Bamako Mali Research Articles

Epidemiological, clinical and therapeutic aspects of pterygium at the district hospital of Commune VI, Bamako Mali

Pterygium is a benign conjunctivo-elastic neoformation of the ocular surface with a triangular shape, canthal base and corneal apex. It extends into the area of the palpebral cleft, preferably in the nasal sector, towards the corneal apex. It is therefore easy to imagine the harmful consequences of its progression on vision The distribution of pterygium is global, but its prevalence is higher in hot, dry climates. Populations living in warm, desert environments, located in peri-equatorial regions at latitudes of 37° north and south of the equator and highly exposed to ultraviolet radiation are at higher risk of developing this disease During our study, we collected 83 cases of pterygium, a frequency of 0.36%. More than half, or 70%, of our patients were women with a sex ratio M/F: 0.36. The age group over 60 years old was the most represented with 26.51%. Itching dominated the warning signs with 36.14%. Stage II was in the majority with 51.81%. Nasal pterygium was the most common with 90%. All our patients have benefited from an excision of the pterygium with autograft of the same eye. We recorded 7 cases of recidivism, i.e. 8.43%. Pterygium, although benign, is a public health problem since, for any type of surgery involved, it is impossible to avoid recurrences, which characterize the disease. In Bamako, at the hospital of the district of commune VI, the evolution was unpredictable but seems more favorable with the limboconjunctival autograft Keywords: surgery, pterygium, commune VI, Bamako.

Epidemiological and Clinical Characteristics of Burn Sequelae at the Dermatology Hospital of Bamako

Introduction: The sequelae of burns induce variable functional, aesthetic and psychological repercussions. They can be minor or major. The sequelae of burns are basically attributable to two causes: the male therapy conducted and the severity of the burn itself. Objective: To describe the clinical and epidemiological characteristics of burn sequelae in the "young" Dermatology Hospital of Bamako in Mali. Methodology: A descriptive and transversal study carried up on patients with burns sequelae and operated in Dermatological hospital of Bamako at the plastic and oncological service from January 2017 to December 2020. The study population consisted of all the patients (138 cases) with burns sequelae. Result: The sex ratio was 1.06. The mean age was 13.73 years (range: 7 months to 74 years). The most affected age group was paediatric with 65.90% of cases and the dominant age group was 0 to 5 years old with 41.3%. Hot liquid was the most frequently found causative agent at 52.9%, followed by fire and hot metal at 31.2% and 8%, respectively. Flanges were the most dominant (56.80%), followed by cupboards (33.73%) and ulcers on old burns (4.73%). Conclusion: A well-conducted therapy would not only reduce the severity of burn sequelae but also avoid them, which would allow empowering patients after burns and reducing the high costs associated with the management of these sequelae.

Polyherbal Combinations Used by Traditional Health Practitioners against Mental Illnesses in Bamako, Mali, West Africa

This study explores the traditional knowledge of plants used by traditional health practitioners (THPs) in the treatment of symptoms or syndromes related to mental illnesses in the district of Bamako in Mali, along with the identification of affiliated traditional treating methods. An exploratory and cross-sectional ethnopharmacological survey was conducted in the district of Bamako. The Malian Federation of Associations of Therapists and Herbalists (FEMATH) assisted in the identification and inclusion of the THPs. Data sampling included semi-structured interviews, questionnaires, and in-depth interviews. Quantitative data were evaluated by analysing reports of the use of different medicinal plants and the number of participants. Fifteen THPs belonging to the district of Bamako participated. In total, 43 medicinal plants belonging to 22 plant families were used by the THPs. The most cited plant species was Securidaca longepedunculata (violet tree), followed by Khaya senegalensis (African mahogany) and Boscia integrifolia (rough-leaved shepherds tree). A great number of herbal combinations, preparation methods, and administration routes were used, often with honey as an adjuvant. To our knowledge, this is the first ethnobotanical survey on the use of medicinal plants in the treatment of all types of mental disorders in Bamako.

Migration of a Progestin Implant into a Pulmonary Artery: Observation of a Case at the Reference Health Center of Commune III of the District of Bamako in Mali

Migration of a Progestin Implant into a Pulmonary Artery: Observation of a Case at the Reference Health Center of Commune III of the District of Bamako in Mali

Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali.

Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1st, 2019, to May 31st, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

Perception and Management of Hemorroid Disease at the CSREF of the Commune Bamako Mali

Perception and Management of Hemorroid Disease at the CSREF of the Commune Bamako Mali

Postoperative Complications in the General Surgery Department of the Cs Ref of Commune I of the District of Bamako Mali

Postoperative Complications in the General Surgery Department of the Cs Ref of Commune I of the District of Bamako Mali

Severe Malaria in Children Aged 6 to 59 Months in the Paediatric Ward of the Commune II Health Centre in Bamako

Introduction: The aim of our work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of severe malaria in children hospitalized in the pediatric ward of the CSRéf commune II of the district of Bamako in Mali. Materials and methods: We conducted a 12-month prospective study from January to December 2017. It took place in the paediatric service of the CSRéf of the commune II of the district of Bamako. Results: The study involved 70 children hospitalised out of 418 in the paediatric ward. The prevalence of severe malaria was 16.7%. The age group of children aged 36-59 months was the most affected with 58.6% with a sex ratio of 1.12 in favour of boys. The reasons for consultation were dominated by fever (43%). The neurological form was the most frequent with 71.4% followed by the anaemic form with 21.4%. Injectable artesunate waś used as first line in 110 patients or 87%. The average duration of hospitalisation was 3.8 days. The evolution waś favourable 97% of patients and 3% death. Conclusion: Malaria remains a public health problem due to its frequency and severity in children.

Profile of Adult Deafness in a Second-Line Health Center in Africa

The aim of this study was to establish the epidemiological, etiological and therapeutic mapping of adult deafness in a second referral hospital in Black Africa. Our retrospective study covered a period of one year from January 1 to December 31, 2018, in the ENT department of the CSREF of the commune I of the district of Bamako in Mali. The study focused on patients treated as outpatients for Deafness and presenting a complete file with a tonal audiometry form. During the study period, 39.28% of the patients admitted to outpatient clinics were adults, 10% had hearing loss, representing 3.9% of all admissions received. The male gender was the most represented, 54.67% with a sex ratio of 1.2. The 18-28 year olds were more numerous (40%), students/pupils 29.33%. Hearing loss was the most common reason for consultation with a rate of 53.33%. Tinnitus was the most frequent associated symptoms with a rate of 44%. The mode of onset was most often progressive (68%). The most common medical conditions were hypertension (22.66%), followed by meningitis (6.66%), with 53.33% of the cases having no particular medical condition. Trauma with 9.33% was the most mentioned risk factor. Chronic otitis media of all kinds was the dominant etiology 61%. 26.67% had a surgical indication and 33.33% a hearing aid. The prevalence of deafness in our context is relatively similar to the literature with similar epidemiological and clinical variables. Regarding the management, we note nevertheless some insufficiencies in particular as for the use of the tools of functional exploration in particular the vocal audiometry and especially at the level of the management but it should be noted that efforts are being accomplished concerning the levelling of the human resources, the surgery and the means of rehabilitation.

Source Apportionment of Ambient Particulate Matter (PM) in Two Western African Urban Sites (Dakar in Senegal and Bamako in Mali)

Following population growth and rapid urbanization, West African cities have become major sources of anthropogenic pollution. Additionally, Saharan dust has had a significant impact, representing a potentially toxic mix of sources for the population. This study characterizes the atmospheric composition and its sources in two African capitals, Bamako, Mali and Dakar, Senegal. TSP, PM10 and PM2.5 samples were collected during the dry season in 2009 when pollution levels were high: chemical analysis included organic carbon (OC), elemental carbon (EC), ions, and metals. PM2.5 and PM10 concentrations were 5–10 times and 3–8 times higher, respectively, than the 2005 WHO 24 h standards. Using PCA and PMF methodologies, five sources were identified in each city. In Bamako, traffic (motor vehicles and resuspended road dust) was the prevailing source of PM2.5 and PM10, accounting for 47% and 45%, respectively. Crustal dust was the second most important source (24–30%), followed by solid fuel combustion (16–13%) and secondary aerosols (10–16%). In Dakar, the following sources of PM2.5 and PM10 are identified: traffic (49%), mineral dust (16–25%), sea salts (15–20%) and industries (10–11%). Our study provides crucial information about the historical change in source characteristics in these two African cities, which can help for future mitigation strategies.

Prevalence of Hepatitis C among Blood Donors at the National Blood Transfusion Center of Bamako in Mali

Introduction and purpose of the study: The overall prevalence of HCV among adults in sub-Saharan Africa has increased from 3.82 to 3.94% (3). We find a disproportionate prevalence of viral hepatitis C in blood donors in several national blood transfusion centers in Sub-Saharan Africa and the aim of our work was to study the seroprevalence of hepatitis C in blood donors from the center national blood transfusion center of Bamako Methods: This was a descriptive cross-sectional study that took place at the CNTS national blood transfusion center in Bamako from July to December 2019. Our study concerned blood donors (volunteers and relatives) presenting to the CNTS in Bamako during the study period. It focused on an exhaustive random sample of CNTS blood donors, the variables studied were gender, marital status, type of donor HCV+, HCV-, age and number of donations. Serodiagnosis was determined by the ELISA technique. Results: We collected 250 samples, the 26-35 age group was the most represented with 49.6%; the prevalence of hepatitis C was 1%. Hepatitis C marker positivity has been observed in family donors. Conclusion: The seroprevalence of hepatitis C during our study was 1%. The ELISA technique with monolisa HCV reagent was used as the method. We found a relationship between seroprevalence and few sociodemographic aspects.

Prevalence and Clinical Relevance of Schistosoma mansoni Co-Infection with Mycobacterium tuberculosis: A Systematic Literature Review.

Tuberculosis disease stands for the second leading cause of death worldwide after COVID-19, most active tuberculosis cases result from the reactivation of latent TB infection through impairment of immune response. Several factors are known to sustain that process. Schistosoma mansoni, a parasite of the helminth genus that possesses switching power from an immune profile type Th1 to Th2 that favors reactivation of latent TB bacteria. The aim of the study was to assess the prevalence of the co-infection between the two endemic infections. Systematic literature was contacted at the University Clinical Research Center at the University of Sciences, Techniques, and Technologies of Bamako in Mali. Original articles were included, and full texts were reviewed to assess the prevalence and better understand the immunological changes that occur during the co-infection. In total, 3530 original articles were retrieved through database search, 53 were included in the qualitative analysis, and data from 10 were included in the meta-analysis. Prevalence of the co-infection ranged from 4% to 34% in the literature. Most of the articles reported that immunity against infection with helminth parasite and more specifically Schistosoma mansoni infection enhances latent TB reactivation through Th1/Th2. In sum, the impact of Schistosoma mansoni co-infection with Mycobacterium tuberculosis is under-investigated. Understanding the role of this endemic tropical parasite as a contributing factor to TB epidemiology and burden could help integrate its elimination as one of the strategies to achieve the END-TB objectives by the year 2035.

Digestive Surgical Emergencies in the General Surgery Department of the Reference Health Center in Commune I of the District of Bamako in Mali

Digestive Surgical Emergencies in the General Surgery Department of the Reference Health Center in Commune I of the District of Bamako in Mali

Liver Abscesses in General Surgery at CsRef CI in Bamako Mali

Liver Abscesses in General Surgery at CsRef CI in Bamako Mali

Inguinal Hernia in Adults: Diagnostic and Therapeutic Aspects at Cs Ref CI Bamako Mali

Inguinal Hernia in Adults: Diagnostic and Therapeutic Aspects at Cs Ref CI Bamako Mali

Epidemiological, Clinical, and Therapeutic Characteristics of Acute Appendicitis at the Reference Health Center in Commune I of the District of Bamako Mali

Epidemiological, Clinical, and Therapeutic Characteristics of Acute Appendicitis at the Reference Health Center in Commune I of the District of Bamako Mali

Microresearch

Objectives: (a) to show that investment in research is an extremely wise move for any country, (b) to illustrate how research influences health decisions, and (c) to illustrate pathways in the “decolonization” of research in low- and middle-income countries (LMIC).
 As shown by data compiled by UNESCO (Figure), the Gross Expenditure on Research and Development (GERD) as percent of national GDP greatly enriches its citizens (it’s an investment). For example, the Netherlands (NL), a country with few natural resources, invests heavily in research and has achieved a high level of prosperity for its citizens. Economists concluded that research is an essential investment for a country’s prosperity!
 The decision-making process by any government is a complex process influenced by budgetary, political, legislated, and other considerations. The importance of “embeddedness” in this process was identified by Koon et-al. who showed that ministerial decisions on health are primarily influenced by people who have a reputation for research and work within the local system. This phenomenon is seen in both rich and poor countries; people who know and understand the culture and context of a country are key influencers on the decision process.
 The challenges of LMIC to develop capacity in research was the topic of a UNESCO conference in Bamako Mali in 2008. Ministers-of-health from LMICs realized that research is critical in any decision process to ensure “evidence-informed” policy decisions. Their “Call to Action” recognized an essential need to build community-based research capacity to ensure health agendas would be decided by national needs informed by their own researchers.
 The pathway to decolonization began anew in 1976 with the introduction of Microfinance offering startup funding, capacity-development, and coaching for local people with entrepreneurial ambition. Like Microfinance, MicroResearch (MR) is an innovative, capacity building, community-focused program, empowering local health researchers to improve health in their communities. Conceived in 2008 MR puts local research teams firmly in the driver’s seat from question selection, proposal development to knowledge translation. As of 2022:
 
 19 partner institutions in 8 countries
 Over 40 two-week training workshops
 1,250 health workers and professionals trained
 
 Including >300 doctors, >200 nurses and 600 other professions
 
 
 126 MR teams have launched research projects (over 50 completed)
 Over 50 PubMed publications and/or policy changes
 Thousands of lives saved as a result of MR research-initiated changes
 MR training programs have been incorporated into local institutes
 
 MR has shown that high-quality research can be achieved locally when supported by training, coaching and access to small grants. MR decolonizes and democratizes research in LMIC.

Single low-dose tafenoquine combined with dihydroartemisinin–piperaquine to reduce Plasmodium falciparum transmission in Ouelessebougou, Mali: a phase 2, single-blind, randomised clinical trial

SummaryBackgroundTafenoquine was recently approved as a prophylaxis and radical cure for Plasmodium vivax infection, but its Plasmodium falciparum transmission-blocking efficacy is unclear. We aimed to establish the efficacy and safety of three single low doses of tafenoquine in combination with dihydroartemisinin–piperaquine for reducing gametocyte density and transmission to mosquitoes.MethodsIn this four-arm, single-blind, phase 2, randomised controlled trial, participants were recruited at the Clinical Research Unit of the Malaria Research and Training Centre of the University of Bamako in Mali. Eligible participants were aged 12–50 years, with asymptomatic P falciparum microscopy-detected gametocyte carriage, had a bodyweight of 80 kg or less, and had no clinical signs of malaria defined by fever. Participants were randomly assigned (1:1:1:1) to standard treatment with dihydroartemisinin–piperaquine, or dihydroartemisinin–piperaquine plus a single dose of tafenoquine (in solution) at a final dosage of 0·42 mg/kg, 0·83 mg/kg, or 1·66 mg/kg. Randomisation was done with a computer-generated randomisation list and concealed with sealed, opaque envelopes. Dihydroartemisinin–piperaquine was administered as oral tablets over 3 days (day 0, 1, and 2), as per manufacturer instructions. A single dose of tafenoquine was administered as oral solution on day 0 in parallel with the first dose of dihydroartemisinin–piperaquine. Tafenoquine dosing was based on bodyweight to standardise efficacy and risk variance. The primary endpoint, assessed in the per-protocol population, was median percentage change in mosquito infection rate 7 days after treatment compared with baseline. Safety endpoints included frequency and incidence of adverse events. The final follow-up visit was on Dec 23, 2021; the trial is registered with ClinicalTrials.gov, NCT04609098.FindingsFrom Oct 29 to Nov 25, 2020, 1091 individuals were screened for eligibility, 80 of whom were enrolled and randomly assigned (20 per treatment group). Before treatment, 53 (66%) individuals were infectious to mosquitoes, infecting median 12·50% of mosquitoes (IQR 3·64–35·00). Within-group reduction in mosquito infection rate on day 7 was 79·95% (IQR 57·15–100; p=0·0005 for difference from baseline) following dihydroartemisinin–piperaquine only, 100% (98·36–100; p=0·0005) following dihydroartemisinin–piperaquine plus tafenoquine 0·42 mg/kg, 100% (100–100; p=0·0001) following dihydroartemisinin–piperaquine plus tafenoquine 0·83 mg/kg, and 100% (100–100; p=0·0001) following dihydroartemisinin–piperaquine plus tafenoquine 1·66 mg/kg. 55 (69%) of 80 participants had a total of 94 adverse events over the course of the trial; 86 (92%) adverse events were categorised as mild, seven (7%) as moderate, and one (1%) as severe. The most common treatment-related adverse event was mild or moderate headache, which occurred in 15 (19%) participants (dihydroartemisinin–piperaquine n=2; dihydroartemisinin–piperaquine plus tafenoquine 0·42 mg/kg n=6; dihydroartemisinin–piperaquine plus tafenoquine 0·83 mg/kg n=3; and dihydroartemisinin–piperaquine plus tafenoquine 1·66 mg/kg n=4). No serious adverse events occurred. No significant differences in the incidence of all adverse events (p=0·73) or treatment-related adverse events (p=0·62) were observed between treatment groups.InterpretationTafenoquine was well tolerated at all doses and accelerated P falciparum gametocyte clearance. All tafenoquine doses showed improved transmission reduction at day 7 compared with dihydroartemisinin–piperaquine alone. These data support the case for further research on tafenoquine as a transmission-blocking supplement to standard antimalarials.FundingBill & Melinda Gates Foundation.TranslationsFor the French, Portuguese, Spanish and Swahili translations of the abstract see Supplementary Materials section.

Sexual Assaults at the One Stop Center Unit in the Health District of Commune V of Bamako (Mali)

Introduction: Sexual assault violates fundamental rights, including physical and psychological integrity and security of the person. The purpose of this work was to take stock of the holistic management of sexual assaults received in the service. Patients and method: We conducted a cross-sectional and descriptive study covering the period from June 2017 to May 2020, i.e. three years. It focused on all survivors of sexual assault received in the unit of <On Stop Center> which houses the Obstetric Gynecology Department of the CSRéf CV of the district of Bamako in Mali. Results: The prevalence of sexual assault was 1.79%. The average age of survivors was 24 years. Sexual assaults mainly concerned adolescent girls (92.20%). The majority of survivors had been admitted (88.84%). They were single (89.80%). The average gesture was 4. The alleged perpetrator was unknown to the survivor in 79.14%. Genitogenital penetration with ejaculation was reported in 70.14% of cases, including 52.40% in a climate of violence. The initial clinical evaluation found recent hymenal lesions found in 13.58% of cases and an intact hymen in 9.42% of survivors. Holistic management included a paraclinical assessment component and a care administration and support component. The drafting of a medical certificate in three copies was systematic. Conclusion: Sexual assaults are relatively common in our department. They are probably underestimated. Keywords: Violence, gender, survivors, bamako.