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Quality of life is defined by the physical, emotional and social well-being of an individual. Primary Open Angle Glaucoma (POAG) is a blinding optic neuropathy, it can change the quality of life by its chronic and irreversible nature. The objective of this study was to evaluate the quality of life in patients with POAG in urban areas.this was a quantitative cross-sectional study with a descriptive aim over 3 months. Patients followed for POAG at CHU-IOTA with an age ≥ 18 years were included and submitted to the GlauQOL-17 questionnaire for data collection.We collected 100 glaucomatous patients, the mean age of patients was 52 years with a standard deviation of 14.02. The extreme ages are 18 and 81 years old. There was a male predominance; (54%) with a sex ratio (M / F) of 1.7. The good visual acuities were majority (higher or equal to 3/10). Among our patients, 35% were at the stage of glaucoma starting at OD and 30% at the stage of moderate glaucoma at OG. Our patients had a poor quality of life score (score50%) in the Anxiety and Driving dimensions. In patients younger than 70 years old, we had a poor anxiety score in all progressive stages of the disease. Scores of self-image dimensions, constraints, and management were greater than 60% in patients over 70 years of age.Alteration of some of the domains studied was proportional to evolution of POAG. This degradation can have physical, psychological and social impacts on his patients.La qualité de vie se définit par le bien-être physique, émotionnel et social d'un individu. Le Glaucome Primitif à Angle Ouvert (GPAO) est une neuropathie optique cécitante, il peut modifier la qualité de vie de par son caractère chronique et irréversible. L'objectif de cette étude était d'évaluer la qualité de vie chez les patients atteints de GPAO en milieu urbain.il s'agissait d'une étude quantitative transversale à visée descriptive sur 3 mois. Les patients suivis pour GPAO au CHU-IOTA avec un âge ≥ 18 ans ont été inclus et soumis au questionnaire GlauQOL-17 pour la collecte des données.Nous avons colligé 100 patients glaucomateux, la moyenne d'âge des patients était de 52 ans avec un écart type de 14,02. Les extrêmes d'âges sont de 18 et 81 ans. Il y avait une prédominance masculine ; (54%) avec un sex-ratio (M/F) de 1.7. Les acuités visuelles bonnes étaient majoritaires (supérieures ou égales à 3/10).Parmi nos patients 35% étaient au stade de glaucome débutant à OD et 30% au stade de glaucome modéré à OG. Nos patients avaient un mauvais score qualité de vie (scoreà 50%) dans les dimensions Anxiété et conduite. Chez les patients de moins de 70 ans nous avons noté un mauvais score d'anxiété dans tous les stades évolutifs de la maladie. Les scores des dimensions image de soi, contraintes, et prise en charge étaient supérieurs à 60% chez les patients de plus de 70 ans.L'altération de certains domaines étudiés était proportionnelle à l'évolution du GPAO. Cette dégradation peut avoir des impacts physiques, psychologiques et sociaux sur ses patients.

Esthetic and functional surgeries in the periocular region fall into the domain of oculoplastic, or plastic and reconstructive surgery and otorhinolaryngology. Oculoplasty is the largest surgical spectrum in ophthalmology including eyelids, orbits and the lacrimal system. Our purpose was to study the frequency of eyelid, lacrimal and orbital (oculoplastic) surgery at the CHU IOTA.Retrospective medical chart review of all the patients who underwent oculoplastic surgery was conducted from October 2015 to September 2016.A total of 233 patients were included with 52% female and 48% male. Patients were 37 years old on average. In total, the surgery was performed on the eyelids in83 cases (35.6%), the orbits in 113 cases (48.5%) and the lachrymal system in 37 cases (15.9%).Eyelid surgery commonly resulted from eye trauma (43,3%), followed by malpositions (30,2%). Mutilating surgery accounted for 92% of the orbital surgery. External dacryocystorhinostomy was the main lacrimal surgery (42%) followed by canalicular lacerations 25%.Oculoplasticsurgeryoccupies an important place in the surgical activities of the ophthalmologic University hospital despite a larger volume for cataractsurgery. Our studydoesn't highlight the outcome of the surgery itself but the epidemiology to help decision makers in their eye health policy including the reduction of mutilating surgery and oculoplastic training.La chirurgie esthétique et fonctionnelle de la région périoculaire est du domaine de l'oculoplastie, ainsi que de la chirurgie plastique et reconstructive et de l'otorhinolaryngologie. L'oculoplastie constitue le plus large éventail chirurgical en ophtalmologie regroupant la paupière, l'orbite et le système lacrymal.Etudier la fréquence des procédures chirurgicales orbito-palpébrales et lacrymales (oculoplasties) dans un centre de troisième référence.Il s'agissait d'une étude rétrospective des dossiers de patients opérés pour pathologies oculoplastiques d'octobre 2015 à septembre 2016.Au total 233 patients ont été inclus dont 52% de sexe féminin et 48% de sexe masculin avec un âge moyen de 37 ans ; parmi lesquels 83 cas (35,6%) de chirurgie palpébrale, 113 cas (48,5%) de chirurgie orbitaire et 37 cas (15,9%) chirurgie lacrymale.La chirurgie palpébrale était dominée parréparationdesplaies traumatiques (43,3%), suivi des malpositions (30,2%). La chirurgie mutilante constituait 92% de la chirurgie orbitaire. La dacryocystorhinostomie par voie externe était la principale chirurgie lacrymale soit 42%, suivie des lacérations canaliculaires 25%.Notre étude ne met pas en exergue le résultat de la chirurgie elle-même, mais l'épidémiologie du traitement chirurgical afin d'aider les décideurs dans leur politique de santé oculaire notamment sur la réduction de la chirurgie mutilante et la formation oculoplastique.

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. Patients and Methods: A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p 0.05 and the 95% confidence interval. Results: The frequency of referrals was 54.3%. Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%. The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%. In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500 g, hypothermic in 43.8% and febrile in 15.1%. The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times in the less than 28 weeks of amenorrhea (WA) (ORa = 18.5; CI = 1.9 - 180; p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6; CI = 1.4 - 29.7; p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. Conclusion: The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.

Climatic variability is one of the main constraints of agriculture in Mali, which will certainly affect long-term sorghum yields. The objective of the present study was to assess the effect of climate variability on sorghum production areas by 2050 in the Sudanian and Sahelian zones of Mali considering three climate scenarios: current scenarios (RCP 2.5), optimistic scenarios (RCP 4.5) and pessimistic scenarios (RCP 8.5). Therefore, 11,010 occurrence points of sorghum (Sorghum bicolor) were collected and associated with the environmental variables of the three climatic scenarios according to the maximum entropy approach (Maxent). Sorghum environmental data and points of occurrence were obtained from AfriClim and GBIF databases, respectively. The correlations carried out and the Jackknife test allowed us to identify variables that contributed more to the performance of the model. Overall, in the Sudanian zone, the suitable area for sorghum production which currently represents 37% of the area of the district of Koulikoro will increase up to 51% by 2050 considering the optimistic scenario (RCP 4.5). Furthermore, considering the pessimistic scenario (RCP 8.5), the suitable zones for sorghum production will experience a decrease of 10%. In the Sahelian zone, the suitable zones for sorghum production that represent 55% of San district area considering the RCP 2.5 scenario will experience a decline of 24% by 2050 considering both the optimistic (RCP 4.5) and pessimistic (RCP 8.5) scenarios. It is suggested to carry out investigations on potential sorghum yield prediction in both study areas in order to identify suitable production areas of the crop in the near future (2050) and long term (2100) as adaptation strategies and resilience of farmers to climate change.

Cattle production is an essential livelihood strategy in south-western Burkina Faso. Although having a distinct cultural role and known to be resistant against African animal trypanosomosis, the Lobi taurine cattle breed is endangered due to its low market value. As the first step in preservation efforts, our study aimed to develop a typology of production systems at the farm level. We used a structured questionnaire and focus group discussions for collecting data on household characteristics, socioeconomic activities, livestock, and access to services. The sample comprised 169 households in three communities. The analytical strategy included factor analysis of mixed data and hierarchical clustering. We identified four distinct types of cattle production systems: (1) sedentary Lobi farms, (2) sedentary crossbreed farms, (3) semi-transhumant Fulani zebu farms, and (4) transhumant Fulani zebu farms. Significant factors in developing this typology were the farmers’ ethnic group, crop diversity, cattle herd size, cattle herd composition, number of small ruminants, and livestock management strategies. Across all production systems, men were considered being primary decision-makers in cattle production, with women, herders, and children being responsible for specific tasks. All identified production systems are increasingly confronting disease pressure and scarcity of water and land. Future efforts in preservation and breeding will need to respond to these trends in the agroecosystem, integrate risk management measures, and resonate with the specific needs of the different household members involved in cattle rearing.

Intravitreal injections (IVT) of a drug aim to rapidly obtain effective concentrations greater than those that would be obtained by a periocular or intravenous injection. The objective of the present study is to demonstrate the contribution of IVT in the treatment of pathologies of the posterior segment of the eye.We conducted a 21-month ambidirectional observational study from January 1, 2020, to September 30, 2021. We included by nonprobability sampling all consenting patients admitted for IVT at IOTA Teaching Hospital.During our study, 201 patients were collected out of 30 739 patients seen in consultation. The hospital frequency of IVT was 0.65%. There were 111 women and 90 men. The M/F ratio was 0.82. The number of patients who received IVT antibiotics was 135. Anti-VEGF was injected in 64 patients. Two patients received IVT corticosteroids. Complications frequently encountered were pain at upon injection (94.03%), IOP spike (11.94%) and cataract (7.46%). In our sample, we observed an improvement in visual acuity in 56.21% of cases and a reduction in macular edema in 45.16% of cases.The contribution of IVT in the treatment of vitreoretinal diseases is extraordinary. Rigorous observation of aseptic technique and good practices protects against infectious complications.IVT has allowed us to effectively treat various diseases of the vitreous and retina. IVT is a simple procedure, but it must be performed with the same aseptic technique as surgical procedures.

Traditional livestock husbandry is of great socio-economic importance for farmers and pastoral populations in Burkina Faso in general and in particular, those in the Southwestern region. The aim of our study is to inventory medicinal plants in cattle husbandry in the Poni province. Methodology consisted of semi-structured interviews; individual conversations with local specialists in the use of local plants. A total of 120 informants were interviewed (60 specialists, 60 non-specialist farmers) across three sites (Bouroum–Bouroum, Loropeni and Kampti) where a community based cattle breeding program has taken place. The results showed that 26 medicinal plants for veterinary use, distributed across 23 genera and 15 families were well known. In total, 9 important cattle diseases for which medicinal plants are used have been recorded. The most frequent diseases reported were foot and mouth disease (22%) and animal trypanosomosis (21%). Among the six (06) modes of preparation recorded for disease treatment, decoction was the most used (62%). Statistical analyses revealed a significant difference between men and women (p = 0.002) with medicinal plant knowledge. Men know more medicinal plants than women do. The results have indicated a disparity of medicinal plant knowledge according to age classes. The results also revealed a significant difference (p = 0.028) of plants recognised by seven ethnic groups. Knowledge of different medicinal plants for veterinary use among the ethnic groups was influenced by the family income source and the main activity. The informant consensus factor (0.5) showed that all the informants agreed on the importance of medicinal plant conservation. Promoting the veterinary use of the plants recorded in this study could be a key to their conservation.

The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice.This was a retrospective descriptive study over a period of 15 months including all girls aged 0-15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure.We collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths).This study shows the seriousness of the immediate complications associated with the practice of excision.

The nephroblastoma is the third pediatric cancer in Mali, this study aimed to describe the prevalence and prognosis of nephroblastoma relapses. Methods: It was a descriptive retrospective study over a 10-year period from January 2005 to March 2015. We collected children aged 0 to 15 years followed for relapse of nephroblastoma in the pediatric oncology unit of university hospital center (UHC) Gabriel Toure. Results: The frequency of relapse of nephroblastoma was 7.4% (19 cases) whose mean age was 42 months with a sex ratio of 1.3. The relapse occurred before the end of the postoperative course in 16% of cases (3 patients). It was local recurrence in 52% of cases (10 patients), pulmonary 16% (3 patients), and hepatic 11% (2 patients). According to the SIOP classification, 47% of patients were diagnosed in stage III (9 patients) and 21% (4 patients) in stage IV. The tumor was high risk in 37%. Palliative chemotherapy was performed in 63% of the patients (12 patients) and the remaining seven were put on a high risk diet. The overall survival at 5 years was 21% or 4 patients. Conclusion: Our results showed all the difficulties in the management of nephroblastoma relapses in our context.

Introduction Among the 1.4 million blind children in the world, 300,000 live in Africa. The causes of blindness vary from one country to another. The purpose of our study was to report the causes of childhood blindness and visual impairment in children attending the only school for the blind in Mali (National Institute for the Blind in Mali, INAM). Materials and methods All children attending the INAM were examined. Blindness was defined as visual acuity less than 3/60 (20/400 or 0.05). Visual impairment was moderate when the visual acuity was less than 6/18 (20/70 or 0.30), but greater than or equal to 6/60 (20/200 or 0.1), and severe when visual acuity was less than 6/60 (20/200 or 0.1), but greater than or equal to 3/60 (20/400 or 0.05). Results The study included a total of 104 children. The average age of our patients was 12 years with a M/F sex-ratio of 1.12. In all, 85.6 % of the children were blind and 14.4 % visually impaired. The main causes of blindness were corneal opacities (26 %), and whole globe lesions and conditions (19.2 %). Ametropia accounted for 60 % of visual impairment. Discussion According to WHO, corneal and retinal damage are the leading cause of blindness (50.6 %) in children. In our series, corneal diseases were the leading cause, following by damage to the whole globe. Conclusion The results of our study indicate that avoidable and treatable causes of childhood blindness are the leading causes of blindness of children at INAM.

Despite existing policies on training health professionnels in essential newborn care (ENC), neonatal mortality still remains high in Mali. Our work aimed to assess the level of knowledge of health staff about ENC. Material and methods: From March 20th to April 20th, 2016, we interviewed newborn care providers at the six reference health centers and the Gabriel Toure University Hospital Center in Bamako. Results: In total, we interviewed 407 newborn care providers with a sex ratio of 0.52. Interviewees had over five years work experience in 62.1%. They considered a low Apgar score as an indication for neonatal resuscitation in 89%, regardless of profile (p = 0.1583). They knew the good aspiration technique in 54%, with nurses and midwives more knowledgeable (p < 0.001) of the reference health centers (p = 0.0000). The interviewees knew the indication and rate of ventilation in 30.2% and 16.0%, respectively. About one third (34%) thought oxygen administration should be systematic during ventilation. The knowledge level on ventilation was the lowest in the group of general practitioners (p = 0.0063 for oxygen indication and p < 0.001 for the technique). Knowledge level for other ENC components (temperature maintenance, eyes care, breastfeeding) were higher. The knowledge of the delay of the breasting did not correlated with either the profile (p = 0.0857) or the place of practice. The knowledge of the first bath was dependent on both the professional profile (p = 0.0002) and the reference level (p = 0.0238). Conclusion: The level of knowledge of health professionnels on ENC should be improved. This will involve the integration of ENC in initial training curricula along with an appropriate continuing training policy thereafter.

L’objectif de ce travail etait d’evaluer l’aptitude visuelle a la conduite automobile des chauffeurs de transports collectifs a Bamako. Nous avons realise une etude transversale descriptive allant du 15 mai au 15 juillet 2013. La methode probabiliste a ete utilisee. Trois cent quatrevingt- cinq chauffeurs ont ete examines au centre hospitalier universitaire de l’Institut d’ophtalmologie tropicale de l’Afrique (fig. 1). L’âge moyen etait de 44,69 ans. Etaient aptes a la conduite automobile de transports collectifs 296 chauffeurs, soit 76,9 %. Parmi les chauffeurs de plus de 50 ans, 42,5 % etaient inaptes a la conduite automobile. La vision des couleurs etait normale dans 98,7 % des cas. L’ametropie, la cataracte et les neuropathies ont represente respectivement 48,5, 25,1 et 17,5 % des causes d’alteration de la vision des chauffeurs. Selon la legislation europeenne, les chauffeurs de transports remuneres doivent se soumettre obligatoirement a un examen periodique de la vue. En l’absence de pareilles mesures dans la legislation malienne, 42,5 % des chauffeurs de plus de 50 ans etaient inaptes a la conduite. L’amelioration de la securite routiere passe par la relecture et la mise en application des textes pour l’obtention et le renouvellement du permis de conduire des chauffeurs de transports collectifs.

We report two observations of congenital hypothyroidism diagnosed in 2011 in the university hospital of Gabriel Toure in Bamako. The first occurred in a male infant of 40 days, admitted for respiratory distress and anterior compressive cervical swelling. Although his neonatal period occurred without any medical particularity, family medical history revealed the presence of unexplored goiter in three paternal uncles. Neurological examination was normal with the presence of constipation. A cervical-thoracic scan showed a homogeneous and symmetric hypertrophy of thyroid lobes with a compression of the trachea. The dosage of thyroid hormones confirmed hypothyroidism (FT4 = 1.6 pmol/l, TSH = 60 µUI/ml). After one month of treatment using Levothyroxine, 10 mg/kg, there was a drastic improvement of respiratory distress, a regression of goiter and normalization of thyroid hormones. At six months of life he had no goiter and psychomotor development was normal. The second case occurred in a male infant of 2 years, from an area of endemic goiter. Puffiness of the face without lower limb edema, constipation, and delayed independent walking were the reasons for consultation. On examination, we noted the absence of goiter, large anterior fontanel with facial dysmorphism (lunar facies, hypertelorism, flat nose, macroglossia) and infiltration of the skin more marked in the face with cold extremities. He required support to sit. The thyroid function tests confirmed hypothyroidism (FT4 = 72 nmol/l, FT3 = 0.40 nmol/l, TSH60 µUI/l). Under levothyroxine, there was normalization of thyroid hormones after one month of treatment and disappearance of the skin infiltration. At six months of treatment he had acquired independent walking. Mental prognosis remains to be evaluated. These cases confirm the necessity of routine neonatal diagnosis of hypothyroidism.Nous rapportons deux observations d'hypothyroïdie congénitale diagnostiquées en 2011 au CHU Gabriel Touré de Bamako. Il s'agit d'un nourrisson de 40 jours, de sexe masculin admis dans le service pour une détresse respiratoire et une tuméfaction cervicale antérieure compressive. Son passé néonatal était sans particularités, il aurait trois oncles paternels ayant un goitre non exploré. Une constipation chronique était le seul signe fonctionnel tandis que l'examen neurologique était normal. Une tomodensitométrie cervico-thoracique montrait une hypertrophie homogène et symétrique des lobes thyroïdiens avec compression de la trachée. Le dosage des hormones thyroïdiennes confirmait l'hypothyroïdie (T4L = 1,6 pmol/l, TSH= 60 µUI/ml). Sous lévothyroxine à 10 µg /kg, on notait une disparition de la détresse respiratoire, une régression du goitre et la normalisation du taux des hormones thyroïdiennes à un mois de traitement. A six mois de vie, il n'avait pas de goitre et son développement psychomoteur était normal. Le second est un nourrisson de 2 ans, de sexe masculin, provenant d'une zone d'endémie goitreuse. Une bouffissure du visage sans œdème des membres inférieurs, une constipation, un retard de la marche autonome constituaient les motifs de consultation. A l'examen, on notait l'absence de goitre, une fontanelle antérieure large avec une dysmorphie faciale (facies lunaire, hypertélorisme, nez aplati, macroglossie) et une infiltration de la peau plus marquée au visage avec une froideur des extrémités. Il s'asseyait avec appui. Le dosage des hormones thyroïdiennes a confirmé l'hypothyroïdie (T4L = 72 nmol/l, T3L= 0,40 nmol/l, TSH60 µUI/l). Sous lévothyroxine, on notait la normalisation des hormones thyroïdiennes à un mois de traitement et la disparition de l'infiltration de la peau. A six mois de traitement il avait acquis la marche autonome. Le pronostic mental reste à être évalué. Ces observations confirment la nécessité du diagnostic néonatal de l'hypothyroïdie.

Les infections sont responsables d'une part importante de la morbidite et de la mortalite chez l'enfant drepanocytaire. Notre objectif etait d’etudier le profil clinique et bacteriologique des infections bacteriennes de l’enfant drepanocytaire dans le service de pediatrie du CHU Gabriel Toure. Materiel et methodes: Nous avons realise une etude retrospective sur 25 dossiers d’hospitalisation d’enfants drepanocytaires febriles ayant beneficie d’une hemoculture sur une periode de 5 ans (2005-2010). Nous avons analyse les caracteristiques cliniques et bacteriologiques des enfants ayant une hemoculture positive. Resultats: Dix des 25 hemocultures realisees etaient positives. La tranche d’âge de 0-5 ans etait la plus touchee (60%). Le suivi etait irregulier pour 7 enfants et 6/10 n'avaient pas recu le vaccin anti pneumococcique. Sur le plan clinique, 5 cas de sepsis, une infection pulmonaire et 4 cas infections osteo articulaires ont ete diagnostiquees. La goutte epaisse etait positive pour 4 patients . Les germes retrouves ont ete : Salmonella enterica serotype Typhi (4 fois), Streptococcus pneumoniae (4 fois), Staphylococcus aureus (1fois), Enterobacter cloacae (1fois) ont ete isoles. Salmonella enterica serotypeTyphia ete isole dans 3 cas d'infections osteo-articulaires et un cas de sepsis, Streptococcus pneumoniae etait en cause dans l'infection pulmonaire et dans un cas de sepsis. L'antibiotherapie probabiliste dans la majorite des cas etait basee sur les cephalosporines de troisieme generation. L’evolution a ete favorable dans 80% des cas. Conclusion : Les complications infectieuses de la drepanocytose peuvent etre graves. La disponibilite de l'hemoculture doit nous permettre de caracteriser le profil bacteriologique dans notre contexte.

The aim of this work was to evaluate the public transport drivers' visual driving ability in Bamako. We carried out a descriptive cross-sectional study from May 15 to July 15, 2013. The probabilistic method was used. 385 drivers were examined at the University Hospital of the Institute of Tropical Ophthalmology of Africa (IOTA). The average age was 44.69 years. 296 drivers (76.9%) were able to drive public transport vehicles. Among drivers over 50 years old, 42.5% are unfit for driving. Color vision was normal in 98.7 % of cases. Ametropia, cataract and neuropathies accounted for 48.5%, 25.1% and 17.5% respectively, of the causes of impaired vision of drivers. According to European legislation, official transport drivers must be subject to periodic eye examinations. In the absence of such measures in Malian legislation, 42.5% of drivers over 50 years old are unfit to drive. The improvement of road safety requires the renewal and application of the texts for the delivery and renewal of the driver's license of public transport drivers.

Le but de cette etude retrospective etait d’evaluer les resultats anatomiques et fonctionnels de la technique de Delorme chez 16 patients en milieu chirurgical ivoirien. Il s’agissait de neuf hommes et de sept femmes d’âge moyen de 48,8 ans, presentant un prolapsus rectal exteriorise permanent. Douze patients etaient des constipes chroniques, et tous avaient une incontinence anale totale. L’intervention etait associee a une myorraphie posterieure des releveurs de l’anus chez neuf patients de plus de 50 ans. Un toucher rectal quotidien etait pratique a partir de j3 jusqu’a la sortie. Le suivi moyen etait de 24 mois. L’evaluation des resultats anatomiques etait basee sur la recidive, et celle des resultats fonctionnels sur l’etude de la constipation, de l’incontinence anale et de la dyschesie postoperatoire. Une rectorragie minime est survenue chez six patients (37,5 %), la mortalite etait nulle. Il n’y avait aucune fistule anastomotique ni stenose rectale. Une recidive observee a trois mois chez une patiente de 24 ans a ete traitee avec succes par myorraphie posterieure des releveurs. La constipation n’a ete ni amelioree ni aggravee, et aucun nouveau cas n’a ete observe. L’incontinence et la dyschesie postoperatoire ont regresse a 24 mois. Nos resultats anatomiques et fonctionnels etaient bons malgre nos indications elargies aux sujets jeunes. Cependant, la faiblesse de notre effectif ne nous permet pas de tirer des conclusions definitives en faveur de cette technique. Notre preference devra rester a la rectopexie avec ou sans colectomie. Cette methode de Delorme devra etre utilisee comme alternative a la rectopexie chez certains patients, chez qui la rectopexie est impossible.

The treatment of cataract blindness is surgical, allowing restored vision. The purpose of this study was to evaluate the functional results of cataract surgery in adults in a tertiary care referral center.Prospective study of 2012 eyes operated for adult cataract from September 1, 2009 to August 31, 2010 (12 months). The results were analyzed by the Monitoring Cataract Surgical Outcomes software (MCSO). The postoperative functional data and the causes of poor outcomes were identified.A total of 1044 women (51.9%) and 968 men (48.1%) underwent cataract surgery. Mean age was 65 years. Extracapsular cataract extraction (ECCE), and manual sutureless small incision cataract surgery (SICS) with posterior chamber IOL implantation in 98%, were the main surgical techniques. Functional results indicated that 45.5% of our patients had good visual acuity (≥3/10) with current spectacles, 33% had limited visual acuity (1/10-2/10), and 21.6% had poor visual acuity (1/10). The proportion of patients with good results improved with best spectacle correction to 63%, vs. 22.9% with limited visual acuity and 14.1% with poor outcomes. The causes of poor outcomes were mainly related to surgical complications (42.1%) and refractive errors (34.8%).These results are inferior to WHO standards, which recommend a rate greater than or equal to 80% for good outcomes and a rate below 5% for bad outcomes.The identification of the causes of poor outcomes underscores the importance of improving surgical skills and the need for postoperative refraction.

In Mali, there were 4508 new cases of tuberculosis in 2003, and 5222 in 2006. Tuberculosis (TB) is thus an important public health problem, decreasing the physical, financial and social capital of individuals, their families and society. Because responses to TB have not yet applied a sufficiently integrated approach that can improve patients' access to quality care, this FORESA project advocates a patient-centered approach. Before any intervention, FORESA thus sought to analyse the situation of TB in Mali and responses to it. The study aims to analyse the discourse about and popular representations of TB (its forms, its signs), the situations in which people are exposed to it or transmit it, and popular practices related to its prevention and the experience of having it. This qualitative, descriptive and analytical study includes a literature review, in-depth interviews with opinion leaders, community health workers and TB patients, focus groups, and the observations of practices. The interviews were recorded, transcribed, and analysed. Subjects provided informed consent to participation. This study showed that: * the terms for TB in local languages (Bambara, Dogon and Fulfuldé) include white cough, big cough, and long cough; * These communities differentiate between 2 main forms of cough (simple and wet); * TB is perceived as a transmissible disease, a disease of contact with a contaminated body or objects; * TB is seen as a serious, contagious, hereditary, shameful disease that may result from the transgression of social norms; * The prevention of TB consists of avoiding people who have the disease or transmitting factors; * Therapeutic remedies, in order, are self-medication, the use of traditional healers, and finally visits to health centres; * The population wants more information about TB and be involved in the fight against it. This study shows the many points of convergence about TB nosology, etiology and therapy between the Mopti population and other groups in Mali (including the Mande, Senoufo and Soso), between the population of Mali and some ethnic groups in Burkina Faso (such as the Dioula, Bobo, Tiéfo Vigué), and between the population of Mali and, Burkina Faso and others in Africa (Gambia, Nigeria, South Africa, etc.). There is also a difference between popular knowledge about TB and biomedical knowledge. The population does not know that TB is transmitted mainly, even exclusively, by nasal droplets or that patients are no longer contagious after two weeks of treatment. The widespread dissemination of this information may have a positive effect, reducing stigmatization and improving access to treatment. Mali must strengthen the skills of all participants in the fight against tuberculosis, to strengthen their framework and to monitor and evaluate their activities.

We are reporting here a 12 month-prospective study on epidemiologic aspects of sore throat in the ENT department of the national hospital Gabriel Touré. We recorded 260 cases of sore throat with 23 loco-regional complications representing 1.8% of all pathologies in our department; the sex ratio was 2.6 in favour of women, and the age group most affected was 20-24 years (18.07%). Sore throat was most frequently diagnosed at the beginning and at the end of the rainy season respectively May and October. In 63 of the cases, local and regional complications were seen, and represented by peri-tonsils phlegm (54%), chronic tonsillitis (41.3%), retropharyngeal abscess (3.2%), and cervical adeno-phlegm (1.6%). Therapy with antibiotics should be of rule, and well justified surgical decisions should be made after informed consent of the patient. Sore throat with its complications should really benefit of better attention and better management.

The purpose of this prospective study was to evaluate retinal damage in patients with sickle cell disease and its links with the different genotypic forms of the disease in patients consulting at the African Tropical Ophthalmology Institute (IOTA). A total of 38 patients with the HbS gene were included over a 12-month study period. Retinal damage was assessed by a computerised angiofluorography in 31 patients. Of the 38 patients studied, 71% had sickle cell disease (SC), 21% had sickle cell trait (AS) and 8% had sickle cell anemia (SS). Sixty-eight percent of patients (n = 21) presented sickle cell retinopathy. The age group with the highest prevalence of proliferative neovascularisation was between 26 and 35 years. Retinopathy was more frequent in SC patients than AS patients: 90% (n = 19) versus 10% (n = 2). None of the 3 SS patients presented retinopathy. Retinal neovascularisation was the most common finding in the 27 affected eyes. This study confirms the frequency and severity of retinal damage in patients with the HbS haemoglobin, particularly among young people with double heterozygous disease (SC) in the tropical African environment. Treatment of this disorder is largely unavailable to patients in sub-Saharan Africa except at the major eye care centres. An early screening and management programme for retinal damage related to SC would reduce ocular complications and optimise visual efficiency in these young active patients.

This work is the result of a retrospective study carried out over three months, from February to April 2002 in the ENT service of Gabriel Touré hospital of Bamako (Mali). The purpose of the study was to find out the prevalence of HIV/aids among ENT patients over the study period. Out of 691 patients, there were 19 cases of seropositivity (2.7%). These seropositive patients were quite often young women, over half of them urban (16/19), jobless and unpaid. The oro-pharyngo-laryngology symptoms though not often obvious in the HIV/AIDS manifestations deserve to be studied more as they can point out possible screening.

Since 1996, there have been reports of cases of cutaneous leishmaniasis in the town of Ouagadougou. The incidence has been on the rise but precise figures are not known. The object of the present study has been, first, to record cases of cutaneous leishmaniasis having occurred in private and public health centres in Ouagadougou from 1996 to 1998 and, second, to determine the progression of the disease in space and time. We wished also to confirm clinical cases in 1998 by parasitological examination, identify different clinical forms of the disease and map out cases in the town. We carried out a retrospective study from 1996 to 1998 and a prospective study in 1998. All cases recorded in this period in visited health centres were included. A total of 1845 cases of cutaneous leishmaniasis was identified, 50.3% of whom concerned women. The age of patients varied between 1 and 79 years for 356 patients, with a mean age of 26.7 years. Cases increased between 1996 and 1998 (1996 = 61 cases, 1997 = 552 cases, 1998 = 1218 cases). The months of highest incidence were August (13%), September (15%) and October (17%). Peripheral districts (28, 30, 29, 16, 15) in south-eastern areas of the town were the worst touched with 87% of cases. On average, patients seek care after 2 months of progression of the disease. The ulcero-crusted form (68.2%) was the most frequent clinical form observed for 327 patients, but almost half of the cases had more than one site of infection, (43.5%). Over half of the patients presented fewer than 10 lesions with an average of 6. The most common locations were on uncovered parts of the body, notably the superior (53%) and inferior limbs (49%). The parasite could be tested for by smear on 52 patients only in 1998 and 53.8% of cases tested were positive. Leishmania major, which is very prevalent in West Africa was identified in one patient. The vectors and main reservoirs of the parasite were not studied. Case management was generally incomplete; the most commonly prescribed drugs were antibiotics (70% of patients), but self-medication was frequent. Our recommendations after this preliminary study are: undertake multidisciplinary studies on cutaneous leishmaniasis in Ouagadougou in order to understand the local aetiology (vectors responsible for transmission, rodent and domestic animals involved in the epidemiological chain, parasite species); identify all other areas in the country where the disease is highly prevalent provide health care staff with a decisional algorithm and protocol therapy carry out and active control programme for cutaneous leishmaniasis in Burkina Faso.

Vitamin A deficiency is a major public health problem in the countries of the Sahel. It causes xerophthalmia and high rates of child mortality and it occurs mostly in underdeveloped regions. People of all ages may suffer from vitamin A deficiency but it is a particular problem in pre-school-age children. Each year, about 250,000 children throughout the world become blind due to vitamin A deficiency. Measles, pneumonia and diarrhea reduce the child's reserves of retinol and increase the dietary requirement for vitamin A. Improvement of social conditions is a radical approach to preventing vitamin A deficiency. Three strategies are currently in use: horticultural activities and health education; fortification of food products; distribution of high-dose vitamin A capsules.

Objetifs le but du travail est d’evaluer le suivi des nourrissons nes de mere seropositive et d’identifier les difficultes. Methode L’etude a concerne le suivi clinique et biologique de 259 nourrissons suivis en pediatrie. Resultats L’âge moyen des meres etait de 27, 4 ans et 68,8 % d’entre elles etaient femmes au foyer. La seropositivite des meres a ete decouverte pendant dans la grossesse dans 42,1 % des cas et 62,5 % des femmes ignoraient le statut serologique de leur conjoint. Cent quatre nouveaux nes n’ont pas recu de prophylaxie antiretrovirale a la naissance et le suivi a debute pour 41,4 % d’entre eux des la naissance. Le mode d’alimentation a ete le lait artificiel pour 70 % des nourrissons. Plus de la motie des cas (140/259) ont beneficie d’au moins une PCR et la serologie VIH realisee a 18 mois chez 130/259 nourrissons est revenue positive dans 9 cas. Vingt cinq nourrissons sont decedes. Les difficutes de suivi ont ete : le nombre eleve d’abandon de suivi, les ruptures d’approvisionnment en lait artificiel et en reactifs (PCR).

In Mali, climate change is a major threat to the productivity of food security crops such as sorghum (Sorghum bicolor (L.) Moench, 1794). The objective of this study was to analyse farmers’ perceptions of climate change effects, on sorghum productivity and the adaptation related strategies. A total of 352 sorghum farmers in the Sudanian and Sahelian zones of Mali were interviewed, using a semi-structured questionnaire. Data collected were related mainly to the farmers’ socio-economic profiles, indicators used to characterise climate change and strategies developed to cope with it. Irregular rainfall, marked rise in temperatures and early cessation of the rainy seasons were the main manifestations of climate change effects according to the respondents. These effects reportedly resulted in a drastic drop in sorghum yields. Use of meteorological information (19.89% of the respondents), use of early and drought-resistant varieties (13.35% of the respondents), and intercropping of sorghum with other crops (25.85% of the respondents) were the strategy options adapted by farmers. The choice of an adaptation strategies was largely dependent on the number of years of experience in sorghum production, and the number of labour providers available in the household. It is imperative to assess and refine the agronomic effectiveness of these coping strategies to improve sorghum productivity in the study areas.

International audience; An indirect immunofluorescence monoclonal antibody assay was found to have higher sensitivity than usual stains for the detection of Pneumocystis carinii, particularly in bronchoalveolar lavage fluids in which there are only a few parasites, as in HIV-patients or in HIV+ patients with prophylaxis or treatment. For patients without any therapy, when different stains give conflicting results, decisions on therapeutic approaches to be used should consider the patient's clinical and biological status. Prospective studies are necessary to evaluate the predictive value of low parasitism in asymptomatic immunosuppressed patients.