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Introduction Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa. Aim We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali. Methods This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019. Results The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35-50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60-276) and median extubation time was three hours (0-96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%. Conclusions Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l'Espoir.

Objectif : L’objectif était d’apporter une mise à jour des données épidémiologiques, évaluer la prise en charge de ces envenimations et faire ressortir les facteurs pronostiques de ces affections dans notre contexte. Patients et Méthodes : Il s’agissait d’une étude prospective transversale allant du 01 Février 2019 au 31 Janvier 2020, ont été inclus à l’étude tous patients admis au service d’accueil des urgences du CHU Gabriel TOURE de Bamako pour envenimation par morsure de serpent. Les caractéristiques démographiques, cliniques, paracliniques, thérapeutiques ont été relevées sur une fiche d’exploitation préalablement établie. Les données ont été saisies sur WORD 2013 et analysées sur SPSS 21. Résultats : 126 cas d’envenimations ont été inclus à l’étude. L’âge moyen des patients était de 25 ans ; le sexe masculin représentait 63,5% des cas. La période hivernale était la période de prédilection des morsures. Le délai de consultation était > 72H dans 40,5%. Un syndrome hémorragique était présent dans 77% des cas. L’hémopéritoine de grande abondance, l’hémorragie intracrânienne, les fausses couches et l’insuffisance rénale étaient les principales complications rencontrées. Nous avons enregistré une mortalité de 10%. Conclusion : Des progrès ont été observés quant à l’approvisionnement en SAV au Mali depuis 2016. Au Mali, l’incidence et la gravité de cette pathologie restent encore mal connues. Les études réalisées sur ce sujet sont rares et se limitent à quelques centres hospitaliers. Une meilleure évaluation de l’incidence et de la morbidité est pourtant indispensable pour améliorer la prise en charge.

Background In 2004, Mali implemented mass drug administration (MDA) aimed at controlling schistosomiasis and soil-transmitted helminths. Despite several rounds of MDA, the health district of Bankass reported low coverage (64.8%) for praziquantel and albendazole in 2017, meaning that this district was still facing challenges in accomplishing the targeted 75% coverage. This study aimed to explore the barriers and gaps that hindered MDA implementation in Bankass. Methods A cross-sectional study was performed. Questionnaires were administrated to all school-aged children in randomly selected villages. Technical directors of community health centers and community drug distributors in the selected villages were included in the interviews. Results A total of 2128 children and 52 health workers were interviewed. Coverage rates were 93.51% (1990/2128) for praziquantel and 95.25% (2027/2128) for albendazole. Among the untreated children, 31.63% (31/98) reported being unaware of the campaign and 26.53% (26/98) were unable to reach the distribution points. Most of the health workers suggested increasing incentives. Conclusion The data showed satisfactory coverage >90%, in contrast with lower rates initially reported by the district health information system. These results raise concerns about the reliability of programmatic data and highlight the importance of population-based surveys for the evaluation of control interventions.

Introduction: Health care-associated infection is an infection acquired during the care delivered in the hospital or in any other care establishment which was neither present, nor in incubation at the admission of the patient or at the time of delivering the care or which does not manifest itself only after the patient has been discharged or an infection contracted by the professional in the course of his duties. Objectives: To identify mean causative germs and to determine their sensitivity to antibiotics and to identify the risk factors of health care-associated infection. Material and methods: It was about a prospective longitudinal study conducted from November 1, 2017 to April 1, 2018 (6 months) in all children admitted to the pediatric surgery service. Non-consenting parents and outpatient necrosectomy case have not been included in this study. Results: This study included 200 patients, of whom 30 experienced the hospital acquired infections with an infection rate of 15%. The surgical site infection was the most common type, with 16 cases (53.3%), followed by burns in 13 cases (43.3%) and urinary tract infection in 1 case (3.3%). The average age of patients with infection was 56.33 ± 48.66 months with extremes of 1 and 180 months. The sex ratio was 1.30 for infected patients and was 1.83 for uninfected patients. The main bacteria responsible for surgical site infection were: Escherichia coli (4 cases), Acinetobacter baumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1 case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). Among burn patients, the most frequent germs were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherichia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted only in the case of urinary tract infection. Antibiotics tested were: amoxicillin, amoxicillin associated with clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. Germs were resistant to amoxicillin in 88.9% of cases, sensitive to the amoxicillin-clavulanic acid combination in 85% of cases, sensitive to tobramycin and gentamicin. Recruitment methods and length of hospitalization were the risk factors noted. Conclusion: Massive awareness among all healthcare providers should be conducted on the adoption of standard precautions for the prevention of health care-associated infections and on the rules of antibiotics prescription to reduce the incidence of health care-associated infection and slow the resistance of germs to antibiotics.

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.

Describe the ultrasound aspects of rotator cuff tear by specifying the contribution of this technique in the shoulder scan.We conducted a prospective six-month analytical study from January 1, 2014 to May 31, 2014, on the rupture of the shoulder rotator cuff in the radiology department of the Béthune hospital center. Ultrasound examinations were performed using a Toshiba Aplion300 device using two linear probes of 13 and 15 Mhz. Data processing is done with SPSS 17.0 software. The Chi-square test was used to compare data with a significant threshold for p0.05.Our work focused on 28 patients who had a cuff tear during the ultrasound examination. The age group between 50 and 59 years was the most represented, 32.1%. Ultrasound showed calcification tendinopathy of the rotator cuff in 46.4% of cases. The rotator cuff tears were present in the supraspinatus, infra-spinal and subscapular tendons in 96.4% (27 cases), 32% (9 cases) and 21.4% (6 cases), respectively. In 58.3% there was a transfixing rupture of the supraspinatus with 72.3% non-transfixing ruptures. Seven patients had supraspinous tendon retraction including 6 cases of retraction stage 1 and 5 cases of stage 2 retraction. The infraspinatus was the second tendon of the cuff affected with 9 cases (32%) followed by the subscapularis 6 cases (21, 4%). We did not record lesions (rupture or calcification) of Teres minor. Radiography was normal in 7 patients, ie 32%.Ultrasonography, coupled with standard radiography, is the firstline examination in the imaging assessment of the symptomatic shoulder. It allows, as in our work, a better morphological analysis of tendon rotator cuff.Décrire les aspects échographiques de la rupture de la coiffe des rotateurs en précisant l'apport de cette technique dans le bilan d'exploration de l'épaule.Nous avons mené une étude prospective à visée analytique sur six mois allant du 1er janvier 2014 au 31 mai 2014 portant sur la rupture de la coiffe des rotateurs de l'épaule dans le service de radiologie du centre hospitalier de Béthune. Les examens échographiques ont été réalisés à l'aide d'un appareil Toshiba Aplion300 en utilisant deux sondes linéaires de 13et 15 Mhz. Le traitement des données a été effectué avec le logiciel SPSS 17.0. Le test de Khi2 a été utilisé pour la comparaison de données avec un seuil significatif pour p0,05.Notre travail a porté sur 28 patients qui présentaient une rupture de coiffe lors de l'examen échographique. La tranche d'âge comprise entre 50 -59 ans était la plus représentée soit 32.1%.L'échographie retrouvait une tendinopathie calcifiante de la coiffe des rotateurs dans 46.4% des cas. Les ruptures de coiffe des rotateurs siégeaient sur les tendons supra épineux, infra épineux et subscapulaire dans respectivement 96,4% (27 cas), 32% (9 cas) et 21,4% (6 cas).Dans 58.3% on retrouvait une rupture transfixiante du supraépineux avec 72.3% de ruptures non transfixiantes. Sept patients présentaient une rétraction du tendon supraépineux dont 6 cas de rétraction stade 1 et 5 cas de rétraction stade 2.L'infra épineux était le second tendon de la coiffe atteint avec 9 cas (32%) suivi du subscapulaire 6 cas (21,4%).Nous n'avons pas enregistré de lésions (rupture ou calcifications) du Teres minor. La radiographie était normale chez 7 patients soit 32%.L'échographie, couplée à la radiographie standard, constitue l'examen de première intention dans le bilan d'imagerie de l'épaule symptomatique. Elle permet comme dans notre travail, une meilleure analyse morphologique des tendons de la coiffe des rotateurs.

Envenomation by snakebite remains a public health problem in Africa. The purpose of our work was to study the acute complications of snakebite envenomation and the risk factors for its complications.This was a retrospective and prospective study over a period of 07 years, which was performed in the department of anesthesia resuscitation and emergencies of CHU-Mother Child "Luxembourg" of Bamako.During this period, 76 cases of Ophidian envenomation were recorded. The average age of the patients was 34 ± 12 years old. . The family of vipers (Echis and Bitis) was the most incriminated 84,61% of the cases. Hemorrhagic complications were observed in 78.94% of patients, other complications (cardiovascular, neurological, dermatological, ophthalmological ...) were observed in 21.05% of patients. The main risk factor for complication observed was the delay in management (6 hours delay) in 100% of patients. The absence of serotherapy and or the initial resort to traditional treatment have been complicating risk factors. Almost all victims of Elapidae bites, 89.9% (5/6 cases) died. Serotherapy was performed urgently in 97.4% of cases. The morbidity in our study was 10.52% with a 7.8% mortality.in our context, the management of envenomations by snake bite remains dependent on a multitude of complications. The prognosis is conditioned by the early administration of symptomatic treatment and a specific antidote.L'envenimation par morsure de serpent reste un problème de santé publique en Afrique. Notre travail avait pour objectif d'étudier les complications aigues de l'envenimation par morsure de serpent, ainsi que les facteurs de risque de ses complications.Il s'agissait d'une étude rétrospective et prospective sur une période de 07 ans, qui a été réalisée dans le département d'anesthésie réanimation et des urgences du CHU-Mère enfant le « Luxembourg » de Bamako.Durant cette période, 76 cas d'envenimations ophidiennes ont été enregistrés. L'âge moyen des patients était de 34±12 ans. . La famille des vipéridés (Echis et Bitis) était la plus incriminée 84,61% des cas. Les complications hémorragiques ont été observées chez 78,94% des patients, d'autres complications (cardiovasculaire, neurologique, dermatologique, ophtalmologique...) ont été observées chez 21,05% des patients. Le principal facteur de risque de survenu de complication observé, était le retard de prise en charge (délai6heures) Chez 100% des patients. L'absence de la sérothérapie et ou le recours initial à un traitement traditionnel ont été des facteurs de risques de complication. La presque totalité des victimes par morsures d'Elapidés soit 89,9% (5/6 cas) sont décédées. La sérothérapie a été effectuée en urgence chez 97,4% des cas. La morbidité dans notre étude a été de 10,52% avec une mortalité à 7,8%.dans notre contexte, la prise en charge des envenimations par morsure de serpent reste tributaire d'une multitude de complications. Le pronostic est conditionné par l'administration précoce d'un traitement symptomatique et d'un antidote spécifique.

Twist is the rarest complication of Meckel's diverticulum (DM). We did not find a case published in African literature. We report a case of twisted "giant" diverticulum occurred in a 15-year-old boy who had consulted for abdominal pain. Operated in emergency, the diagnosis was intraoperative. The diverticulum was 14 cm long and 5 cm in diameter. It was twisted at its base, totally necrotic and perforated at the top. We performed a resection carrying the diverticulum followed by a terminoterminal ileal ileal anastomosis. The postoperative course was simple.La torsion est la plus rare des complications du diverticule de Meckel (DM). Nous n'avons pas trouvé de cas publié dans la littérature africaine. Nous rapportons un cas de diverticule « géant » tordu survenu chez un garçon de 15 ans qui avait consulté pour douleur abdominale. Opéré en urgence, le diagnostic était per-opératoire. Le diverticule avait 14 cm de long et 5 cm de diamètre. Il était tordu à sa base, totalement nécrosé et perforé à son sommet. Nous avons réalisé une résection emportant le diverticule suivie d'une anastomose iléo-iléale termino-terminale. Les suites opératoires ont été simples.

Neonatal gastric perforation (PGNN) is a rare and serious pathology when management is not early. We did not find a case published in African literature. . We report 2 cases of PGNN registered in pediatric surgery of C.H.U Gabriel TOURE. The clinical pictures were that of a neonatal occlusion. X-rays of the abdomen without preparation revealed pneumoperitoneum in both cases. Congenital origin was retained for both cases. Surgical treatment consisted of excision-suture of the perforation margins. The operative sequences were simple in both cases.La perforation gastrique néonatale (PGNN) est une pathologie rare et grave lorsque la prise en charge n'est pas précoce. Nous n'avons pas trouvé de cas publié dans la littérature africaine. . Nous rapportons 2 cas de PGNN enregistrés en chirurgie pédiatrique du C.H.U Gabriel TOURE. Les tableaux cliniques étaient celui d'une occlusion néonatale. La radiographie de l'abdomen sans préparation a permis de mettre en évidence un pneumopéritoine dans les 2 cas. L'origine congénitale a été retenu pour les 2 cas. Le traitement chirurgical a consisté à une excision-suture des berges des perforations. Les suites opératoires ont été simples dans les 2 cas.

To study the epidemiological, clinical and evolutionary aspects of head trauma in children at the emergency room.This was a descriptive longitudinal study over 1 year from February 2016 to February 2017, which included any patient aged 0 to 15 years who had cranial trauma The data were collected from a pre-established questionnaire, analyzed by the software (SPSS 22.0, EXCEL and WORD 2010).The chi-square test or Fisher's exact test was used for the statistical analysis, a value0.5 considered significant.During the study period, 19825 consultations were performed at the emergency service of which 297 cranial trauma occurred in children, ie 1.5%. The male sex was predominant at 68% with a Sex ratio (H / F) = 2.13. The 6-10 age group was the most represented with 39.4%. The students were the most represented with 58.9%. Road accidents were the predominant mechanism of injury with 54.9%. Civil protection transported 29% of the wounded. The motorcycle-pedestrian mechanism was more frequent at 27.6% (n = 82). CT was severe in 17.8% (n = 53) of patients. The photomotor reflex was abnormal in 29% (n = 86). The trauma of the lower limb was associated in 39.3%. Craniosphalic CT with cervical scan was the most performed with 73.8%. The brain lesions were in the majority with 41.1%. The average care time was 9.82h in 54.2%. Exclusive medical treatment was adopted in 91.2% of cases. The tramadol and paracetamol combination was mainly used in analgesia with 78.1% of cases The evacuation of the hematoma was the most used surgical procedure with 65.4%. Hyperthermia was the most represented ACSOS (secondary cerebral aggression of systemic origin) with 6.7%. Death before care accounted for 5.4% (n = 16), hospital death at 12.8% (n = 38). The admission time to UE was 24-48h in 31.6% (n = 168). Prognostic factors were related to Motor Photo Reflex (p = 0.002), mechanism (p = 0.01), Glasgow scoreto 9 (p = 0.003), time to management (p = 0.002) and the association of ACSOS.CT in children remains a real public health problem responsible for considerable morbidity and mortality Pre-hospital management of ACSOS (secondary cerebral aggression of systemic origin) would significantly reduce this morbidity and mortality.Analyser l'aspect épidémioclinique et évolutif des traumatismes crâniens chez l'enfant au service d'accueil des urgences (SAU).Etude longitudinale descriptive sur 1 an qui a inclus tout patient âgé de 0 à 15 ans victime de TCE. Les données ont été recueillies à partir d'un questionnaire préétabli, analysées par les logiciels SPSS 22.0, EXCEL et WORD 2010, les tests (chi-carré, Fisher) ont été utilisés pour l'analyse statistique, une valeurà 0,05 considérée comme significative.19825 ont été admis au SAU dont 9912 victimes de traumatismes, parmi lesquelles 297 TCE ont été diagnostiqués chez l'enfant soit 1,5%. Le sexe masculin a été prédominant à 68%. La tranche d'âge 6-10 ans a été la plus représentée 39,4%. Les élèves étaient les plus représentés avec 58,9%. Les accidents de la Voie publique ont été le mécanisme lésionnel le plus fréquent 54,9%.La protection civile a transporté 29% des blessés. Le mécanisme moto-piéton a été plus fréquent à 27,6% (n=82). Le TC était grave chez 17.8% (n=53). Le reflexe photomoteur était anormal chez 29% (n=86). Le traumatisme du membre inferieur était associé dans 39,3%. Le taux de réalisation de la TDM cranioencephalique avec balayage cervical a été de 73,8% et a objectivé des lésions cérébrales dans 41,1%.Le délai d'admission au SAU était 31.6% (n=168) entre 24-48h. Le délai de prise en charge chirurgicale moyenne était de 9,82h chez 54.2%. Le traitement médical exclusif a été adopté dans 91,2% des cas. L'association tramadol et paracétamol a été la plus utilisée en analgésie avec 78,1% des cas. Le geste chirurgical a représenté 8,8% à type d'évacuation de l'hématome avec 65,4%. L'hyperthermie était l'agression cérébrale secondaire d'origine systémique (ACSOS) la plus représentée avec 6,7%. Le décès avant soins a représenté 5.4% (n=16), le décès hospitalier était de 12.8% (n=38). Les facteurs pronostiques étaient le réflexe photo moteur (p=0,002), le mécanisme (p=0,01), le score de Glasgowà 9 (p=0,003), le délai de prise en charge (p=0,002) et l'association d'au moins deux ACSOS.le TCE chez l'enfant demeure un véritable problème de santé publique responsable d'une morbimortalité élevée, la prise en charge des ACSOS en pré hospitalier diminuerait significativement cette morbimortalité.

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

Callosobruchus maculatus is the main pest of stored cowpeas in West Africa. To control this pest, chemicals are frequently used during post-harvest storage. In this study we assessed insecticide re...

Background Typhoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates Methods We searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019. Results Twenty-four papers from six countries were included. Reported mortality rates ranged from 4.6–75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16–100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively. Conclusions Current estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.

Climate change is a reality in Africa’s drylands. Pastoralists are engaging and embracing a range of adaptive strategies to adjust to these changes. The socioeconomic factors driving them to engage in a portfolio of multiple adaptation strategies have not been adequately addressed in the existing literature. A multivariate probit model was used to analyze them as determinants of adaptive capacity that promotes or hinders adaptation to climate change. Adaptation is represented by uptake of multiple strategies (irrigation, livestock migration, fodder production, and improved livestock breeds) by households, a demonstration of a household’s ability to diversify and adapt to the effects of climate change. The household asset base, particularly social capital represented by government assistance, stands out as it positively influenced by the uptake of four out of five adaptation strategies; that is, irrigation, livestock manure, fodder production, and improved breeds. Information heavily supports the adaptation process as it influenced all the five adaptation strategies analyzed but has a heterogeneous effect, supporting households to either adopt or reject a strategy. Crop-based information positively determines uptake of yield-enhancing strategies while relevant information for livestock activities contributes to the uptake of livestock-based strategies. These findings suggest that mainstreaming agricultural innovations, building a household asset base, and facilitating access to agronomic and climatic information will enable dryland communities to better adapt to climate change.

Objective: Pediatric jaundice is caused by various conditions. Although some data is available on this issue, data from Mali is insufficient. The present retrospective observational study was an attempt to determine the etiology of pediatric jaundice in the pediatric department of Gabriel Toure teaching hospital in Bamako, Mali. Methods: We reviewed all pediatric patients with jaundice who were hospitalized and treated in this department during January 1 to December 31, 2016 (n = 168). Result: Pediatric jaundice patients accounted for 1.88% of the hospitalized patients, with median age of 6 years and male/female ratio being 1.6. Infectious, cholestatic, and hemolytic jaundice accounted for 75%, 11% and 10%, respectively. Malaria and sickle cell disease accounted for 67% and 9%, respectively. Hepatomegaly and splenomegaly were observed in 49 (29%) and 23 (13.7%) patients, respectively. Of 168, 9 patients died. Conclusion: Infectious jaundice, especially jaundice due to malaria, was the most frequent. However, variety of etiologies was observed, of which the practitioners should be aware. The observation presented here may become fundamental data in health-policy making in this area.

Background In Mali, cutaneous leishmaniasis (CL) and filariasis are co-endemic. Previous studies in animal models of infection have shown that sand fly saliva enhance infectivity of Leishmania parasites in naïve hosts while saliva-specific adaptive immune responses may protect against cutaneous and visceral leishmaniasis. In contrast, the human immune response to Phlebotomus duboscqi (Pd) saliva, the principal sand fly vector in Mali, was found to be dichotomously polarized with some individuals having a Th1-dominated response and others having a Th2-biased response. We hypothesized that co-infection with filarial parasites may be an underlying factor that modulates the immune response to Pd saliva in endemic regions. Methodology/Principal findings To understand which cell types may be responsible for polarizing human responses to sand fly saliva, we investigated the effect of salivary glands (SG) of Pd on human monocytes. To this end, elutriated monocytes were cultured in vitro, alone, or with SG, microfilariae antigen (MF ag) of Brugia malayi, or LPS, a positive control. The mRNA expression of genes involved in inflammatory or regulatory responses was then measured as were cytokines and chemokines associated with these responses. Monocytes of individuals who were not exposed to sand fly bites (mainly North American controls) significantly upregulated the production of IL-6 and CCL4; cytokines that enhance leishmania parasite establishment, in response to SG from Pd or other vector species. This selective inflammatory response was lost in individuals that were exposed to sand fly bites which was not changed by co-infection with filarial parasites. Furthermore, infection with filarial parasites resulted in upregulation of CCL22, a type-2 associated chemokine, both at the mRNA levels and by its observed effect on the frequency of recruited monocytes. Conclusions/Significance Together, our data suggest that SG or recombinant salivary proteins from Pd alter human monocyte function by upregulating selective inflammatory cytokines., Author summary In Mali, cutaneous leishmaniasis (CL) and filariasis are co-endemic. We hypothesized that co-infection with helminth parasites may modulate the immune response to saliva of the CL vector Phlebotomus duboscqi (Pd). Hence, we investigated the effect of Pd salivary glands (SG) on human monocytes in subjects exposed or unexposed to sand fly bites in the context of a concomitant filaria infection. Monocytes of unexposed individuals selectively upregulated the production of IL-6 and CCL4 in response to SG from Pd or other vector species. In contrast, monocytes of individuals exposed to sand fly bites lost their responsiveness to SG, microfilariae antigen and LPS, irrespective of co-infection with filaria. Nevertheless, infection with filaria significantly upreguled the frequency of CCL22+monocytes, IL-10+mDCs and regulatory T cells. Together, our data suggest that repeated exposure to Pd saliva alters human monocyte function towards a tolerized phenotype while co-infection with filaria favors a Leishmania-promoting Th2/regulatory response.

Background In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions. Methods To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings. Results We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38 years old with extremes ranging from 18 to 86 years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94 km and 23.19 km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender. Conclusion This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods.

Background Ivermectin-based onchocerciasis elimination, reported in 2009–2012, for Bakoye and Falémé, Mali, supported policy-shifting from morbidity control to elimination of transmission (EOT). These foci are coendemic with lymphatic filariasis (LF). In 2007–2016 mass ivermectin plus albendazole administration was implemented. We report Ov16 (onchocerciasis) and Wb123 (LF) seroprevalence after 24–25 years of treatment to determine if onchocerciasis EOT and LF elimination as a public health problem (EPHP) have been achieved. Methods The SD Bioline Onchocerciasis/LF Ig[immunoglobulin]G4 biplex rapid diagnostic test (RDT) was used in 2186 children aged 3–10 years in 13 villages (plus 2 hamlets) in Bakoye and in 2270 children in 15 villages (plus 1 hamlet) in Falémé. In Bakoye, all-age serosurveys were conducted in 3 historically hyperendemic villages (1867 individuals aged 3 -78 years). Results In Bakoye, IgG4 seropositivity was 0.27% (95% confidence interval [CI] = .13%–.60%) for both Ov16 and Wb123 antigens. In Falémé, Ov16 and Wb123 seroprevalence was 0.04% (95% CI = .01%–.25%) and 0.09% (95% CI = .02%–.32%), respectively. Ov16-seropositive children were from historically meso/hyperendemic villages. Ov16 positivity was, Ov16–Wb123 (onchocerciasis– lymphatic filariasis [LF]) seroprevalence was measured in children aged ≤10 years to determine if onchocerciasis and elimination was achieved in 2 coendemic foci (Bakoye and Falémé) in Mali under long-term ivermectin treatment, which stopped in 2016. These goals seem to have been achieved.

In West Africa, Aedes aegypti remains the major vector of dengue virus. Since 2013, dengue fever has been reemerging in Burkina Faso with annual outbreaks, thus becoming a major public health problem. Its control relies on vector control, which is unfortunately facing the problem of insecticide resistance. At the time of this study, although data on phenotypic resistance were available, information related to the metabolic resistance in Aedes populations from Burkina Faso remained very scarce. Here, we assessed the phenotypic and the metabolic resistance of Ae. aegypti populations sampled from the two main urban areas (Ouagadougou and Bobo-Dioulasso) of Burkina Faso. Insecticide susceptibility bioassays to chlorpyriphos-methyl 0.4%, bendiocarb 0.1% and deltamethrin 0.05% were performed on natural populations of Ae. aegypti using the WHO protocol. The activity of enzymes involved in the rapid detoxification of insecticides, especially non-specific esterases, oxidases (cytochrome P450) and glutathione-S-transferases, was measured on individual mosquitos. The mortality rates for deltamethrin 0.05% were low and ranged from 20.72% to 89.62% in the Bobo-Dioulasso and Ouagadougou sites, respectively. When bendiocarb 0.1% was tested, the mortality rates ranged from 7.73% to 71.23%. Interestingly, in the two urban areas, mosquitoes were found to be fully susceptible to chlorpyriphos-methyl 0.4%. Elevated activity of non-specific esterases and glutathione-S-transferases was reported, suggesting multiple resistance mechanisms involved in Ae. aegypti populations from Bobo-Dioulasso and Ouagadougou (including cytochrome P450). This update to the insecticide resistance status within Ae. aegypti populations in the two biggest cities is important to better plan dengue vectors control in the country and provides valuable information for improving vector control strategies in Burkina Faso, West Africa.

Background Access to community-based healthcare services is one of the key characteristics in successful public health policy. In Mali, community-based interventions do not reach nomadic communities, remote and hard-to-reach areas. Methods: In order to determine a better healthcare strategy for these nomadic populations, we conducted a cross-sectional survey in the administrative region of Timbuktu in Mali using the administration of questionnaires to community members. Results: A total of 520 individuals from two nomadic communities, Gossi and Ber, were included in the questionnaire survey. Inhabitants of the two nomadic communities were livestock breeders (27%), housekeepers (26.4%), local traders (11%), farmers (6 %) and artisans (5.5%). The median age of the study participants was 38 years (18-86 years). The participants from Gossi and Ber lived at a mean distance of 40.94 km and 23.19 km from the closest health center, respectively. The major complaints with respect to accessing healthcare were cost (35.7%), distance to the health center (46.2%), quality of the provided services (39.2 %) and means of transportation (79.4%). More than 25% of the participants from the community stated that they will never accept to being examined by a health care provider of the opposite gender. Conclusion It appears from the interviews results that these nomadic populations have health needs not presently covered by the current health delivery system. Tackling the method and organization of health care delivery by adapting them to the local lifestyle, culture and values could lead to significant improvements health outcomes.

ObjectivesNatural products commonly used in traditional medicine, such as essential oils (EOs), are attractive sources for the development of molecules with anti-proliferative activities for future treatment of human cancers, e.g., prostate and cervical cancer. In this study, the chemical composition of the EO from Cymbopogon nardus was characterized, as well as its antioxidativeproperties and anti-inflammatory and antiproliferative activities on LNCaP cells derived from prostate cancer.MethodsThe chemical composition of the EO was determined by GC/FID and GC/MS analyses. The antioxidative properties were assessed using DPPH radical scavenging assay and ABTS+• radical cation decolorization assay, and the anti-inflammatory capacity was determined by the inhibition of the lipoxygenase activity. Antiproliferative activity was evaluated by MTT assay.ResultsCollectively, our data show that the major constituents of C. nardus EO are citronellal (33.06 %), geraniol (28.40 %), nerol (10.94 %), elemol (5.25 %) and delta-elemene (4.09 %). C. nardus EO shows modest antioxidant and anti-inflammatory activity compared to the standard galic acid. C. nardus EO exhibits the best antiproliferative activity on the prostate cancer cell line LNCaP with an IC50 of 58.0 ± 7.9 μg/mL, acting through the induction of the cell cycle arrest.ConclusionsThis study has determined that C. nardus EO efficiently triggers cytotoxicity and pens a new field of investigation regarding the putative use of this EO in vivo.

Natural products commonly used in traditional medicine, such as essential oils (EOs), are attractive sources for the development of molecules with anti-proliferative activities for future treatment of human cancers, e.g., prostate and cervical cancer. In this study, the chemical composition of the EO fromThe chemical composition of the EO was determined by GC/FID and GC/MS analyses. The antioxidative properties were assessed using DPPH radical scavenging assay and ABTS+• radical cation decolorization assay, and the anti-inflammatory capacity was determined by the inhibition of the lipoxygenase activity. Antiproliferative activity was evaluated by MTT assay.Collectively, our data show that the major constituents ofThis study has determined that

Seven medicinal plants used in folk medicine to relieve various diseases including diabetes, were investigated for antihyperglycemic activities. Two types of extracts for each plant were processed by decoction and by soaking in an aqueous-acetone mixture. The inhibitory activities were tested on α-amylase and α-glucosidase along with chelating activity. The aqueous-acetone extracts of Feretia apodanthera and Ozoroa insignis exerted strong inhibition on α-glucosidase (96.51±0.14 and 96.44±0.68 %, respectively) but lower inhibition on α-amylase (21.60±1.69 and 93.85±6.58 %, respectively) and displayed a weak chelating activity as compared to the respective standards acarbose and ethylenediaminetetraacetic acid. Subsequent column fractionation resulted in selectively strong inhibition of α-glucosidase. The inhibitory activities of α-amylase and α-glucosidase were weakly correlated (R=0,389) and both were inversely correlated with metal chelating activity (R=-0.731 and R=-0.809, respectively). Volatile compounds, 1-nonadecene and 1-heptadecene identified by GC-MS were related to the inhibitory activities of α-amylase and α-glucosidase enzymes. This potent inhibition of sugar degrading enzymes may help to manage the hyperglycemia occurring in type 2 diabetes.

Although Wuchereria bancrofti (Wb), the causative agent of lymphatic filariasis, is endemic throughout Mali, the prevalence of Wb microfilaremia (Mf) can vary widely between villages despite similar prevalence of infection as assessed by circulating antigen. To examine this variation, cross-sectional data obtained during screening prior to an interventional study in two neighboring villages in Mali were analyzed. The overall prevalence of Wb, as assessed by Wb CAg(circulating antigen), was 50.3% among 373 participants, aged 14-65. Wuchereria bancrofti Mf-positive and negative individuals appeared randomly distributed across the two villages (Moran's I spatial statistic = -0.01, Z score = 0.1, P>0.05). Among the 187 subjects positive for Wb CAg, 117 (62.5%) had detectable Mansonella perstans microfilaremia (Mp Mf) and 64 (34.2%) had detectable Wb microfilaremia. The prevalence of Mp microfilaremia was 73.4% in the Wb Mf-positive group (as compared to 56.9% in the Wb Mf-negative group; p=0.01), and median Wb Mf load was increased in co-infected subjects (267Mf/ml vs 100 Mf/ml; p

Background: Encephaloceles are congenital neural tube defects characterized by the protrusion of meninges and/or brain tissue from a defect in the skull. The incidence of the disease is about 0.8 - 5.6/10,000 live births. They are classified based on the location and type of skull defect as occipital encephalocele, encephalocele of the cranial vault, frontoethmoidal encephalocele, and basal encephaloceles. Surgical reduction being the first line treatment and resection of herniated structures may be necessary when the encephalocele is large. In the present study, the authors present their experience in treating 17 patients with encephaloceles. Methods: This study is a retrospective analysis of 17 patients from January 2013 to December 2016 in Gabriel Toure Hospital, Bamako, Mali. A history was obtained from the family at presentation. Medical information before and during the pregnancy was compiled. All patients underwent CT scan as a routine preoperative imaging study, to evaluate the encephalocele and to plan the surgical procedure. The following data were recorded for analysis: age, sex, location of encephalocele, neurological status, operative method, postoperative complications and surgical results. Results: There were 10 (58.8%) female and 7 (41.2%) male patients. The patients ranged in age from 3 days to 36 months. The most common site of encephalocele sac was the occipital region in 14 (82.4%) cases followed by the frontal region in 2 (11.8%) cases and the vertex in 1 (5.9%) case. The sac size was less than 3 cm in 5 (17.6%) cases, 3 - 5 cm in 8 (47.1%) cases and more than 5 cm in 4 (23.5%) cases. Three (17.6%) children presented with CSF leakage. Hydrocephalus was present in the preoperative period in 6 (35.3%) cases; all of them required VP shunt procedure. None of the cases had a preoperative neurologic deficit. Surgical excision was performed in all cases. In the postoperative period, meningitis developed in 2 cases (11.8%), wound infection in 1 case (5.9%) and seizure in 1 case (5.9%). Three patients (17.6%) died during postoperative follow-up. Postoperative hydrocephalus occurred in 1 (5.88%) patient requiring a VP shunt. Conclusion: Encephaloceles are commonly seen in the practice of neurosurgery in the world as well as in Mali. In this study, the clinical manifestations and surgical results of 17 cases have been reviewed. We recommend early repair and excision of encephaloceles to avoid rupture or skin excoriation.

Agroforestry is increasingly regarded as an important adaptation and mitigation strategy against climate change. In particular, the use of fertilizer trees has been promoted as a practice that contributes to improved soil fertility through nitrogen fixation, by increasing supply of nutrients for crop production. While a lot of the evidence on the impact of fertilizer trees relies on on-farm experiments and correlational analysis, there is a paucity of rigorous evidence under actual smallholder farming conditions. This paper analyzes the impacts of adopting fertilizer trees such as Gliricidia sepium and Faidherbia albida on household food security. We draw on survey data of 338 farmers in Malawi and use an endogenous switching regression to rigorously analyze adoption impacts. Econometric results show that use of fertilizer tree adoption increases the value of food crops by 35%. Disaggregation of the impacts through stratification by land ownership further reveal that farmers with smaller farms of up to 2 acres realize the highest gains. Furthermore, fertilizer tree use in conjunction with improved maize seed also significantly increased value of food crops. This study offers preliminary insights that contribute to an emerging field of research on quantitative assessment of agricultural interventions such as agroforestry practices using novel analytical approaches. We provide some policy insights and recommend the need for future research to be designed around development initiatives that consider fine-scale variation in social, economic and ecological context of farmers to improve uptake and adaptation to realize the full potential of agroforestry in improving soil fertility and household food security.