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Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As the Universal Health Insurance Plan (RAMU) is gradually being implemented in Mali, community-based health insurance (CBHI) -considered one of the pillars of this programme- must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale than before, moving from municipalities to circles (departments). A mixed-method study was carried out in the Mopti region to assess the acceptability of this innovation among CBHI elected representatives. In April 2021, 118 questionnaires were administered to CBHI elected representatives, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon et al. (2017) developed an approach outlining seven dimensions of acceptability (attitude, burden, values, coherence, opportunity costs, perceived efficiency, and personal effectiveness), which was used as a conceptual model for data analysis. The results obtained by factor analysis indicate that more than half of individuals (58%) reported above-average acceptability. Elected representatives feel well supported in their activities by the Technical Union of Malian Mutuality (TUM), the umbrella organisation of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected representatives note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. The new CBHI is highly advantageous for the population in terms of content, financial, and geographical access. Professionalisation is an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected representatives are concerned about the sustainability of this CBHI and rely on the State and its partners to assume responsibility. The TUM will play an essential role in continuing its support and fulfiling its functions as a delegated management organisation within the framework of the RAMU., (© 2024 The Author(s). The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Background: In Burkina Faso, only 70% of people living with HIV knew their status in 2018, while the first 95 target of the UNAIDS suggests that by 2025 at least 95% of people living with HIV (PLHIV) know their HIV status. Female sex workers (FSW) are one of the most HIV-vulnerable groups, making it crucial to estimate the rate and associated factors of HIV testing among FSW., Methods: We conducted a cross-sectional study focused on FSW in five main cities of Burkina Faso (Ouagadougou, Bobo-Dioulasso, Koudougou, Tenkodogo, and Ouahigouya). A respondent-driven sampling (RDS) approach was used to recruit participants. Data were collected through in-person interviews between June and August 2022. The HIV testing rate in the past twelve months was examined by sociodemographic characteristics and risky behaviors. A modified Poisson regression in a generalized estimating equation with an exchangeable correlation structure was used to explore the associated factors of HIV testing., Results: Of 1338 FSW (average age: 27.6 ± 7.25 years) HIV negative, 57.8% (95% CI: 54.2-61.3) reported having been tested for HIV in the last 12 months. Among those who started sex work before the age of 18, 48.0% (95% CI: 39.1-57.1) reported having been tested for HIV in the last 12 months. The HIV testing rate among FSWs within the last 12 months was independently associated with age, education level, and being member of an FSW supportive association. Indeed, FSW aged 25 years and more had a 14% higher rate of being tested for HIV within 12 months compared to those 15 to 24 years old (adjusted prevalence ratio (aPR): 1.14 [95%CI: 1.05-1.24]). The HIV testing rate among those who are not members of an FSW supportive association was 16% lower (aPR: 0.84 [95%CI: 0.72-0.97]) than those who are members of FSW supportive associations., Conclusion: The HIV testing rate among FSW is low in Burkina Faso, suggesting an important challenge to reach the first 95% target of UNAIDS among FSW. Innovative diagnostic strategies for the early identification of HIV-infected FSW are essential to achieve the first 95 target by 2025 in Burkina Faso., (© 2024. The Author(s).)

Adapting organic farming to climate change is a major issue. Cotton yields in Mali are declining due to deteriorating climatic conditions, soil fertility, and poor management. This study aimed to improve organic cotton yield in Mali in the future climate with the optimal choice of compost type, date, and dose of application. Experimental data collected in 2021 from the Sotuba research station in Mali was used for calibration and evaluation of the crop model DSSAT CSM-CROPGRO-Cotton model using phenology, leaf area index, and seed cotton yield. Climate data from the RCP4.5 and RCP8.5 scenarios of the GFDL-ESM2M model were used for future weather datasets for 2020-2039, 2040-2059, and 2060-2079. The model was able to simulate anthesis and maturity with excellent results, with nRMSE < 4%, and seed cotton yields moderately well, an nRMSE of 26% during calibration and 20.3% in evaluation. The scenario RCP8.5 from 2060 to 2079 gave the best seed cotton yields. Seed cotton yields with RCP4.5 and RCP8.5 were all better with the mid-May application period of small ruminant silo compost at 7.5 t/ha. In such conditions, more than 75% of the cases would produce more than 2000 kg/ha of seed cotton., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dembélé et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The impact of lower thresholds for elevated blood pressure (BP) on adverse perinatal outcomes has been poorly explored in sub-Saharan African populations. We aimed to explore the association between lower BP cutoffs (according to the 2017 American College of Cardiology/American Heart Association [ACC/AHA] criteria) and adverse perinatal outcomes in Kaya, Burkina Faso., Methods: This retrospective cohort study included 2,232 women with singleton pregnancies between February and September 2021. BP was categorized according to the ACC/AHA criteria and applied throughout pregnancy. A multivariable Poisson regression model based on Generalized Estimating Equation with robust standard errors was used to evaluate the association between elevated BP, stage 1 hypertension, and adverse perinatal outcomes, controlling for maternal sociodemographic characteristics, parity, and the number of antenatal consultations, and the results were presented as adjusted risk ratios (aRRs) with corresponding 95% confidence intervals (CIs)., Results: Of the 2,232 women, 1000 (44.8%) were normotensive, 334 (14.9%) had elevated BP, 759 (34.0%) had stage 1 hypertension, and 139 (6.2%) had stage 2 hypertension. There was no significant association between elevated BP and adverse pregnancy outcomes. Compared to normotensive women, women with elevated BP had a 2.05-fold increased risk of delivery via caesarean section (aRR;2.05, 95%CI; 1.08-3.92), while those with stage 1 hypertension had a 1.41-fold increased risk of having low birth weight babies (aRR; 1.41, 95%CI; 1.06-1.86), and a 1.32-fold increased risk of having any maternal or neonatal adverse outcome (aRR; 1.32, 95%CI; 1.02-1.69)., Conclusions: Our results suggest that the risk of adverse pregnancy outcomes is not increased with elevated BP. Proactive identification of pregnant women with stage 1 hypertension in Burkina Faso can improve hypertension management through enhanced clinical surveillance., (© 2023. The Author(s).)

Ubiquitous use of plasticizers has led to a widespread internal exposure of the European population. Until today, metabolites are detected in almost every urine sample analysed. This raised the urgent need for a toxicological interpretation of the internal exposure levels. The European Human Biomonitoring Initiative (HBM4EU) contributes substantially to the knowledge on the actual exposure of European citizens to chemicals prioritised within HBM4EU, on their potential impact on health and on the interpretation of these data to improve policy making. On that account, human biomonitoring guidance values (HBM-GVs) are derived for the general population and the occupationally exposed population agreed at HBM4EU consortium level. These values can be used to assess phthalate exposure levels measured in HBM studies in a health risk assessment context. HBM-GVs were derived for five phthalates (DEHP, DnBP, DiBP, BBzP and DPHP) and for the non-phthalate substitute Hexamoll® DINCH. For the adult general population, the HBM-GVs for the specific metabolite(s) of the respective parent compounds in urine are the following: 0.5 mg/L for the sum of 5-oxo-MEHP and 5-OH-MEHP; 0.19 mg/L for MnBP, 0.23 mg/L for MiBP; 3 mg/L for MBzP; 0.5 mg/L for the sum of oxo-MPHP and OH-MPHP and 4.5 mg/L for the sum of OH-MINCH and cx-MINCH. The present paper further specifies HBM-GVs for children and for workers., (Copyright © 2021 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

The European Joint Program "HBM4EU" is a joint effort of 30 countries and the European Environment Agency, co-funded under the European Commission's Horizon 2020 program, for advancing and implementing human biomonitoring (HBM) on a European scale and for providing scientific evidence for chemical policy making. One important outcome will be a Europe-wide improvement and harmonization of health risk assessment following the coordinated derivation or update of health-related guidance values referring to the internal body burden. These guidance values - named HBM guidance values or HBM-GVs - can directly be compared with HBM data. They are derived within HBM4EU for priority substances identified by the HBM4EU chemicals prioritization strategy based on existing needs to answer policy relevant questions as raised by national and EU policy makers. HBM-GVs refer to both the general population and occupationally exposed adults. Reports including the detailed reasoning for the values' proposals are subjected to a consultation process within all partner countries of the consortium to reach a broad scientific consensus on the derivation approach and on the derived values. The final HBM-GVs should be applied first within the HBM4EU project, but may also be useful for regulators and risk assessors outside this project. The subsequent adoption of derived HBM-GVs at EU-level needs to be discussed and decided within the responsible EU bodies. Nevertheless, the establishment of HBM-GVs as part of HBM4EU is already a step forward in strengthening HBM-based policy efforts for public and occupational health. The strategy for deriving HBM-GVs which is based on already existing approaches from the German HBM Commission, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) as well as from the US-based scientific consultant Summit Toxicology, the allocation of a level of confidence to the derived values, and the consultation process within the project are comprehensively described to enlighten the work accomplished under the HBM4EU initiative., (Copyright © 2020 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

Background: Post-partum family planning services can prevent maternal and child morbidity and mortality in low-resource settings. We assessed the effect of a family planning intervention package on modern contraceptive use at 12 months post partum in predominantly rural Burkina Faso., Methods: Yam Daabo was a two group, multi-intervention, single-blinded, cluster randomised controlled trial. Primary health-care centres were randomly allocated to intervention or control clusters in a 1:1 ratio with only data analysts masked to the allocation assignment. Interventions comprised refresher training for the provider, a counselling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. The primary outcome was modern contraceptive prevalence at 12 months, and secondary outcomes were modern contraceptive prevalence at 6 weeks and 6 months post partum. Analysis was by modified intention to treat. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334)., Findings: From July 27-Oct 17, 2016, eight clinics were randomised and 571 women were enrolled and allocated: 286 to four intervention clusters and 285 to four control clusters. Of these, 523 completed the 12-month study exit interview (260 in the intervention group, 263 in the control group) and 523 were included in the intention-to-treat analysis. At 12 months, modern contraceptive prevalence was 55% among women who received the package and 29% among those who received routine care in control clusters (adjusted prevalence ratio 1·79, 95% CI 1·30-2·47). Significant differences in modern contraceptive prevalence were also seen between intervention and control groups at 6 weeks (42% and 10%, respectively; adjusted prevalence ratio 3·88, 95% CI 1·46-10·35) and 6 months (59% and 24%, respectively; 2·31, 1·44-3·71)., Interpretation: A package of six low-technology interventions, aimed at strengthening existing primary health-care services and enhancing demand for these services, can effectively increase modern contraceptive use for up to a year post partum in rural settings in Burkina Faso and has the potential to be suitable in similar settings in this country and others., Funding: Government of France., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Current tools and strategies are not sufficient to reliably address threats and outbreaks of arboviruses including Zika, dengue, chikungunya, and yellow fever. Hence there is a growing public health challenge to identify the best new control tools to use against the vector Aedes aegypti. In this study, we investigated Ae. aegypti sugar feeding strategies in Bamako, Mali, to determine if this species can be controlled effectively using attractive toxic sugar baits (ATSB)., Methodology: We determined the relative attraction of Ae. aegypti males and females to a variety of sugar sources including flowers, fruits, seedpods, and honeydew in the laboratory and using plant-baited traps in the field. Next, we observed the rhythm of blood feeding versus sugar feeding activity of Ae. aegypti in vegetation and in open areas. Finally, we studied the effectiveness of spraying vegetation with ATSB on Ae. aegypti in sugar rich (lush vegetation) and in sugar poor (sparse vegetation) urban environments., Principal Findings: Male and female laboratory sugar feeding rates within 24 h, on 8 of 16 plants offered were over 80%. The survival rates of mosquitoes on several plant sources were nearly as long as that of controls maintained on sucrose solution. In the field, females were highly attracted to 11 of 20 sugar sources, and 8 of these were attractive to males. Peak periods of host attraction for blood-feeding and sugar feeding in open areas were nearly identical and occurred shortly after sunrise and around sunset. In shaded areas, the first sugar-seeking peak occurred between 11:30 and 12:30 while the second was from 16:30 to 17:30. In a 50-day field trial, ATSB significantly reduced mean numbers of landing / biting female Ae. aegypti in the two types of vegetation. At sugar poor sites, the mean pre-treatment catch of 20.51 females on day 14 was reduced 70-fold to 0.29 on day 50. At sugar rich sites, the mean pre-treatment catch of 32.46 females on day 14 was reduced 10-fold to a mean of 3.20 females on day 50., Conclusions: This is the first study to show how the vector Ae. aegypti depends on environmental resources of sugar for feeding and survival. The demonstration that Ae. aegypti populations rapidly collapsed after ATSB treatment, in both sugar rich and sugar poor environments, is strong evidence that Ae. aegypti is sugar-feeding frequently. Indeed, this study clearly demonstrates that Ae. aegypti mosquitoes depend on natural sugar resources, and a promising new method for vector control, ATSB, can be highly effective in the fight against Aedes-transmitted diseases., Competing Interests: The authors have declared that no competing interests exist.

Background: A neglected aspect of alien invasive plant species is their influence on mosquito vector ecology and malaria transmission. Invasive plants that are highly attractive to Anopheles mosquitoes provide them with sugar that is critical to their survival. The effect on Anopheles mosquito populations was examined through a habitat manipulation experiment that removed the flowering branches of highly attractive Prosopis juliflora from selected villages in Mali, West Africa., Methods: Nine villages in the Bandiagara district of Mali were selected, six with flowering Prosopis juliflora, and three without. CDC-UV light traps were used to monitor their Anopheles spp. vector populations, and recorded their species composition, population size, age structure, and sugar feeding status. After 8 days, all of the flowering branches were removed from three villages and trap catches were analysed again., Results: Villages where flowering branches of the invasive shrub Prosopis juliflora were removed experienced a threefold drop in the older more dangerous Anopheles females. Population density dropped by 69.4% and the species composition shifted from being a mix of three species of the Anopheles gambiae complex to one dominated by Anopheles coluzzii. The proportion of sugar fed females dropped from 73 to 15% and males from 77 to 10%., Conclusions: This study demonstrates how an invasive plant shrub promotes the malaria parasite transmission capacity of African malaria vector mosquitoes. Proper management of invasive plants could potentially reduce mosquito populations and malaria transmission.

In the acute phase of noma, the role of surgery is minor and the treatment consists in the realisation of local or regional flaps and sometimes the management of haemorragia. For reasons social and economic reconstruction of the loss of substance should be conducted on site. The treatment consists of surgical excision of fibrous tissue, the removal of the ankylosis and the closure of the PDS by local flaps, or free pediculated. Because of the extreme variety of loss of substance (PDS) and the multiple surgical options, a systematic and eventually, the standardization of the surgical approach in the treatment of sequelae of noma is essential., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: To determine the incidence of postoperative peritonitis, and describe their clinical, paraclinical and therapeutic aspects., Patients and Methods: This was a retrospective study conducted between 1980 and 2010 in the Department of Surgery B of the Point G University Hospital. It focused on all patients who underwent surgical intra-abdominal in the Surgery B department., Results: We collected 25 cases of postoperative peritonitis, 84% were male subjects. The average age of patients was 37.2 years ± 17.0. The clinical picture was dominated by abdominal pain (92%), abdominal defense (92%), and fever (84%). Abdominal ultrasound played an important role in diagnosing 72% of cases. Etiologies were dominated by anastomotic leak (32%), infection of the collection phrenic, iatrogenic perforation (28%). Interventions made at surgery were: suture of the perforation or anastomotic recovery plus peritoneal cleansing and drainage in 36% of cases, peritoneal cleansing and drainage in 36%. There were postoperative complications in five patients. The mortality rate was 4%., Conclusion: Postoperative peritonitis are rare in our service. When they occur their rate of morbidity and mortality are high., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: The objective of this study was to determine the frequency of peritonitis by typhoid ileal perforation in the teaching hospitals of Bamako and Kati., Patients and Methods: We conducted a retrospective study over a 24 years period (1984-2007). Every patient admitted and operated in urgency for peritonitis by ileal perforation were listed and included in this study., Results: During the study period, 1868 acute peritonitis were operated on in the three major health centres of Bamako and Kati. We collected data concerning 543 typhoid ileal perforations which represented 29.0% of all peritonitis. The peritonitis by typhoid perforation constituted 28.5% of the peritonitis in the teaching hospital of the Point G, 30.6% in the Gabriel Touré teaching hospital and 6.4% in the teaching hospital of Kati. Among the peritonitis by typhoid perforation, 56.7% were listed in the Point G teaching hospital, 43.0% in the Gabriel Torre teaching hospital and 0.3% in the Kati teaching hospital. Between 1984-2004 we collected data from two hundred and fifty seven (257) patients suffering from peritonitis by typhoid ileal perforation, a total of 24.4% of the peritonitis recorded. Between 2005-2007, the data for two hundred eighty six (286) patients suffering from peritonitis by typhoid ileal perforation was collected, a total of 35% of the peritonitis recorded. The typhoid ileum perforation remains the 2nd overall cause of generalized peritonitis after that of appendicular origin., Conclusion: Peritonitis by typhoid ileum perforation has seen a significant increase from 2004 in the teaching hospitals of Bamako and Kati., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

The purpose of this study was to describe the common mesentery in its occlusive form and practice driving before this emergency. The mesentery is a common abnormality of rotation of the primitive intestinal loop or omphalomesenteric loop during embryonic development., Two cases of intestinal obstruction by strangulation were received in urgency. They were a 55 year old man who checked himself into the emergency department and a 14 year old girl brought in by her parents. These were 2 cases of acute intestinal obstruction on incomplete common mesentery. The intestine was turned to complete common mesentery in both cases. Embryologically, it is anomalies of rotation and joining of the primitive intestine that are causing the incomplete common mesentery , the source of acute intestinal obstruction due to strangulation., Conclusion: The common mesentery poses a diagnostic and therapeutic problem. Its symptomatology is that of occlusion by strangulation and the surgeon must note this before any obstruction., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: To study the therapeutic aspects and prognosis of volvulus of the sigmoid colon in surgical departments., Patients and Methods: Our study was retrospective from January 2000 to December 2009 (10 years). All patients who underwent sigmoid volvulus in the Point G teaching hospital surgical departments were taken into account., Results: We recorded 96 patients operated for volvulus of sigmoid over 882 cases of bowel obstruction, a rate of 10.9%. The average age was 47.2 years ± 18.9. In per-operative, there was a necrosis of the colon rate of 16.7% (14 cases). Performed surgical treatment modalities were: sigmoidectomy with primary anastomosis in 29.2% of cases (28), sigmoidectomy followed by colostomy and secondary anastomosis in 60.4% of patients (58) and 10.4% rare of simple devolvulation. The immediate postoperative period were marked by a morbidity rate of 7.3% (7 cases) and a mortality rate of 7.3% (7 cases)., Conclusion: In spite of various therapeutic modalities of volvulus of the sigmoid colon, the rates of postoperative morbidity and mortality are rising in the general surgery of the Point G teaching Hospital., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: To evaluate the management of postoperative pain in the Point G teaching hospital., Patients and Methods: We carried out a prospective study, in 2008. Inclusion criteria for the personnel: be a staff member from the department of surgery or anaesthesia reanimation; willing to fill out the questionnaire. Inclusion criteria for patients: to be operated and hospitalized in one of the departments of surgery and anaesthesia reanimation., Results: We collated the responses of 600 patients and 113 personnel. 92% of the patients underwent post-operative analgesia. The delay between the request and treatment of the patient was extensive in 92% of cases. The medical personnel and nursing staff had not received specific training on treating the pain in respectively 55% and 70% of cases. We noted an absence of informational support and of pre-established consensual protocols, written and validated on the management of postoperative pains., Conclusion: The treatment of the postoperative pains shows important shortcomings within the Point G teaching hospital and these insufficiencies are found across levels., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Unlabelled: The purpose of this work was to determine the size of the bile duct by echograph. The frequent injuries of the bile duct in various pathologies in particular infection, made of it a very investigated organ especially by echograph. Its size can be modified by various pathologies. So it is of interest to know about its normal size., Patients and Method: Sixty normal subjects, among which 29 women, were examined by echograph in the university hospital of the Point G. They were voluntary subjects with an empty stomach for 12 hours. Three different sonographers successively performed this examination according to the same protocol with an Aloka SSD 1700 device type and a Kontron Medical/Imagic Maestro. These devices were provided with a convex probe of 3.5-megahertz multifrequency and with a linear probe of 7.5-megahertz. The subjects were in dorsal position. Reference points for the display of the bile duct were the liver, the gallbladder and the pancreas. The limits of the bile duct were marked by the cursor of the echograph. The transverse diameter (in mm) of the bile duct was measured in its origin and in its ending. No subject of the sample was obese enough to hamper the visibility of the gall-bladder and the bile duct and no subject had histories of cholecystectomy. Data analysis was made using the software Ear information version 6. The difference between variables was considered as significant when P<0,05., Results: Forty subjects out of 60 were between 20 and 39 years old. The transverse diameter of the bile duct was measured 38 times (63.3%) in its origin and 50 times (83.3%) in its ending. The failure of visibility of the proximal segment was 37.7% and the failure of visibility of the distal segment of the bile duct was 17.7%. The average transverse diameter of the bile duct in its origin was 2.61.4 mm; extremes were 2 and 5 mm. The average transverse diameter of the bile duct in its ending was 3.10.7 mm; extremes were 2 and 5 mm. The transverse diameter of the bile duct in its origin of the subjects was contained between 3 and 4 mm in 80% of the cases. The transverse diameter of the bile duct in its ending of the subjects was contained between 3 and 4 mm in 40% of the cases. The difference was very significant between the diameter of the bile duct in its origin and in its ending (P<10(-6))., Conclusion: The distal segment of the bile duct was seen more accurately than the proximal segment by echograph. The diameter of the bile duct in its ending was significantly superior to that of the bile duct in its origin., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: In 1986, the Government of Mali launched its Expanded Program on Immunization (EPI) with the goal of vaccinating, within five years, 80% of all children under the age of five against six target diseases: diphtheria, tetanus, pertussis, poliomyelitis, tuberculosis, and measles. The Demographic and Health Survey carried out in 2001 revealed that, in Kita Circle, in the Kayes region, only 13% of children aged 12 to 23 months had received all the EPI vaccinations. A priority program was implemented in 2003 by the Regional Health Department in Kayes to improve EPI immunization coverage in this area., Methods: A cross-sectional survey using Henderson's method (following the method used by the Demographic and Health Surveys) was carried out in July 2006 to determine the level of vaccination coverage among children aged 12 to 23 months in Kita Circle, after implementation of the priority program. Both vaccination cards and mothers' declarations (in cases where the mother cannot make the declaration, it is made by the person responsible for the child) were used to determine coverage., Results: According to the vaccination cards, 59.9% [CI 95% (54.7-64.8)] of the children were fully vaccinated, while according to the mothers' declarations the rate was 74.1% [CI 95% (69.3-78.4)]. The drop-out rate between DTCP1 and DTCP3 was 5.5%, according to the vaccination cards. The rate of immunization coverage was higher among children whose mothers had received the anti-tetanus vaccine [OR = 2.1, CI 95% (1.44-3.28)]. However, our study found no difference associated with parents' knowledge about EPI diseases, distance from the health centre, or socio-economic status. Lack of information was one reason given for children not being vaccinated against the six EPI diseases., Conclusion: Three years after the implementation of the priority program (which included decentralization, the active search for missing children, and deployment of health personnel, material and financial resources), our evaluation of the vaccination coverage rates shows that there is improvement in the EPI immunization coverage rate in Kita Circle. The design of our study did not, however, enable us to determine the extent to which different aspects of the program contributed to this increase in coverage. Efforts should nevertheless be continued, in order to reach the goal of 80% immunization coverage. ABSTRACT IN FRENCH: See the full article online for a translation of this abstract in French.

Nosocomial infections are a common and increasing problem globally, and particularly in Africa. The significant economic burden of these infections on the health care system as well as their impact on patient morbidity and mortality is well recognised within the medical communities.The goal of this study was to investigate factors that influence nosocomial infection in all in-patients from the surgery wards (surgery ward A and B, Gynoeco-obstetrics, urology and intensive care) at the national hospital of Point G in Bamako, Mali. We report the number of nosocomial infection during a prospective study between June 2003 and January 2004. Of 1043 in-patients, 102 had had a nosocomial infection with a global prevalence of 9.7% (8.0-11.4). Of 1024 patients with surgery, 101 had had a nosocomial infection, a post-surgery nosocomial infection rate of 9.8% (8.1-11.5). We observed different site of nosocomial infection such as suppuration sup-aponevrotics (41.2%), parietal infection sub-aponevrotics (32.4%), urinary infection (17.6%) and organ suppuration (3.9%). Other nosocomial infection observed were pneumonia (2.9%) and catheterisation (2.0%). The nosocomial infection rate was 10.3% in male while it was 7.3% in female. The difference between male and female was not statistically significative (chi2 = 2.33, p = 0.12). Nosocomial infection was more prevalent in patients after emergency surgery (15.1%) than in scheduled surgery patients (8.5%) (chi2 = 8.15, p = 0.004). The classes III and IV of ALTEMEIER had the higher proportion of nosocomial infection (35.9%) against 4.8% for the classes I and II (chi2 = 144.95, p < 0.001). The patients with ASA score I had a lower nosocomial infection rate than patients from the intensive care unit or patients of Class II + III + IV (chi2 = 13.2, p = 0.001). Patients classified according to the National Nosocomial Infection Surveillance System (NNISS) with a score 0 had a nosocomial infection rate less than patients classified as NNISS score 1, 2 or 3 (chi2 = 82.0, p < 0.001). The study results underline the need for further investigations of the role of microbial agents and antimicrobial resistance in the outcome of patients with nosocomial infection.

This study describes epidemiologic, etiologic and evaluative aspects of Pleurisy pneumology department of Point "G". From 1st January 1998 to 31 December 2002 was realised a study about hospitalized patients in the department. Pleurisy represented 15; 9% of hospitalizations. The sex Ratio was 2,3 en for men aged of 41 years 55 of pleurisy were located on right. In 60% of cases the liquid was sero-fibrin, purulent in 25% of cases and haemorrhagic in 15%. Tuberculosis was the most frequent etiology with 37% of cases. According to liquid aspect tuberculosis represented 54, 3% of sero-fibrin pleurisy in one hand, on the other 60% of haemorrhagic pleurisy was due to cancer. The serology HIV have been realised on 89 patients and it was positive on 56% of cases. Association pleurisy/HIV tuberculosis etiology represented 56% of cases. Among 369 patients we have counted 100 deaths, 27% and 86% of these death occurred before a month of hospitalization. Even if the prevalence of neoplastic pleurisy increases, tuberculosis still the 1st etiology of pleurisy. It co-infection with HIV is the principal cause of morbidity and mortality.