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This article is a dynamic reading of space, specifically urban space, based on two African novels: Shut Up and Die by Alain Mabanckou and The Blood of Masks by Seydou Badian. The study shows that the urban space is conducive to libertinism, but that it remains also a place of incarceration in the literal and symbolic sense. From a socio-critical study and based on spatial analysis theories, we undertake a comparative study of the two abovementioned narratives to indicate that the city in Africa and/or in Europe, even from different times, experience the same realities. Furthermore, the article demonstrates that colonization and its corollaries have influenced the behavior of men in cities whether in Africa or in Europe. Résumé : Cet article est une lecture dynamique de l’espace, spécifiquement de l’espace urbain, à partir de deux romans africains : Tais-toi et meurs d’Alain Mabanckou et Le Sang des masques de Seydou Badian. L’étude montre que l’espace urbain est un terrain favorable au libertinage, mais qu'il demeure aussi un endroit d’incarcération au sens propre et symbolique. À partir d’une étude sociocritique et à l’aide des théories d’analyse de l’espace, on entreprend une étude comparative des deux récits susmentionnés, pour montrer que la ville en Afrique et/ou en Europe, même à des époques différentes, connaissent les mêmes réalités. Par ailleurs, l’article montre que la colonisation et ses corollaires ont impacté le comportement des hommes dans les villes, que ce soit en Afrique ou en Europe.

Background A trial in African children showed that combining seasonal vaccination with the RTS,S/AS01E vaccine with seasonal malaria chemoprevention reduced the incidence of uncomplicated and severe malaria compared with either intervention given alone. Here, we report on the anti-circumsporozoite antibody response to seasonal RTS,S/AS01E vaccination in children in this trial. Methods Sera from a randomly selected subset of children collected before and 1 month after 3 priming doses of RTS,S/AS01E and before and 1 month after 2 seasonal booster doses were tested for anti-circumsporozoite antibodies using enzyme-linked immunosorbent assay. The association between post-vaccination antibody titer and incidence of malaria was explored. Results A strong anti-circumsporozoite antibody response to 3 priming doses of RTS,S/AS01E was seen (geometric mean titer, 368.9 enzyme-linked immunosorbent assay units/mL), but titers fell prior to the first booster dose. A strong antibody response to an annual, pre-malaria transmission season booster dose was observed, but this was lower than after the primary vaccination series and lower after the second than after the first booster dose (ratio of geometric mean rise, 0.66; 95% confidence interval [CI], .57–.77). Children whose antibody response was in the upper tercile post-vaccination had a lower incidence of malaria during the following year than children in the lowest tercile (hazard ratio, 0.43; 95% CI, .28–.66). Conclusions Seasonal vaccination with RTS,S/AS01E induced a strong booster antibody response that was lower after the second than after the first booster dose. The diminished antibody response to the second booster dose was not associated with diminished efficacy. Clinical Trials Registration NCT03143218.

Background Mass drug administration (MDA) with azithromycin (AZ) is being considered as a strategy to promote child survival in sub-Saharan Africa, but the mechanism by which AZ reduces mortality is unclear. To better understand the nature and extent of protection provided by AZ, we explored the profile of protection by time since administration, using data from a household-randomized, placebo-controlled trial in Burkina Faso and Mali. Methods Between 2014 and 2016, 30 977 children aged 3–59 months received seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine and either AZ or placebo monthly, on 4 occasions each year. Poisson regression with gamma-distributed random effects, accounting for the household randomization and within-individual clustering of illness episodes, was used to compare incidence of prespecified outcomes between SMC+AZ versus SMC+placebo groups in fixed time strata post-treatment. The likelihood ratio test was used to assess evidence for a time-treatment group interaction. Results Relative to SMC+placebo, there was no evidence of protection from SMC+AZ against hospital admissions and deaths. Additional protection from SMC+AZ against malaria was confined to the first 2 weeks post-administration (protective efficacy (PE): 24.2% [95% CI: 17.8%, 30.1%]). Gastroenteritis and pneumonia were reduced by 29.9% [21.7; 37.3%], and 34.3% [14.9; 49.3%], respectively, in the first 2 weeks postadministration. Protection against nonmalaria fevers with a skin condition persisted up to 28 days: PE: 46.3% [35.1; 55.6%]. Conclusions The benefits of AZ-MDA are broad-ranging but short-lived. To maximize impact, timing of AZ-MDA must address the challenge of targeting asynchronous morbidity and mortality peaks from different causes., Mass administration of azithromycin (AZ-MDA) alongside seasonal malaria chemoprevention in children in Burkina Faso and Mali has broad-ranging but short-lived benefits. To maximize impact, AZ-MDA must address the challenge of targeting asynchronous peaks in morbidity and mortality from different causes.

ntroduction : L'OMS estime que 145 700 personnes, dont une majorité d'enfants de moins de 5 ans, sont mortes de la rougeole en 2013. Une flambée de rougeole a éclaté à Bamako en 2014, faisant 109 cas. Nous nous sommes alors proposé d'analyser les facteurs liés à cette épidémie afin de comprendre leur niveau d'association à celle-ci et de fournir des pistes aux autorités pour la prise des mesures de prévention ciblées. Méthodologie : Il s'agissait d'une étude cas-témoin. Les cas constituaient tous les cas confirmés de rougeole à Bamako en 2014 et les témoins tous les cas suspects de rougeole mais non confirmés et les cas notifiés d'autres maladies épidémiques en 2014 à Bamako. Notre échantillon était constitué de 96 sujets sélectionnés selon un échantillonnage exhaustif pour les cas (48) et aléatoire simple pour les témoins (48). Les données ont été analysées par le logiciel SPSS version 20. Résultats : L'analyse montre que le risque de rougeole était plus élevé chez les non vaccinés OR = 2,55 [1,12 – 5,82]. Le risque n'a pas été significatif pour les sujets ayant un contact avec un malade OR = 5,77 [0,67 – 49,61]. Les participants n'ayant pas eu la vitamine A ont un risque plus élevé OR = 2,83 [1,20 – 6,65]. Conclusion : la rougeole est influencée par le statut vaccinal et l'administration de la vitamine A. Par conséquent les autorités doivent, en tenant compte de ces résultats, coupler la vaccination contre la rougeole à l'administration de la vitamine A.

Mass administration of azithromycin has reduced mortality in children in sub-Saharan Africa but its mode of action is not well characterised. A recent trial found that azithromycin given alongside seasonal malaria chemoprevention was not associated with a reduction in mortality or hospital admissions in young children. We investigated the effect of azithromycin on the nutritional status of children enrolled in this study.A total of 19 578 children in Burkina Faso and Mali were randomised to receive either azithromycin or placebo alongside seasonal malaria chemoprevention with sulfadoxine-pyrimethamine plus amodiaquine monthly for three malaria transmission seasons (2014-2016). After each transmission season, anthropometric measurements were collected from approximately 4000 randomly selected children (2000 per country) at a cross-sectional survey and used to derive nutritional status indicators. Binary and continuous outcomes between treatment arms were compared by Poisson and linear regression.Nutritional status among children was poor in both countries with evidence of acute and chronic malnutrition (24.9-33.3% stunted, 15.8-32.0% underweight, 7.2-26.4% wasted). There was a suggestion of improvement in nutritional status in Burkina Faso and deterioration in Mali over the study period. At the end of each malaria transmission season, nutritional status of children did not differ between treatment arms (seasonal malaria chemoprevention plus azithromycin or placebo) in either the intention-to-treat or per-protocol analyses (only children with at least three cycles of SMC in the current intervention year).The addition of azithromycin to seasonal malaria chemoprevention did not result in an improvement of nutritional outcomes in children in Burkina Faso and Mali.L'administration massive d'azithromycine a réduit la mortalité infantile en Afrique subsaharienne mais son mode d'action n'est pas bien caractérisé. Un essai récent a révélé que l'azithromycine administrée parallèlement à la chimioprévention du paludisme saisonnier n'était pas associée à une réduction de la mortalité ou des hospitalisations chez les jeunes enfants. Nous avons étudié l'effet de l'azithromycine sur l'état nutritionnel des enfants inscrits à cette étude. MÉTHODES: 19.578 enfants au Burkina Faso et au Mali ont été randomisés pour recevoir soit de l'azithromycine soit un placebo parallèlement à une chimioprévention du paludisme saisonnier avec du sulfadoxine-pyriméthamine plus de l’amodiaquine par mois pendant trois saisons de transmission du paludisme (2014-2016). Après chaque saison de transmission, des mesures anthropométriques ont été recueillies auprès d'environ 4.000 enfants sélectionnés au hasard (2.000 par pays) lors d'une enquête transversale et utilisées pour dériver des indicateurs de l'état nutritionnel. Les résultats binaires et continus entre les bras de traitement ont été comparés par la régression linéaire et de Poisson. RÉSULTATS: L'état nutritionnel des enfants était médiocre dans les deux pays avec des signes de malnutrition aiguë et chronique (24,9 à 33,3% de retard de croissance, 15,8 à 32,0% d'insuffisance pondérale, 7,2 à 26,4% d'émaciation). Il a été suggéré une amélioration de l'état nutritionnel au Burkina Faso et une détérioration au Mali au cours de la période d'étude. A la fin de chaque saison de transmission du paludisme, l'état nutritionnel des enfants ne différait pas entre les bras de traitement (chimioprévention contre le paludisme saisonnier plus azithromycine ou placebo) dans les analyses en intention de traiter ou selon le protocole (seulement les enfants avec au moins trois cycles de chimioprévention dans l’année d’intervention en cours).L'ajout d'azithromycine à la chimioprévention du paludisme saisonnier n'a pas entraîné d'amélioration des résultats nutritionnels chez les enfants au Burkina Faso et au Mali.

Introduction: Idiopathic central serous chorioretinopathy (ICSC) is characterized by the buildup of fluid leading to circumscribed elevation of the retina within the posterior pole. This condition affects young people between the ages of 20 - 50 years. The disease is seen predominantly in men as compared to women. We report the cases of two (02) patients received in consultation at IOTA-Teaching Hospital between July 2019 and February 2020. Case Presentation: We report two cases of Idiopathic stress central serous chorioretinopathy. The first case is a 37-year-old man that we received in consultation for visual acuity decrease from a sudden installation for 1 hour. The clinical and paraclinical arguments permitted us to retain the diagnosis of Idiopathic stress central serous chorioretinopathy. The patient benefited from laser treatment and the clinical evolution was good. The second case is a 42-year-old man, who consulted for a sudden reduction of visual acuity that had been evolving for 3 weeks. The clinical and paraclinical contexts were in favour of the diagnosis of Idiopathic stress central serous chorioretinopathy. The patient was treated with spironolactone. The clinical evolution was favourable. Conclusion: Our study confirms the existence of central serous chorioretinopathy (CSC) in Black African patients. Studies show the connection between CSC and stress.

A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01In Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01In 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01Despite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas.https://www.clinicaltrials.gov/ct2/show/NCT03143218 , registered 8th May 2017.

International audience; Background: Malaria control remains a challenge in many parts of the Sahel and sub-Sahel regions of Africa.Methods: We conducted an individually randomized, controlled trial to assess whether seasonal vaccination with RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria and whether the two interventions combined were superior to either one alone in preventing uncomplicated malaria and severe malaria-related outcomes.Results: We randomly assigned 6861 children 5 to 17 months of age to receive sulfadoxine-pyrimethamine and amodiaquine (2287 children [chemoprevention-alone group]), RTS,S/AS01E (2288 children [vaccine-alone group]), or chemoprevention and RTS,S/AS01E (2286 children [combination group]). Of these, 1965, 1988, and 1967 children in the three groups, respectively, received the first dose of the assigned intervention and were followed for 3 years. Febrile seizure developed in 5 children the day after receipt of the vaccine, but the children recovered and had no sequelae. There were 305 events of uncomplicated clinical malaria per 1000 person-years at risk in the chemoprevention-alone group, 278 events per 1000 person-years in the vaccine-alone group, and 113 events per 1000 person-years in the combination group. The hazard ratio for the protective efficacy of RTS,S/AS01E as compared with chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to 1.01), which excluded the prespecified noninferiority margin of 1.20. The protective efficacy of the combination as compared with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8) against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against hospital admission with severe malaria according to the World Health Organization definition, and 72.9% (95% CI, 2.9 to 92.4) against death from malaria. The protective efficacy of the combination as compared with the vaccine alone against these outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI, 42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively.Conclusions: Administration of RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria. The combination of these interventions resulted in a substantially lower incidence of uncomplicated malaria, severe malaria, and death from malaria than either intervention alone. (Funded by the Joint Global Health Trials and PATH; ClinicalTrials.gov number, NCT03143218.).

IntroductionMalaria has been the leading cause of morbidity and mortality for several decades in Mali, with an increase from 2017 to 2020 (2,884,837 confirmed cases and 1,454 deaths). On the recommendation of the World Health Organization (WHO) and in the interests of efficient use of resources, Mali has begun a process of stratifying the health districts to target malaria control strategies.MethodMalaria, entomological and environmental data were collected through the local health information system (LHIS), the Demographic and Health Survey (DHS 2018), research institutions and MALI-METEO services. The WHO has recommended stratification at the district level consisted of assigning each district to one of 4 classes according to criteria based on incidence adjusted for attendance rate. Variables associated with monthly malaria incidence at the district level were identified using a general additive non-linear regression model.ResultsFrom 2017 to 2019, the median incidence across 75 health districts of Mali was 129.34 cases per 1,000 person-year (IQR=86.48). The results showed different periods of high malaria transmission in health districts level and durations varying from 2 to 6 months, showing a double peak for some health districts, which were located in the flooded areas. environmental variables such as rainfall, vegetation index (NDVI), maximum temperature and relative humidity were significantly associated at malaria incidence with a lag of around one month. A strata defines a geographical area with similar epidemiological, environmental and socio-economic factors. Stratification resulted in 12 health districts of very low transmission, 19 low transmission, 20 moderate transmission and 24 in high transmission areas. The number of rounds of season malaria chemoprevention will be based on the number of months in the high transmission period.ConclusionThis first stratification in Mali will allow targeting malaria control strategies. This approach will be dynamic and revised yearly in order to integrate information from the national epidemiological surveillance.

La tradition et le sacré peuvent être considérés comme deux thèmes fondamentaux toujours présents dans les romans de Seydou Badian. Ces deux éléments peuvent contribuer à la résolution des conflits dans la société, selon les circonstances. La tradition peut contribuer à apaiser la tension sociale grâce à certaines valeurs culturelles. Le sacré peut également intervenir dans le même contexte par le bon usage qu’en font les « connaisseurs ». Cet article tente de montrer l’intervention de la tradition et du sacré dans la résolution de la crise ou du conflit dans les romans de Seydou Badian.

Introduction : La presente etude a pour objet d’identifier les facteurs associes a la cessation de l’allaitement maternel exclusif (AME) chez les meres d’enfants de 0 a 6 mois dans les milieux urbain et rural au Mali. Methode : Il s’agit d’une etude longitudinale prospective, realisee a Bamako (milieu urbain) et Dialakoroba (milieu rural) d’avril a novembre 2016. Au total, 228 meres ont ete enrolees (114 par milieu) de facon volontaire dans les centres de sante. Un suivi mensuel de six mois a ete realise au domicile. Le logiciel SPSS® 20 a ete utilise pour la saisie et l’analyse des donnees. L’evenement attendu etait de donner a l’enfant un autre aliment que le lait maternel. Les tests statistiques du Chi2, du log-rank et le hazard ratio (HR) ont ete utilises avec un seuil de signification p ≤ 0,05. Resultats : Environ 68,5 % des meres du milieu urbain et 71,5 % de celles du milieu rural avaient cesse l’AME avant six mois. Les facteurs associes a cette cessation de l’AME etaient : l’utilisation du biberon (HR = 2,61 ; IC 95 % : [1,46-4,48]), les soins de l’enfant comme occupation principale pendant moins de trois mois (HR = 3,18 ; IC 95 % : [1,95-5,20]), le soutien a la mere pendant moins de trois mois (HR = 3,79 ; IC 95 % : [2,31-6,22]), le conseil sur l’AME (HR = 0,64 ; IC 95 % : [0,46-0,98]) et l’experience d’allaitement (HR = 0,34 ; IC 95 % : [0,15-0,84]). Conclusion : La prise en compte des facteurs identifies permettra d’ameliorer la pratique de l’AME a six mois dans les sites de l’etude.

In Mali, since 2007, artemether-lumefantrine has been the first choice against uncomplicated malaria. Despite its effectiveness, a rapid selection of markers of resistance to partner drugs has been documented. This work evaluated the treatment according to the World Health Organization&rsquo, s standard 28-day treatment method. The primary endpoint was the clinical and parasitological response corrected by a polymerase chain reaction. It was more than 99.9 percent, the proportion of patients with anemia significantly decrease compared to baseline (p &lt, 0.001), and no serious events were recorded. Plasmodium falciparum remains sensitive to artemether-lumefantrine in Mali.

International audience; Context: In Mali, malaria transmission is seasonal, exposing children to high morbidity and mortality. A preventative strategy called Seasonal Malaria Chemoprevention (SMC) is being implemented, consisting of the distribution of drugs at monthly intervals for up to 4 months to children between 3 and 59 months of age during the period of the year when malaria is most prevalent. This study aimed to analyze the evolution of the incidence of malaria in the general population of the health districts of Kati, Kadiolo, Sikasso, Yorosso, and Tominian in the context of SMC implementation.Methods: This is a transversal study analyzing the routine malaria data and meteorological data of Nasa Giovanni from 2016 to 2018. General Additive Model (GAM) analysis was performed to investigate the relationship between malaria incidence and meteorological factors.Results: From 2016 to 2018, the evolution of the overall incidence in all the study districts was positively associated with the relative humidity, rainfall, and minimum temperature components. The average monthly incidence and the relative humidity varied according to the health district, and the average temperature and rainfall were similar. A decrease in incidence was observed in children under five years old in 2017 and 2018 compared to 2016.Conclusion: A decrease in the incidence of malaria was observed after the SMC rounds. SMC should be applied at optimal periods.

Background Malaria and malnutrition remain major problems in Sahel countries, especially in young children. The direct effect of malnutrition on malaria remains poorly understood, and may have important implications for malaria control. In this study, nutritional status and the association between malnutrition and subsequent incidence of symptomatic malaria were examined in children in Burkina Faso and Mali who received either azithromycin or placebo, alongside seasonal malaria chemoprevention. Methods Mid-upper arm circumference (MUAC) was measured in all 20,185 children who attended a screening visit prior to the malaria transmission season in 2015. Prior to the 2016 malaria season, weight, height and MUAC were measured among 4149 randomly selected children. Height-for-age, weight-for-age, weight-for-height, and MUAC-for-age were calculated as indicators of nutritional status. Malaria incidence was measured during the following rainy seasons. Multivariable random effects Poisson models were created for each nutritional indicator to study the effect of malnutrition on clinical malaria incidence for each country. Results In both 2015 and 2016, nutritional status prior to the malaria season was poor. The most prevalent form of malnutrition in Burkina Faso was being underweight (30.5%; 95% CI 28.6–32.6), whereas in Mali stunting was most prevalent (27.5%; 95% CI 25.6–29.5). In 2016, clinical malaria incidence was 675 per 1000 person-years (95% CI 613–744) in Burkina Faso, and 1245 per 1000 person-years (95% CI 1152–1347) in Mali. There was some evidence that severe stunting was associated with lower incidence of malaria in Mali (RR 0.81; 95% CI 0.64–1.02; p = 0.08), but this association was not seen in Burkina Faso. Being moderately underweight tended to be associated with higher incidence of clinical malaria in Burkina Faso (RR 1.27; 95% CI 0.98–1.64; p = 0.07), while this was the case in Mali for moderate wasting (RR 1.27; 95% CI 0.98–1.64; p = 0.07). However, these associations were not observed in severely affected children, nor consistent between countries. MUAC-for-age was not associated with malaria risk. Conclusions Both malnutrition and malaria were common in the study areas, high despite high coverage of seasonal malaria chemoprevention and long-lasting insecticidal nets. However, no strong or consistent evidence was found for an association between any of the nutritional indicators and the subsequent incidence of clinical malaria.

In Mali, since 2007, artemether-lumefantrine has been the first choice against uncomplicated malaria. Despite its effectiveness, a rapid selection of markers of resistance to partner drugs has been documented. This work evaluated the treatment according to the World Health Organization’s standard 28-day treatment method. The primary endpoint was the clinical and parasitological response corrected by a polymerase chain reaction. It was more than 99.9 percent, the proportion of patients with anemia significantly decrease compared to baseline (p < 0.001), and no serious events were recorded. Plasmodium falciparum remains sensitive to artemether-lumefantrine in Mali.

Background: Previous controlled studies demonstrated seasonal malaria chemoprevention (SMC) reduces malaria morbidity by &gt, 80% in children aged 3&ndash, 59 months. Here, we assessed malaria morbidity after large-scale SMC implementation during a pilot campaign in the health district of Koutiala, Mali. Methods: Starting in August 2012, children received three rounds of SMC with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). From July 2013 onward, children received four rounds of SMC. Prevalence of malaria infection, clinical malaria and anemia were assessed during two cross-sectional surveys conducted in August 2012 and June 2014. Investigations involved 20 randomly selected clusters in 2012 against 10 clusters in 2014. Results: Overall, 662 children were included in 2012, and 670 in 2014. Children in 2014 versus those surveyed in 2012 showed reduced proportions of malaria infection (12.4% in 2014 versus 28.7% in 2012 (p = 0.001)), clinical malaria (0.3% versus 4.2%, respectively (p &lt, 0.001)), and anemia (50.1% versus 67.4%, respectively (p = 0.001)). A propensity score approach that accounts for environmental differences showed that SMC conveyed a significant protective effect against malaria infection (IR = 0.01, 95% CI (0.0001, 0.09), clinical malaria (OR = 0.25, 95% CI (0.06, 0.85)), and hemoglobin concentration (&beta, = 1.3, 95% CI (0.69, 1.96)) in 2012 and 2014, respectively. Conclusion: SMC significantly reduced frequency of malaria infection, clinical malaria and anemia two years after SMC scale-up in Koutiala.

Background Seasonal malaria chemoprevention (SMC) is now widely deployed in the Sahel, including several countries that are major contributors to the global burden of malaria. Consequently, it is important to understand whether SMC continues to provide a high level of protection and how SMC might be improved. SMC was evaluated using data from a large, household-randomised trial in Houndé, Burkina Faso and Bougouni, Mali. Methods and findings The parent trial evaluated monthly SMC plus either azithromycin (AZ) or placebo, administered as directly observed therapy 4 times per year between August and November (2014–2016). In July 2014, 19,578 children aged 3–59 months were randomised by household to study group. Children who remained within the age range 3–59 months in August each year, plus children born into study households or who moved into the study area, received study drugs in 2015 and 2016. These analyses focus on the approximately 10,000 children (5,000 per country) under observation each year in the SMC plus placebo group. Despite high coverage and high adherence to SMC, the incidence of hospitalisations or deaths due to malaria and uncomplicated clinical malaria remained high in the study areas (overall incidence rates 12.5 [95% confidence interval (CI): 11.2, 14.1] and 871.1 [95% CI: 852.3, 890.6] cases per 1,000 person-years, respectively) and peaked in July each year, before SMC delivery began in August. The incidence rate ratio comparing SMC within the past 28 days with SMC more than 35 days ago—adjusted for age, country, and household clustering—was 0.13 (95% CI: 0.08, 0.20), P < 0.001 for malaria hospitalisations and deaths from malaria and 0.21 (95% CI 0.20, 0.23), P < 0.001 for uncomplicated malaria, indicating protective efficacy of 87.4% (95% CI: 79.6%, 92.2%) and 78.3% (95% CI: 76.8%, 79.6%), respectively. The prevalence of malaria parasitaemia at weekly surveys during the rainy season and at the end of the transmission season was several times higher in children who missed the SMC course preceding the survey contact, and the smallest prevalence ratio observed was 2.98 (95% CI: 1.95, 4.54), P < 0.001. The frequency of molecular markers of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) resistance did not increase markedly over the study period either amongst study children or amongst school-age children resident in the study areas. After 3 years of SMC deployment, the day 28 PCR-unadjusted adequate clinical and parasitological response rate of the SP + AQ regimen in children with asymptomatic malaria was 98.3% (95% CI: 88.6%, 99.8%) in Burkina Faso and 96.1% (95% CI: 91.5%, 98.2%) in Mali. Key limitations of this study are the potential overdiagnosis of uncomplicated malaria by rapid diagnostic tests and the potential for residual confounding from factors related to adherence to the monthly SMC schedule. Conclusion Despite strong evidence that SMC is providing a high level of protection, the burden of malaria remains substantial in the 2 study areas. These results emphasise the need for continuing support of SMC programmes. A fifth monthly SMC course is needed to adequately cover the whole transmission season in the study areas and in settings with similar epidemiology. Trial registration The AZ-SMC trial in which these data were collected was registered at clinicaltrials.gov: NCT02211729., Matthew Cairns and colleagues show additional courses of seasonal chemoprevention are needed in Burkina Faso and Mali to control malaria., Author summary Why was this study done? Seasonal malaria chemoprevention (SMC) is recommended for children under 5 years of age in countries of the Sahel and sub-Sahel. Many countries in West and Central Africa now have large-scale SMC programmes. The malaria burden remains high in several countries that have introduced SMC, including Burkina Faso and Mali, which are amongst the most important contributors to the global burden of malaria cases and deaths. It is important to understand whether SMC retains a high level of protection in these areas and how its impact might be improved. What did the researchers do and find? In this study, the level of protection provided by SMC was investigated using data from a large but closely supervised clinical trial in 2 districts in southern Burkina Faso and Mali. SMC was delivered 4 times per year over 3 years, reaching a very high percentage of children. All the daily doses of SMC were supervised by the study team. Specific substudies showed that molecular markers of resistance to the combination of antimalarials used for SMC were rare amongst malaria parasites and that the SMC combination was highly effective in curing infections detected at the end of the rainy season. Malaria incidence was markedly reduced in the period immediately after each SMC course. In the first 4 weeks after SMC, malaria cases were reduced by 78%, and malaria hospitalisations and deaths from malaria were reduced by 87%. Despite the benefits of SMC, the number of malaria cases, hospital admissions for malaria, and deaths from malaria remained very high in the study areas. There was a large peak in July each year, coinciding with the beginning of the rainy season, before SMC delivery began in August. What do these findings mean? SMC is likely to be averting a very large number of malaria cases, hospitalisations, and deaths in the study areas, but malaria has still not been brought under control. At least one additional monthly course of SMC is needed to address the high burden of malaria, including malaria deaths, that currently occurs outside the peak transmission season. This is likely to be the case in other areas of the Sahel that have a longer transmission season than can be covered by a 4-month SMC programme. Additional new tools are needed urgently to further reduce malaria in these districts and areas with similar epidemiology.

The study had for object to identify factors associated to the cessation of the exclusive breast-feeding at the mothers of children from 0 to 6#160;months in the urban and rural circles in Mali.The study was longitudinal forward-looking, realized in Bamako (urban area) and in Dialakoroba (rural area) from April till November, 2016. in total, 218 mothers were enlisted (114 by area) in a voluntary way in health centers. A monthly follow-up of six months was realized in the place of residence. The SPSS 20 software was used for the seizure and the data analysis. The expected event was to give to the child another food than maternal milk. Test statistics such as Chi2 of Log Rank and Hazard Ratio (HR) were used with threshold of meaning p ≤ 0,05.In urban zones and rural respectively 68,5 % and 71,5% of the mothers had stopped the Exclusive Breast-feeding (EBF) before six months. Factors associated to this cessation of the EBF were: the use of the feeding-bottle (HR=2,61; IC 95%: [1,46-4,48]), the care of the child during less than three months as main occupation (HR=3,18; IC 95%: [1,95-5,20]), the support for the mother during less than three months (HR=3,79; IC 95%: [2,31-6,22]), the advice(council) on the EBF (HR=0,64; IC 95%: [0,46-0,98]) and the experience (experiment) of breastfeeding (HR=0,34; IC 95%: [0,15-0,84]).The consideration of the identified factors(mailmen) will allow to improve the practice of the EBF in six months in the sites of the study.

BackgroundTsetse-transmitted trypanosomosis is a deadly, neglected tropical disease and a major challenge for mixed crop-livestock agriculture in sub-Saharan Africa. It is caused by several species of the genusTrypanosoma. Information on the occurrence of tsetse flies and African animal trypanosomosis (AAT) is available for different areas of Mali. However, these data have never been harmonized and centralized, which prevents the development of comprehensive epidemiological maps and constrains an evidence-based planning of control actions. To address this challenge, we created a dynamic geo-spatial database of tsetse and AAT distribution in Mali.MethodsA digital repository containing epidemiological data collected between 2000 and 2018 was assembled. In addition to scientific publications, the repository includes field datasheets, technical reports and other grey literature. The data were verified, harmonized, georeferenced and integrated into a single spatially-explicit database.ResultsFor the tsetse component, approximately 19,000 trapping records, corresponding to 6000 distinct trapping locations and 38,000 flies were included in the database.Glossina palpalis gambiensiswas the most widespread and abundant species, and it was found in the southern, southern-central and western parts of the country.Glossina tachinoideswas only found in the South. Only a few specimens ofGlossina morsitans submorsitanswere detected. For the AAT component, approximately 1000 survey records were included, corresponding to 450 distinct survey sites and 37,000 tested bovines. AAT was found in all surveyed regions, although data for the tsetse-free North and North-East are lacking.Trypanosoma vivaxandTrypanosoma congolensewere the dominant species, whileTrypanosoma bruceiinfections were much less numerous.ConclusionsThe atlas of tsetse and AAT in Mali provides a synoptic view of the vector and disease situation at the national level. Still, major geographical gaps affect the North, the North-East and the West, and there is also a severe lack of data over the past five years. Trypanosomosis remains a major animal health problem in Mali. However, despite its prevalence and distribution, monitoring and control activities are presently very limited. Efforts should be made to strengthen the progressive control of AAT in Mali, and the atlas provides a new tool to identify priority areas for intervention.

BACKGROUND: Mass administration of azithromycin for trachoma control led to a sustained reduction in all-cause mortality among Ethiopian children. Whether the addition of azithromycin to the monthly sulfadoxine-pyrimethamine plus amodiaquine used for seasonal malaria chemoprevention could reduce mortality and morbidity among African children was unclear. METHODS: We randomly assigned children 3 to 59 months of age, according to household, to receive either azithromycin or placebo, together with sulfadoxine-pyrimethamine plus amodiaquine, during the annual malaria-transmission season in Burkina Faso and Mali. The drug combinations were administered in four 3-day cycles, at monthly intervals, for three successive seasons. The primary end point was death or hospital admission for at least 24 hours that was not due to trauma or elective surgery. Data were recorded by means of active and passive surveillance. RESULTS: In July 2014, a total of 19,578 children were randomly assigned to receive seasonal malaria chemoprevention plus either azithromycin (9735 children) or placebo (9843 children); each year, children who reached 5 years of age exited the trial and new children were enrolled. In the intention-to-treat analysis, the overall number of deaths and hospital admissions during three malaria-transmission seasons was 250 in the azithromycin group and 238 in the placebo group (events per 1000 child-years at risk, 24.8 vs. 23.5; incidence rate ratio, 1.1; 95% confidence interval [CI], 0.88 to 1.3). Results were similar in the per-protocol analysis. The following events occurred less frequently with azithromycin than with placebo: gastrointestinal infections (1647 vs. 1985 episodes; incidence rate ratio, 0.85; 95% CI, 0.79 to 0.91), upper respiratory tract infections (4893 vs. 5763 episodes; incidence rate ratio, 0.85; 95% CI, 0.81 to 0.90), and nonmalarial febrile illnesses (1122 vs. 1424 episodes; incidence rate ratio, 0.79; 95% CI, 0.73 to 0.87). The prevalence of malaria parasitemia and incidence of adverse events were similar in the two groups. CONCLUSIONS: Among children in Burkina Faso and Mali, the addition of azithromycin to the antimalarial agents used for seasonal malaria chemoprevention did not result in a lower incidence of death or hospital admission that was not due to trauma or surgery than antimalarial agents plus placebo, although a lower disease burden was noted with azithromycin than with placebo. (Funded by the Joint Global Health Trials scheme; ClinicalTrials.gov number, NCT02211729.).

Additional file 2: Text S2. The structure of the database on tsetse and African animal trypanosomosis in Mali.

Previous studies have shown that a single season of intermittent preventive treatment in schoolchildren (IPTsc) targeting the transmission season has reduced the rates of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Efficacy over the course of multiple years of IPTsc has been scantly investigated. Methods: An open, randomized-controlled trial among schoolchildren aged 6–13 years was conducted from September 2007 to January 2010 in Kolle, Mali. Students were included in three arms: sulphadoxine-pyrimethamine+artesunate (SP+AS), amodiaquine+artesunate (AQ+AS), and control (C). All students received two full doses, given 2 months apart, and were compared with respect to the incidence of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Results: A total of 296 students were randomized. All-cause clinic visits were in the SP+AS versus control (29 (20.1%) vs. 68 (47.2%); 20 (21.7%) vs. 41 (44.6%); and 14 (21.2%) vs. 30 (44.6%); p < 0.02) in 2007, 2008, and 2009, respectively. The prevalence of asymptomatic parasitemia was lower in the SP+AS compared to control (38 (7.5%) vs. 143 (28.7%); and 47 (12.7%) vs. 75 (21.2%); p < 0.002) in 2007 and 2008, respectively. Hemoglobin concentration was significantly higher in children receiving SP+AS (11.96, 12.06, and 12.62 g/dL) than in control children (11.60, 11.64, and 12.15 g/dL; p < 0.001) in 2007, 2008, and 2009, respectively. No impact on clinical malaria was observed. Conclusion: IPTsc with SP+AS reduced the rates of all-cause clinic visits and anemia during a three-year implementation.

IntroductionSeasonal malaria chemoprevention (SMC), with sulphadoxine–pyrimethamine plus amodiaquine (SP+AQ) is effective but does not provide complete protection against clinical malaria. The RTS,S/AS01Emalaria vaccine provides a high level of protection shortly after vaccination, but this wanes rapidly. Such a vaccine could be an alternative or additive to SMC. This trial aims to determine whether seasonal vaccination with RTS,S/AS01Evaccine could be an alternative to SMC and whether a combination of the two interventions would provide added benefits.Methods and analysisThis is an individually randomised, double-blind, placebo-controlled trial. 5920 children aged 5–17 months were enrolled in April 2017 in Mali and Burkina Faso. Children in group 1 received three priming doses of RTS,S/AS01Evaccine before the start of the 2017 malaria transmission season and a booster dose at the beginning of two subsequent transmission seasons. In addition, they received SMC SP+AQ placebo on four occasions each year. Children in group 2 received three doses of rabies vaccine in year 1 and hepatitis A vaccine in years 2 and 3 together with four cycles of SMC SP+AQ each year. Children in group 3 received RTS,S/AS01Evaccine and four courses of SMC SP+AQ. Incidence of clinical malaria is determined by case detection at health facilities. Weekly active surveillance for malaria is undertaken in a randomly selected subset of children. The prevalence of malaria is measured in surveys at the end of each transmission season. The primary endpoint is the incidence of clinical malaria confirmed by a positive blood film with a minimum parasite density of 5000 /µL. Primary analysis will be by modified intention to treat defined as children who have received the first dose of the malaria or control vaccine.Ethics and disseminationThe protocol was approved by the national ethics committees of Mali and Burkina Faso and the London School of Hygiene and Tropical Medicine. The results will be presented to all stakeholders and published in open access journals.Trial registration numberNCT03143218

Summary Background Artemether–lumefantrine and artesunate–amodiaquine are used as first-line artemisinin-based combination therapies (ACTs) in west Africa. Pyronaridine–artesunate and dihydroartemisinin–piperaquine are potentially useful for diversification of ACTs in this region, but further safety and efficacy data are required on malaria retreatment. Methods We did a randomised, multicentre, open-label, longitudinal, controlled phase 3b/4 clinical trial at seven tertiary centres in Burkina Faso, Guinea, and Mali. Eligible participants for first malaria episode and all retreatment episodes were adults and children aged 6 months and older with microscopically confirmed Plasmodium spp malaria (>0 to

BackgroundWHO recommended seasonal malaria chemoprevention (SMC) in 2012 for Sahel countries in Africa with the aim to reduce malaria among children under 5 years old by using sulphadoxine-pyrimethamine and amodiaquine (SP+AQ). This strategy was scaled up in Mali from 2012. The use of millions of doses of SP+AQ could generate potential Plasmodium falciparum resistance in mutant parasites. The aim of this study was to monitor the prevalence of Pfdhfr +Pfdhps+pfcrt +pfmdr1 mutations in parasites infecting the target population.MethodsTwo cross-sectional surveys were conducted before (August 2012, n=662) and after (June 2014, n=670) a pilot implementation of SMC in the health district of Koutiala. Children aged 3–59 months received 3 and 4 rounds of curative doses of SP+AQ over two malaria seasons in 2012 and 2013, respectively. Genotypes of P. falciparum Pfdhfr codons 51, 59, 108 and 164; Pfdhps codons 437 and 540, Pfcrt codon 76 and Pfmdr1 codon 86 were analysed by PCR on DNA of parasites from SMC population blood samples (after and before) and non-SMC patients aged 7 years or above (November 2014, n=500).ResultsIn the SMC population 191 and 85 children before and after SMC implementation, respectively, were included in’the molecular analysis. In the non-SMC patients, 220 were’successfully PCR analysed. In the SMC population, the’prevalence of the six-mutation Pfcrt [Pfdhfr-dhps quintuple +Pfcrt-76T] genotype increased significantly after SMC implementation, from 0.0% to 7.1% (p=0.0008). The post-intervention prevalence of the six-mutation Pfmdr1 [Pfdhfr-dhps quintuple +Pfmdr1–86Y] and the seven-mutation Pfcrt +Pfmdr1 [Pfdhfr-dhps quintuple +Pfmdr1–86Y+Pfcrt-76T] genotypes were both 1.2% among the SMC population. No six-mutation and seven-mutation genotypes were observed among SMC population at baseline nor in the non-SMC patient population (p=0.30).ConclusionSMC increased the prevalence of the six-mutation Pfcrt genotype of P. falciparum that can lead to resistance in a population exposed to SMC with SP+AQ.

Background Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP)+amodiaquine (AQ) is being scaled up in countries of the Sahel in West Africa. However, the potential development of Plasmodium falciparum resistance to the respective component drugs is a major concern. Methods Two cross-sectional surveys were conducted before (August 2012) and after (June 2014) a pilot implementation of SMC in Koutiala, Mali. Children aged 3–59 months received 7 rounds of curative doses of SP+AQ over two malaria seasons. Genotypes of P. falciparum dhfr codons 51, 59 and 108; dhps codons 437 and 540, pfcrt codon 76 and pfmdr1codon 86 were analysed by PCR on DNA from samples collected before and after SMC, and in non-SMC controls. Results In the SMC population 191/662 (28.9%) and 85/670 (13.7%) of children were P. falciparum- positive by microscopy and were included in the molecular analysis before (2012) and after SMC implementation (2014), respectively. In the control population 220/310 (71%) were successfully PCR analysed. In the SMC children the prevalence of all molecular markers of SP resistance increased significantly after SMC including the dhfr-dhps quintuple mutant genotype, which was 1.6% before but 7.1% after SMC (p=0.02). The prevalence of Pfmdr1–86Y significantly decreased from 26.7% to 15.3% (p=0.04) while no significant change was seen for pfcrt K76T. In 2014, prevalence of all molecular markers of SP resistance were significantly higher among SMC children compared to the non-SMC control population (p Conclusions SMC increased the prevalence of molecular markers of P. falciparum resistance to SP in the treated children. However, there was no significant flow of these resistance genes into the general parasite population after 2 years and 7 rounds of SMC.

Background Seasonal malaria chemoprevention (SMC) with sulphadoxine-pyrimethamine (SP) plus amodiaquine (AQ) is being scaled up in Sahelian countries of West Africa. However, the potential development of Plasmodium falciparum resistance to the respective component drugs is a major concern. Methods Two cross-sectional surveys were conducted before (August 2012) and after (June 2014) a pilot implementation of SMC in Koutiala, Mali. Children aged 3–59 months received 7 rounds of curative doses of SP plus AQ over two malaria seasons. Genotypes of P. falciparum Pfdhfr codons 51, 59 and 108; Pfdhps codons 437 and 540, Pfcrt codon 76 and Pfmdr1codon 86 were analyzed by PCR on DNA from samples collected before and after SMC, and in non-SMC patient population as controls (November 2014). Results In the SMC population 191/662 (28.9%) and 85/670 (12.7%) of children were P. falciparum positive by microscopy and were included in the molecular analysis before (2012) and after SMC implementation (2014), respectively. In the non-SMC patient population 220/310 (71%) were successfully PCR analyzed. In the SMC children, the prevalence of all molecular markers of SP resistance increased significantly after SMC including the Pfdhfr-dhps quintuple mutant genotype, which was 1.6% before but 7.1% after SMC (p = 0.02). The prevalence of Pfmdr1-86Y significantly decreased from 26.7% to 15.3% (p = 0.04) while no significant change was seen for Pfcrt 76T. In 2014, prevalence of all molecular markers of SP resistance were significantly higher among SMC children compared to the non-SMC population patient (p < 0.01). No Pfdhfr-164 mutation was found neither at baseline nor post SMC. Conclusion SMC increased the prevalence of molecular markers of P. falciparum resistance to SP in the treated children. However, there was no significant increase of these markers of resistance in the general parasite population after 2 years and 7 rounds of SMC.

The study of the risk of the bovine trypanosomiasis in the area of framing of the PROGEBE aims to measure the impact of the exchange of the medium occurred on the various risk factors. That investigation for parasitology and entomological survey year was carried out between November 2011 and January 2012. On the whole blood samples taken, 956 were examined for the search for trypanosomes by using the technique of the buffy coat. In 29 animals that appeared very infected, 27.5% T. congolense stalemate, 72.5% by T. vivax; That is to say a total average prevalence of 2.82% was the most important observed prevalence on the websites of: 15 Tousseguela box (prevalence=6.78%) and Manankoro, 11 cases (prevalence=4.07%). Three positive cells were recorded on the website of Madina Diassa (prevalence=1.16%). On the other hand in Sagabary, no case of infection to the trypanosomes was observed. One with 70 points and prospective buyers APPROBATION risk, 30 are positive with the flies. The most infested websites are: Sagabary 14.75 flies/trap/day and 6.4 Tousseguela flies/trap/day. Two species of tsetse were captured: Glossina palapalis gambiensis on 4 sites and Glossina tachinoides only on the websites of Manankoro Diassa and Madina.

The prevalence of trypanosomiasis in cattle was estimated on farms circle Kadiolo between July and August 2009. This study was consecutive to complaints agro-pastoralists in the area due to heavy mortalities recorded in cattle in general and in particular oxen. Blood samples from 473 cattle of all ages, sexes were collected in 15 villages identified by the local technical support (state and private) and by associations of agro pastoralists in the area; examined for trypanosomes using Buffy Coat technique. A total of 146 cattle (30.86 to 100) were found infected with trypanosomes: 14 (9.58 to 100) with Trypanosoma vivax, 131 (89.72 to 100) with T. congolense and 1 (0.68 to 100) with T. brucei. This study showed that trypanosomiasis was the leading cause of death oxen in the circle Kadiolo.

Proposed space missions will require large scale, light weight, space based structural systems. Large space structure technology (LSST) systems will have to accommodate (among others): ocean data systems; electronic mail systems; large multibeam antenna systems; and, space based solar power systems. The structures are to be delivered into orbit by the Space Shuttle. Because of their inherent size, modelling techniques and scaling algorithms must be developed so that system performance can be predicted accurately prior to launch and assembly. When the size and weight-to-area ratio of proposed LSST systems dictate that the entire system be considered flexible, there are two basic modelling methods which can be used. The first is a continuum approach, a mathematical formulation for predicting the motion of a general orbiting flexible body, in which elastic deformations are considered small compared with characteristic body dimensions. This approach is based on an a priori knowledge of the frequencies and shape functions of all modes included within the system model. Alternatively, finite element techniques can be used to model the entire structure as a system of lumped masses connected by a series of (restoring) springs and possibly dampers. In addition, a computational algorithm was developed to evaluate the coefficients of the various coupling terms in the equations of motion as applied to the finite element model of the Hoop/Column.

Serological surveys are essential to quantify immunity in a population but serological cross-reactivity often impairs estimates of the seroprevalence. Here, we show that modeling helps addressing this key challenge by considering the important cross-reactivity between Chikungunya (CHIKV) and O’nyong-nyong virus (ONNV) as a case study. We develop a statistical model to assess the epidemiology of these viruses in Mali. We additionally calibrate the model with paired virus neutralization titers in the French West Indies, a region with known CHIKV circulation but no ONNV. In Mali, the model estimate of ONNV and CHIKV prevalence is 30% and 13%, respectively, versus 27% and 2% in non-adjusted estimates. While a CHIKV infection induces an ONNV response in 80% of cases, an ONNV infection leads to a cross-reactive CHIKV response in only 22% of cases. Our study shows the importance of conducting serological assays on multiple cross-reactive pathogens to estimate levels of virus circulation., O’nyong nyong and Chikungunya virus are arboviruses present in Africa but their prevalence is unknown, partly due to high antibody cross-reactivity with one another. Here, the authors develop a statistical model that accounts for cross-reactivity to characterise circulation of both viruses from seroprevalence surveys.