[Show abstract][Hide abstract] ABSTRACT: Cancer today is being treated as a public health problem in Africa, as in developed countries. Objective: The aim of this retrospective study was to evaluate the epidemiology and outcome of children treated in the Pediatric Oncology Unit of Gabriel Touré Teaching Hospital in Bamako (Mali), six years after it opened. Methods: Retrospective study of the files of all children aged 15 and younger diagnosed with cancer and treated by chemotherapy between January 1, 2005, and December 31, 2010. Results: The study included 690 children. Their mean age was 24 months. The time from observation of first symptoms to consultation was less than 3 months in 200 cases (29%), from 3 to 10 months in 256 (37.1%), and more than 10 months in 234 (33.9%). The five most common childhood cancers were malignant non-Hodgkin's lymphoma (NHL) (n=231, 33.5%), retinoblastoma (n=170, 24.6%), nephroblastoma (n=102, 14.8%), acute lymphoblastic leukemia (n=54, 7%), and Hodgkin's disease (n=34, 4%). Six years after the unit opened and after a mean follow-up of 3 years, we recorded 272 deaths (39.4%); at least 238 children are still alive (34.5%), with 180 cases (26.1%) lost to follow-up. Conclusion: Childhood cancer survival is still low in Mali, and the rate of loss to follow-up quite high.
[Show abstract][Hide abstract] ABSTRACT: To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula.
Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database.
Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts.
The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula.
Progrès en Urologie 10/2013; 23(12):1000-1003. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe the malaria morbidity and the frequencies of molecular markers of resistance to chloroquine and sulfadoxine-pyrimethamine in pregnant women at delivery in Mali. Two hundred pregnant women have been included at the delivery clinic in Fana. The age group of 14-19 years was predominant. Fifty two per cent (52.3%: 104/200) were malaria slides positive in their peripheral blood and 15% (30/200) of the women carried parasite in their placenta. The prevalence rate of anemia was 44.5% (89/200). PCR technique was successfully performed on 16 paired samples. The frequency of the Pfcrt K76T mutants in Plasmodium falciparum infections in peripheral blood was 68.8% (11/16) and 100 % (16/16) in the placenta (p = 0.004). The frequency in peripheral blood of the DHFR N51I mutation was 12.5% (2/16) and 18.8% (3/16) in the placenta (p=0.12). The frequencies of the DHPS A437G mutants were similar in both sites 25% (4/16). No DHPS K540E and DHFR 164L mutations were found in the Fana pregnancy women samples.
Bulletin de la Société de pathologie exotique 07/2013;
[Show abstract][Hide abstract] ABSTRACT: Objective. The objective of this study was to determine the prevalence of intestinal helminths and Schistosoma haematobium before and after the rainy season in Pongonon, Mali. Methods. Volunteers aged one year and above were included. The Kato-Katz method was used to detect eggs and cysts in stool samples, and Wattman filtration to detect S. haematobium eggs in urine samples. Two cross-sectional surveys were conducted in July and November 2007. Results. In July (beginning of the rainy season), 304 volunteers were included; 278 were seen again in November (at the end of the rainy season). We found more intestinal helminths at the end of the rainy season (8.3%) compared to the beginning of the season (2.9%) (P = 0.01). There was no infection with S. haematobium in July but 7.6% in November (P < 0.001). The prevalence of intestinal helminths in children and adults was similar (P > 0.05), but the prevalence of infection with S. haematobium was higher in children aged 6 to 16 years (17/153) than in adults (2/74) (P = 0.02). Conclusion. Infections with helminth and S. Haematobium were both more prevalent at the end of the rainy season. Adults were infected as well as children and may constitute potential reservoirs of parasites. Effective control of these parasitic infections requires mass drug administration programs that take place during the seasons of high parasite egg excretion and that also include adult populations in some areas.
[Show abstract][Hide abstract] ABSTRACT: Studies performed in Burkina Faso and Mali showed differences in susceptibility to malaria between the Fulani and other sympatric ethnic groups, the Mossi and Dogon. We carried out a longitudinal survey and three cross-sectional studies from 2003 to 2005 in order to assess the prevalence of anemia in Dogon and Fulani. The distribution of the study population by sex was comparable between the two ethnic groups (p = ns). The Fulani are mainly cattle breeders and the Dogons, farmers. They were exposed to similar entomological inoculation rates, and studies on "knowledge, attitude, and practices" showed no difference between the two ethnic groups. The cross-sectional studies were performed during the intense malaria transmission season (in September 2003 and 2005) and during the dry season (in March 2004). Longitudinal clinical follow-up studies were performed from August to December 2005 using the WHO 28 days in vivo test, after administration of a curative dose of antimalarial drugs to patients with mild malaria. During the cross-sectional studies, both Fulani men and women had significantly lower hemoglobin levels than their Dogon counterparts; this difference was most evident in the women (in 2005: 9.4 g/dl in Fulani vs 10.7 g/dl in Dogon, p = 0.0002). Clinical longitudinal follow-up data showed that Fulani children aged 10-14 years have lower hemoglobin levels than Dogon children. At day 0, the mean of hemoglobin level was 9.6 g/dl in Dogon children vs. 8.7 g/dl in Fulani children (p = 0.01). At day 28, after malaria treatment, we also observed a significant difference in hemoglobin levels in children (10.6 g/dl in Dogon vs 9.3 g/dl in Fulani, p < 0.001). A stronger association between anemia and spleen enlargement was found in the Fulani (53.2% with spleen enlargement) than in the Dogon (32.9%) [p = 0.005]. The Fulani suffer more from anemia than the Dogon, despite their lower susceptibility to malaria. The difference in anemia between Dogon and Fulani must be further investigated to determine possible factors involved in malaria susceptibility.
Bulletin de la Société de pathologie exotique 10/2012;
[Show abstract][Hide abstract] ABSTRACT: Introduction
Despite the marked reduction in reported cases of P. falciparum malaria, this disease remains a major global health threat claiming the lives of 655,000 people and putting an estimated 3.3 billion of the world’s population at risk of illness. Although people living in malaria-endemic areas mount a broad range of immune responses to a great variety of parasite antigens, protective immunity to clinical malaria develops only slowly, and some argue the duration of such responses is comparatively short-lived. The concept of original antigenic sin, whereby an initial infection imprints a certain response pattern that prevents the immune system from mounting more efficient responses upon subsequent infections, may explain these observations.
In a longitudinal cohort study of Malian children aged 0.5 to 10 years, we investigate whether a child experiencing repeated malaria episodes mounts similar immunological responses each time. We also investigated whether these responses can be grouped into distinct patterns, and whether any distinct patterns associate with disease outcome.
We are currently characterizing the quality and magnitude of parasite antigen-specific T cell responses after in vitro stimulation of peripheral blood mononuclear cells collected during an acute malaria episode using multi-parameter flow cytometry. Based on cell surface phenotype we classify memory CD4+ and CD8+T cells into effector memory (CD45RO+CCR7−) and central memory (CD45RO+CCR7+) T cells and characterize their function by measuring the production of IFNϒ, TNFα, IL-2 and IL-10. We also quantify cytokine levels in the corresponding supernatants and plasma samples using multi-parameter Bioplex assays.
The results of this study will enable us to determine whether original antigenic sin influences malaria incidence, and may reveal an association between a specific immunological response pattern and enhanced protection from a subsequent malaria episode, which can be further explored in identifying candidate vaccine antigens.
[Show abstract][Hide abstract] ABSTRACT: Acute respiratory infections (ARI) are a major public health issue in Mali. The objective of this study was to examine the management of ARI within the community among children aged 2 to 59 months. The study was based on a pilot community intervention over a period of 15 months (June 2008-August 2009) in 4 health districts in Mali. A survey was conducted two weeks before the intervention in order to determine the incidence of ARI. During the intervention phase, 80 community health workers (CHW) and 1,123 mothers were trained, equipped and supervised. 3,532 children aged 2 to 59 months were managed. Two health areas were selected in each district. A "CHW" area (i.e. an area where CHWs were trained and supervised) and a "mother" area (i.e. an area where mothers were trained and supervised) were randomly selected. Among the managed ARI cases, there were more cases of pneumonia in the "mother" areas (29.5%) than in the "CHW" areas (24.9%) (p = 0.003). The study also found that the duration of the prescription period was more appropriate in "CHW" areas (99.5%) than in "mother" areas (97.6%) (p = 0.03). In addition, the reduction in the incidence of complicated cases (before and after intervention) was more significant in "mother" areas (from 69? to 6?, with p = 10?6) than in "CHW" areas (from 24? to 11?, with p = 0.01). The results suggest that mothers with the appropriate training, equipment and supervision are able to manage cases of ARI.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and
to examine the relationship between the strains and their drug susceptibility profiles.
METHODS: Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify
strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali.
RESULT: Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and
M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1;
38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB
LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than
MTB T1 (respectively OR 0.1, 95%CI 0.03–0.4 and OR 0.1, 95%CI 0.01–0.8). Age ⩾32 years (OR 1.4,
95%CI 0.4–3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1–2.5) and male sex (OR
4, 95%CI 0.9–16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%).
CONCLUSION: This study indicates a low level of primary drug resistance in Bamako, affirms the importance
of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.
The International Journal of Tuberculosis and Lung Disease 05/2012; · 2.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and to examine the relationship between the strains and their drug susceptibility profiles.
Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali.
Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1; 38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than MTB T1 (respectively OR 0.1, 95%CI 0.03-0.4 and OR 0.1, 95%CI 0.01-0.8). Age ≥ 32 years (OR 1.4, 95%CI 0.4-3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1-2.5) and male sex (OR 4, 95%CI 0.9-16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%).
This study indicates a low level of primary drug resistance in Bamako, affirms the importance of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.
The International Journal of Tuberculosis and Lung Disease 04/2012; 16(7):911-6. · 2.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Data about childhood acute lymphoblastic leukemia, the most common childhood malignancy in industrialized countries, are scarce in African publications. The purpose of this prospective, unicentric study were to assess the socio-demographic, clinic and laboratory characteristics of the children treated for lymphoblastic leukemia in our pediatric oncology unit in Gabriel Touré Teaching Hospital in Bamako, Mali.
This study includes all children between 1 and 15 years old treated for cytologically documented acute lymphoblastic leukemia from January 1, 2007 to September 30, 2009.
A total of 12 cases including 8 boys and 4 girls (sex ration, 2) were treated during the study period. Mean age was 92 months. Age was less than 4 years old in 2 cases. 5 (41,7%) were between 5 and 9 years in 5 (41.7%) and between 10 to 15 years in five. At the time of presentation, 9 patients (75%) were in a cachectic state; 10 had lymphadenopathies, splenomegaly and hepatomegaly; and 2 had neurological involvement. The delay for definitive diagnosis was 5 months in 4 cases (33,3 %) and less than 5 months in the remaining cases. Initial white blood cell count was more than 50 000/mm3 in 10 cases and less less than 50 000/mm3 in 2 cases. All patients were treated using the LAL GFAOP protocol including LAL1 in 6 cases, LAL2 in 5 and LAL3 in 1. Treatment complications were included 6 undocumented infections in 6 cases, hemorrhage in 2 and severe anemia in 4. Four patients died. At 5 years follow-up, overall survival rate was 66,7%.
A multicentric study including a greater number of children is needed to increase understanding of the characteristics of childhood acute lymphoblastic leukemia in sub-Saharan Africa.
Médecine tropicale: revue du Corps de santé colonial 12/2011; 71(6):629-31.
[Show abstract][Hide abstract] ABSTRACT: In 2003, Mali introduced intermittent preventive therapy in pregnancy (ITPp) with sulfadoxine-pyrimethamine (SP) for the control of malaria in pregnancy, consisting of 2 doses of SP given in the 2nd and 3rd trimester. This widely used regimen, although very effective, leaves many women unprotected from malaria during the last 4-to-8 weeks of gestation, which is a pivotal period for fetal weight gain. The aim of the study was to compare the efficacy and safety of 3-dose versus 2-dose IPTp-SP for the prevention of placental malaria and associated low birth weight (LBW).
We conducted a parallel-group, open-label, individually randomized controlled superiority trial involving 814 women of all gravidity, enrolled from April 2006 through March 2008. All women were seen at least 3 times and received either 2 (n = 401) or 3 (n = 413) doses of IPTp-SP. The primary endpoint measured was placental malaria, LBW, preterm births, and maternal anemia were secondary endpoints, and severe maternal skin reactions and neonatal jaundice were safety endpoints.
Among the 96% of study subjects who were followed up until delivery, the prevalence of placental malaria was 2-fold lower in the 3-dose group (8.0%) than in the 2-dose group (16.7%); the adjusted prevalence ratio (APR) was 0.48 (95% confidence interval [CI], 0.32-0.71). LBW and preterm births were also reduced; the prevalence of LBW was 6.6% in the 3-dose group versus 13.3% in the 2-dose group (APR, 0.50; 95% CI, 0.32-0.79), and the prevalence of preterm births was 3.2% versus 8.9% (APR, 0.37; 95% CI, 0.19-0.71). No significant reductions in maternal anemia or differences in safety endpoints were observed.
Adding a third dose of ITPp-SP halved the risk of placental malaria, LBW, and preterm births in all gravidae, compared with the standard 2-dose regimen, in this area of highly seasonal transmission with low levels of SP resistance. Clinical Trials Registration: ISRCTN 74189211.
[Show abstract][Hide abstract] ABSTRACT: Introduction. The aim of this retrospective, unicentric study over 5 years is to describe the epidemiologic, pathologic, clinic and therapeutic aspects of children treated for Hodgkin lymphoma in our paediatric oncology unit. Patients and Methods. From January 2005 to December 2009, all children under 18 years of age, with Hodgkin lymphoma were included in this study. The treatment protocol was the GFAOP (Groupe Franco-Africain d'Oncologie Pédiatrique) Hodgkin lymphoma treatment protocol. Results. During the study period, 217 cancer cases were diagnosed in our centre. Of these cases, 7 were Hodgkin Lymphoma (LH) (0.04%). The mean age was 11.7 years. The sex-ratio was 6/1. 4% (5/7) of patients were stage IIB and 28.6% (2/7) stage IIIB of Ann-Arbor classification. There were 3 cases (42.8%) of sclero-nodular subtype, 2 cases (28.6%) of lymphocyte-rich classical HL subtype, 1 case (14.3%) of mixed cellularity and 1 case (14.3%) of lymphocyte depleted subtype. With a median followup of 37 months, 5 patients (71.4%) are alive, and 2 patients (28.6%) died. Conclusion. Broader multicentric studies are needed for more accurate data on this malignancy.
[Show abstract][Hide abstract] ABSTRACT: The prevalence of epilepsy in Sub-Saharan Africa is about 15 per thousand; against 6 to 8 per thousand in industrialized countries. Health, social, economic conditions and misknowledge could explain this situation. The objective of this survey was to study the knowledge of parents of children with or without epilepsy about this disease in Mali. 423 adults were interviewed, 15% children with epilepsy. The mean age was 34 ± 9,3 years; females represents 60% of the population. 26% of interviewed subjects heard about epilepsy from their neighbourhood, 20% from traditional healers, 11% from health care professional; the tonic-clonic crisis was the most known form of the disease. 59% thought epilepsy to be contagious. The organicity of the disease was known by 51% of the population. 23 % of the population believed there was a link between the onset of the crisis and the presence of the hole moon. 78% of subjects have already seen at least one crisis of epilepsy, but only 33% have got an attitude of first help that was to pour fresh water on the face of the patient in 22% of cases. 57% of subject's acknowledge having as first recourse traditional medicine. The fight against epilepsy in Mali as in the others countries of the third world should go through information and education of the population, in particular parents.
[Show abstract][Hide abstract] ABSTRACT: Introduction Approximately 20 000 new cases of Hodgkin lymphoma are diagnosed each year in North America and Europe. However in Africa,
the incidence of this condition is almost unknown. While publications from western countries and the rest of world are numerous
in the literature, few data from Africa about this malignancy are available. The aim of this retro and prospective, unicentric
study over 3 years is to describe the epidemiologic, pathologic, clinical and therapeutic aspects of children treated for
Hodgkin lymphoma in our paediatric oncology unit of Gabriel-Touré Hospital, Bamako (Mali).
Patients and methods From January 2005 to December 2007, all children under 18 years of age, with histologically proven Hodgkin lymphoma, not previously
treated by chemotherapy and HIV negative, were included in this study. Informed consent was obtained from parents. The treatment
protocol was the GFAOP (Groupe franco-africain d’oncologie pédiatrique) Hodgkin lymphoma treatment protocol: COPP/ABV (Cyclophosphamid,
Vincristin, Prednisone, Procarbazin, Adriamycine, bleomycin and vinblastine).
Results During the study period, 217 cancer cases were diagnosed in our centre. Of these cases, 7 were Hodgkin Lymphoma (0.04%). The
average age was 11.7 years. The sex-ratio was 6/1 in favor of boys. 6.71% (5/7) of the patients were stage IIB and 28.6 %
(2/7) of the patients were stage IIIB of the Ann-Arbor classification. Histologically, there were 42.8% cases of sclero-nodular
subtype, 28.6% of lymphocyte-rich subtype, 14.3 % of mixed cellularity and 14.3% of lymphocyte depleted subtype. After 4 years
follow-up, 5 patients (71.4 %) were alive, and 2 patients (28.6 %) had died from drug toxicity.
Conclusion Hodgkin lymphoma is a relatively rare condition in African children which can be cured. Broader multicentric studies are needed
for more accurate data on this malignancy.
Journal africain du cancer / African Journal of Cancer 01/2011; 3(2):98-103.