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The 2014-2016 Ebola epidemic in Guinea highlighted the need for more extensive evaluation of laboratories diagnostic capacities and preparedness in anticipation of future emerging viral disease outbreaks. We developed a questionnaire to assess the diagnostic capacities and preparedness of the four major medical laboratories in Guinea and Mali that are responsible for the provision of Ebola, Lassa, and Dengue diagnostics. The questionnaire inquired about the current state and need for equipment and reagents and adequacy of equipment and training received. In Guinea, all three diagnostic laboratories have the capacity and are well-prepared to perform Ebola diagnostics, however, only two have the capacity and trained staff to diagnose Lassa and none are currently prepared to diagnose Dengue infection. In Mali, the University Clinical Research Center (UCRC) laboratory, which was in charge of Ebola diagnostics during the last epidemic, currently has the capacity and is prepared to diagnose Ebola, Lassa, and Dengue infections. Combined, Guinea and Mali appear to have complementary capacity and preparedness to diagnose these Category A Priority Pathogens. While, the equipment, reagents and training efforts should be maintained, the gap in Dengue diagnostic capability in Guinea should be addressed with further equipping and training of additional district laboratories to strengthen the public health response for all viral diseases in these high-risk, yet, low-resource settings.

Context and objective. In sub-Saharan Africa, the epicenter of HIV infection, rapid tests are proposed in first line, but diagnosis value of these tests is rarely performed. The goal of the present study was to evaluate the performance of 2 rapid tests used for the diagnosis of HIV-2 infection compared to a baseline test in order to propose in algorithm for HIV infection diagnosis in health care system. Methods. A cross-sectional study was carried out in three treatment centers in Mali (Bamako, Segou and Sikasso). The tests evaluated were: Genie® II HIV-1/HIV-2 (Sanofi Diagnostic Pasteur, France) and ImmunoComb® II HIV 1&2 BiSpot (Organics, Strasbourg, France). The study involved 34 sera collected consecutively. The l’INNO-LIA HIV I/II Score confirmatory test was used as a reference test in Belgium. Performance of tests were assessed using sensibility, specificity, positive predictive value, negative predictive value and kappa concordance. Results. Patients’ ages ranged from 12 years to 78 years, 19 patients were women (55.8%) and 28 patients had HIV-2 infection. The sensitivity of the rapid tests was 96.4%. The kappa concordance coefficient was 0.85. We found 28 HIV-2 positive patients out of 34 patients. Conclusions. The two rapid tests used in Mali yielded satisfactory results, but the quality of HIV-1 and 2 discrimination serology could be improved. Contexte et objectif. Dans les pays d’Afrique subsaharienne épicentre de l’infection à VIH, les tests rapides sont proposés en première intention, mais la valeur diagnostique de ces tests est rarement réalisée. L’objectif du présent travail était d’évaluer la performance de 2 tests rapides utilisés pour le diagnostic de l’infection à VIH-2 par rapport un test de référence afin de proposer des algorithmes de tests simples et rapides utilisables dans les structures sanitaires. Méthodes.Une étude transversale a été réalisée, dans trois centres de prise en charge au Mali (Bamako, Ségou et Sikasso). Les tests évalués étaient le Genie® II HIV-1/HIV-2 (Sanofi Diagnostic Pasteur, France) et l’ImmunoComb® II HIV 1&2 BiSpot (Organics, Strasbourg, France). L’étude a porté sur 34 sérums collectés consécutivement. Le test de confirmation l’INNO-LIA HIV I/II Score a été utilisé comme test de référence en Belgique. La performance de deux tests précités a été évaluée en recherchant la sensibilité, la spécificité, la valeur prédictive positive (VPP), la valeur prédictive négative (VPN) et la concordance. Résultats. L’âge des patients variait de 12 ans à 78 ans, 19 patients étaient des femmes (55,8%) et 28 patients avaient le VIH-2. La sensibilité des tests rapides était de 96,4%. Le coefficient de concordance kappa était de 0,85. Conclusions. Les deux tests rapides utilisés au Mali ont donné des résultats satisfaisants, et peuvent être proposés en première intention dans l’algorithme national du diagnostic de l’infection à VIH-2 au Mali.

Aims: We evaluated different treatment regimens administered to patients infected with HIV-2 in Mali, and studied pol polymorphisms that may influence susceptibility to antiretrovirals. Methodology: We collected 57 blood samples from HIV - 2 seropositive patients in health centers in Mali (Bamako, Segou and Sikasso), including 21 treated patients and 36 untreated patients. The confirmation of the serological status and the measurement of the viral load were carried out in Brussels. Genotypic analysis of protease, reverse transcriptase and integrase was then performed on specimens with detectable viral load. The search for ARV resistance mutations and polymorphism positions was performed in comparison with reference sequences. Results: The most used treatment regimen was ZDV-3TC-LPV/ r. Genotypic analysis of protease, reverse transcriptase and integrase was performed on 20 samples from patients with detectable viral load: 16 untreated patients and 4 treated patients. Seventy-five percent of the strains analyzed correspond to group A of HIV-2. In 2cas, mutations associated with resistance to the administered molecules were found. Three viral strains from untreated patients had NRTI or PI resistance mutations. In integrase, no mutation associated with resistance was observed. Conclusion: The circulation of strains carrying resistance mutations to NRTIs and PIs has been observed in Mali.

The Malian pharmacovigilance program has been associated with modest growth over the past years. The purpose of this chapter is to assess the current state of pharmacovigilance (PV) in Mali and the adverse drug reactions reported to the National Pharmacovigilance Center of Mali. The profiles and number of adverse drug reactions (ADRs), the degree of toxicity, and the WHO and Naranjo scores are evaluated. We found that three university teaching hospitals in Mali conducted such PV studies. Our results showed that although there is a recognition of the need for PV, the practice was very limited. Only 67.6% of participant practitioners had an accepted knowledge for PV and its methodology. This situation is attributed to the insufficient knowledge about what can or should be reported in PV and a lack of a reliable notification process. Nevertheless, this study highlighted the profile of commonly used ADRs and the problems inherent to systematic reporting.

The objective of this study was to examine the evolution of the movement patterns and trends of the wild poliovirus in Mali through surveillance of acute flaccid paralysis. A retrospective descriptive study was conducted between 1 January 1998 and 31 December 2005 on 1,002 cases of acute flaccid paralysis (AFP) investigated across the country. Reports made to the National Center for Immunization (CNI) of children under 15 years suffering from AFP were included as part of the epidemiological surveillance. The isolation of the poliovirus was done with stool examinations carried out at the Pasteur Institute in Abidjan. Among 1,002 cases of AFP, 156 stool samples were positive for enteroviruses including 59 cases of poliovirus (31 cases of polio vaccine and 28 cases of wild poliovirus), a frequency of 2.3%. Children 0 to 5 years of age were most affected by AFP (59.78%). Paralysis of the legs represented the most frequently affected zone (69.56%). The Mopti region was most heavily affected are with 11 cases of the 28 cases of wild poliovirus, of which boys were most affected (71.43%). Despite the efforts made so far in the fight against polio, wild poliovirus continues to circulate and spread in Mall and the West African sub-region. All countries in West Africa and on the African continent must reach a sufficient level of vaccination coverage in order to eradicate the wild strain like industrialized countries have.

Cholera represents a public health problem in developing countries like Mali.This work aims to describe the characteristics of the cholera epidemics which occurred in Mali between 1995 and 2004.A retrospective survey was conducted within the Division of the fight against the diseases of epidemic potential and the Institute of Public Health and Research of the Ministry of Health of Mali. Individual medical records tracking the follow-up of patients as well as the registers of these structures were used as sources to collect data for the study.There were 12,176 cases of cholera recorded, including 1,406 deaths, from 1995 to 2004. Cholera outbreaks in Mali have been a regular occurrence every year since 2001. The regions of Mopti and Segou seem to be the most impacted by these epidemics. The lethal rates were higher than 1% at the time of each of these epidemics during this period. Vibrio cholerae O: 1, biotype El Tor were responsible for the epidemics, and the serotype Ogawa was prevalent.Cholera epidemics have been constant in Mali since the beginning of the 21st century in spite of the efforts which have been made to prevent and control them. A rigorous analysis of the factors which support this persistence and appropriate measures are essential to reverse cholera in this country.