in children younger than five by 50% by 2011 as compared to levels in 2000.</p

Isolation and characterization of Bacillus thuringiensis (Ernst Berliner) strains indigenous to agricultural soils of Mali.

The objective of this work was to isolate and characterize Bacillus thuringiensis from agricultural and other insect breeding sites in Mali. A hundred soil samples were collected from Bamako district, Segou, Sikasso and Timbuktu regions. B. thuringiensis (Bt) was isolated from the samples using a heat-acetate method and the isolates were identified and classified using morphological and biochemical tests. The frequency of B. thuringiensis in soils was noted. The results showed that, 15 out of the 3111 bacterial isolates were putative Bt. thuringiensis. Most isolates produced parasporal crystals. The average Bt index for all the areas sampled was 5.1%; the highest frequency was recorded for Niono in Segou region (11.7) and the lowest for Bozola in Bamako district (0.5). Contrary the known information on the high content and distribution of B. in soils, the agricultural soils of Mali contain few Bt strains, confirmed by the low Bt index obtained.201

Infections bactériennes invasives chez l'enfant drépanocytaire à Bamako, Mali

Résumé Les infections sont responsables d'une part importante de la morbidité et de la mortalité chez l'enfant drépanocytaire. Notre objectif était d’étudier le profil clinique et bactériologique des infections bactériennes de l’enfant drépanocytaire dans le service de pédiatrie du CHU Gabriel Touré. Matériel et méthodes: Nous avons réalisé une étude rétrospective sur 25 dossiers d’hospitalisation d’enfants drépanocytaires fébriles ayant bénéficié d’une hémoculture sur une période de 5 ans (2005-2010). Nous avons analysé les caractéristiques cliniques et bactériologiques des enfants ayant une hémoculture positive. Résultats: Dix des 25 hémocultures réalisées étaient positives. La tranche d’âge de 0-5 ans était la plus touchée (60%). Le suivi était irrégulier pour 7 enfants et 6/10 n'avaient pas reçu le vaccin anti pneumococcique. Sur le plan clinique, 5 cas de sepsis, une infection pulmonaire et 4 cas infections ostéo articulaires ont été diagnostiquées. La goutte épaisse était positive pour 4 patients. Les germes retrouvés ont été : Salmonella enterica sérotype Typhi (4 fois), Streptococcus pneumoniae (4 fois), Staphylococcus aureus (1fois), Enterobacter cloacae (1fois) ont été isolés. Salmonella enterica sérotypeTyphia été isolé dans 3 cas d'infections ostéo-articulaires et un cas de sepsis, Streptococcus pneumoniae était en cause dans l'infection pulmonaire et dans un cas de sepsis. L'antibiothérapie probabiliste dans la majorité des cas était basée sur les céphalosporines de troisième génération. L’évolution a été favorable dans 80% des cas. Conclusion : Les complications infectieuses de la drépanocytose peuvent être graves. La disponibilité de l'hémoculture doit nous permettre de caractériser le profil bactériologique dans notre contexte