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Abstract Malaria is the leading cause of morbidity and mortality in Mali. Between 2017 and 2020, the number of cases increased in the country, with 2,884,827 confirmed cases and 1454 reported deaths in 2020. We performed a malaria risk stratification at the health district level in Mali with a view to proposing targeted control interventions. Data on confirmed malaria cases were obtained from the District Health Information Software 2, data on malaria prevalence and mortality in children aged 6–59 months from the 2018 Demographic and Health Survey, entomological data from Malian research institutions working on malaria in the sentinel sites of the National Malaria Control Program (NMCP), and environmental data from the National Aeronautics and Space Administration. A stratification of malaria risk was performed. Targeted malaria control interventions were selected based on spatial heterogeneity of malaria incidence, malaria prevalence in children, vector resistance distribution, health facility usage, child mortality, and seasonality of transmission. These interventions were discussed with the NMCP and the different funding partners. In 2017–2019, median incidence across the 75 health districts was 129.34 cases per 1000 person-years (standard deviation = 86.48). Risk stratification identified 12 health districts in very low transmission areas, 19 in low transmission areas, 20 in moderate transmission areas, and 24 in high transmission areas. Low health facility usage and increased vector resistance were observed in high transmission areas. Eight intervention combinations were selected for implementation. Our work provides an updated risk stratification using advanced statistical methods to inform the targeting of malaria control interventions in Mali. This stratification can serve as a template for continuous malaria risk stratifications in Mali and other countries.

Abstract Background The current first-line treatments for uncomplicated malaria recommended by the National Malaria Control Programme in Mali are artemether–lumefantrine (AL) and artesunate–amodiaquine (ASAQ). From 2015 to 2016, an in vivo study was carried out to assess the clinical and parasitological responses to AL and ASAQ in Sélingué, Mali. Methods Children between 6 and 59 months of age with uncomplicated Plasmodium falciparum infection and 2000–200,000 asexual parasites/μL of blood were enrolled, randomly assigned to either AL or ASAQ, and followed up for 42 days. Uncorrected and PCR-corrected efficacy results at days 28 and 42. were calculated. Known markers of resistance in the Pfk13, Pfmdr1, and Pfcrt genes were assessed using Sanger sequencing. Results A total of 449 patients were enrolled: 225 in the AL group and 224 in the ASAQ group. Uncorrected efficacy at day 28 was 83.4% (95% CI 78.5–88.4%) in the AL arm and 93.1% (95% CI 89.7–96.5%) in the ASAQ arm. The per protocol PCR-corrected efficacy at day 28 was 91.0% (86.0–95.9%) in the AL arm and 97.1% (93.6–100%) in the ASAQ arm. ASAQ was significantly (p

Nous avons effectué du 2 février 2009 au 1 février 2010 une étude rétrospective sur les aspects épidémiocliniques du paludisme chez les enfants de 5 à 12 ans, au Centre de Santé de Référence de la commune IV du district de Bamako. L’enquête a porté sur 836 sujets dont 302 cas de paludisme diagnostiqué. Les variables cliniques aussi bien que parasitologiques ont été évaluées chez chaque enfant. La goutte épaisse ou le test de diagnostique rapide a été réalisé pour diagnostiquer le paludisme. Nos résultats ont montré que la fièvre intermittente représentait le motif de consultation le plus fréquent, soit 51% des cas. La majorité de nos patients, soit 77,2% ont fait le paludisme simple contre 22,8% de cas de paludisme grave. La goutte épaisse était positive dans 156 cas sur 461 (33,8%) et le test rapide 146 cas de positif sur 375 (38,9%). Le taux de guérison était de 97,7% des cas dont 74,8% (226/302) avec les Combinaisons Thérapeutiques à base d'Artémisinine (CTA). Notre travail a montré que les enfants d’âge scolaire, n’étant pas pris en charge gratuitement par le Programme National de Lutte contre le Paludisme constituent un groupe à risque aussi élevé et méritent une attention particulière tout autant que ceux de moins de cinq ans.

Nous avons effectué du 2 février 2009 au 1 février 2010 une étude rétrospective sur les aspects épidémiocliniques du paludisme chez les enfants de 5 à 12 ans, au Centre de Santé de Référence de la commune IV du district de Bamako. L'enquête a porté sur 836 sujets dont 302 cas de paludisme diagnostiqué. Les variables cliniques aussi bien que parasitologiques ont été évaluées chez chaque enfant. La goutte épaisse ou le test de diagnostique rapide a été réalisé pour diagnostiquer le paludisme. Nos résultats ont montré que la fièvre intermittente représentait le motif de consultation le plus fréquent, soit 51% des cas. La majorité de nos patients, soit 77,2% ont fait le paludisme simple contre 22,8% de cas de paludisme grave. La goutte épaisse était positive dans 156 cas sur 461 (33,8%) et le test rapide 146 cas de positif sur 375 (38,9%). Le taux de guérison était de 97,7% des cas dont 74,8% (226/302) avec les Combinaisons Thérapeutiques à base d'Artémisinine (CTA). Notre travail a montré que les enfants d'âge scolaire, n'étant pas pris en charge gratuitement par le Programme National de Lutte contre le Paludisme constituent un groupe à risque aussi élevé et méritent une attention particulière tout autant que ceux de moins de cinq ans.

Background. We performed 2 cross-sectional studies in Ménaka in the Northeastern Mali across 9 sites in different ecological settings: 4 sites have permanent ponds, 4 without ponds, and one (City of Ménaka) has a semipermanent pond. We enrolled 1328 subjects in May 2004 (hot dry season) and 1422 in February 2005 (cold dry season) after the rainy season. Objective. To examine the seasonality of malaria parasite prevalence in this dry northern part of Mali at the edge of the Sahara desert. Results. Slide prevalence was lower in hot dry than cold dry season (4.94 versus 6.85%, P=0.025). Gametocyte rate increased to 0.91% in February. Four species were identified. Plasmodium falciparum was most prevalent (74.13 and 63.72%). P. malariae increased from 9.38% to 22.54% in February. In contrast, prevalence of P. vivax was higher (10.31%) without seasonal variation. Smear positivity was associated with splenomegaly (P=0.007). Malaria remained stable in the villages with ponds (P=0.221); in contrast, prevalence varied between the 2 seasons in the villages without ponds (P=0.004). Conclusion. Malaria was mesoendemic; 4 species circulates with a seasonal fluctuation for Plasmodium falciparum.

Rice bran contains essential nutrients, antioxidants, and bioactives with anti-inflammatory and diarrheal protective properties important for infants. This 6-month randomized controlled trial investigated the effects of heat-stabilized rice bran supplementation during Malian infant weaning. Fifty healthy 6-month-old infants were randomized to a rice bran intervention (N = 25) or non-intervention control group (N = 25). Intervention infants received dose-escalating rice bran supplementation for 6 months (1–5 g/day). Monthly infant dried blood spot and anthropometric measurements were collected. Dried blood spot metabolite abundances were compared monthly according to diet for six months. Supplementation resulted in favorable weight-for-age and weight-for-length z-score changes. Non-targeted dried blood spot-based metabolomics identified 796 metabolites, of which 33% had significant fold differences between groups (7–12 months). Lipids and amino acids represented 70.6% of the metabolites identified. Rice bran supplementation during infant weaning significantly modulated the metabolites involved in antioxidant defenses and with neuroactive properties including reduced glutathione, glycine, glutamate, cysteinylglycine, tryptophan betaine, and choline. These findings support rice bran as a weaning ingredient to meet infant nutritional requirements and with the potential to reduce oxidative stress and improve cognitive outcomes. This study provides evidence for dried blood spots as a cost-effective tool to detect infant biomarkers of nutritional and metabolic status.