Optimization for a long-term electricity supply strategy with renewable energy is essential for electricity security and financial and environmental sustainability. The main goal of this study is to find the equilibrium between electricity demand and sustainable optimal electricity supply mix scenarios of the Taoussa area at the least cost for the development of north in Mali, by using the Model for Energy Supply Strategy Alternatives and their General Environmental Impact (MESSAGE) from the International Atomic Energy Agency (IAEA) for the period 2020-2035. This model is applied to obtain the least-cost electricity and supply of electricity under electricity demand forecasted by reference scenario (RS) and two alternative scenarios (Low scenario, LS; High scenario, HS), technical information on power generation per technology and regional information. The result obtained from the optimization of the power management strategy shows that the final electricity generation is 1.02 times greater than the electricity demand and the annual increase of power generation is equivalent to 8.13%, 10.32% and 12.56%, under different scenarios. The maximum power from PV and hydropower by scenarios are from April to May in the hot season. Thus, the proposed MESSAGE model is useful in improving the economical-environmental optimization of the operation of large-scale hybrid renewable electricity supply.
Cryptococcosis and tuberculosis are life-threatening opportunistic infections that occur in apparently immunocompetent or severely immunocompromised individuals worldwide. As both infections are strongly linked to HIV infection, they may share certain clinical manifestations, and the interaction of their treatments should be considered. However, despite their similarity, concurrent tuberculosis and cryptococcal infections have rarely been reported in West Africa. Herein, we present 3 cases of neuromeningeal cryptococcosis and lung tuberculosis coinfection collected prospectively over a year at the Department of Infectious Diseases of the Point G Teaching Hospital in Bamako. Two patients had HIV disease, and the third patient had no underlying immunosuppressive illnesses. Thus, active screening for tuberculosis and cryptococcosis, particularly in individuals with HIV, can reduce misdiagnosis and ensure appropriate coinfection management. Moreover, this may reduce mortality due to AIDS-related opportunistic infections in resource-limited settings.
Objectives: To analyze the clinical and biological characteristics and to evaluate the risk factors associated to the mortality of patients with COVID-19 in Commune 4 of the District of Bamako. Methods: The cohort consisted of COVID-19 patients treated from March 2020 to June 2022 at the Bamako Dermatology Hospital and the Pasteur private Polyclinic in Commune 4 in Bamako. The variables studied were sociodemographic, clinical and biological. For the analysis of deaths, explanatory variables were grouped into sociodemographic factors, comorbidities and symptoms. Binomial logistic regression models were used to test the risk factors for mortality. Results: Among the 1319 patients included, 38.4% were asymptomatic, 46% and 15.5% developed moderate and severe forms respectively. The predominant signs were cough (48.5%), respiratory difficulty (24.6%) and headache (19.7%). There was a male predominance of 58.2%. High blood pressure (19.9%) and diabetes (10%) are the main comorbidities. Men were in the majority (58.2%). High blood pressure (19.9%) and diabetes (10%) are the main comorbidities. D-dimer<500µg/l was found in 53.3% of cases and the mean hemoglobin level was 12.9±1.7g/l. The case fatality rate was 3.71% in our series. In bivariate analysis, age>60 years, High blood pressure, diabetes, clinical severity, D-dimer <500 µg/l were associated with death. By the logistic regression method, age >60 years, increased heart rate, the severity of disease and mainly acute respiratory distress syndrome (polypnea, respiratory difficulty) were the factors associated with death. Conclusion: These main findings elucidate the factors associated with severity and lethality outside of health care system constraints. Old age, heart rate and the development of respiratory distress were the factors associated with increased fatalities.
The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference (MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse [95%CI] into MUAC < 125 mm and/or edema was 26.1% [21.7; 30.8] and 1.7% [0.6; 3.6] to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.
Experimental studies on the biology of malaria parasites have mostly been based on laboratory-adapted lines, but there is limited understanding of how these may differ from parasites in natural infections. Loss-of-function mutants have previously been shown to emerge during culture of some Plasmodium falciparum clinical isolates in analyses focusing on single-genotype infections. The present study included a broader array of isolates, mostly representing multiple-genotype infections, which are more typical in areas where malaria is highly endemic. Genome sequence data from multiple time points over several months of culture adaptation of 28 West African isolates were analysed, including previously available sequences along with new genome sequences from additional isolates and time points. Some genetically complex isolates eventually became fixed over time to single surviving genotypes in culture, whereas others retained diversity, although proportions of genotypes varied over time. Drug resistance allele frequencies did not show overall directional changes, suggesting that resistance-associated costs are not the main causes of fitness differences among parasites in culture. Loss-of-function mutants emerged during culture in several of the multiple-genotype isolates, affecting genes (including AP2-HS, EPAC and SRPK1) for which loss-of-function mutants were previously seen to emerge in single-genotype isolates. Parasite clones were derived by limiting dilution from six of the isolates, and sequencing identified de novo variants not detected in the bulk isolate sequences. Interestingly, several of these were nonsense mutants and frameshifts disrupting the coding sequence of EPAC, the gene with the largest number of independent nonsense mutants previously identified in laboratory-adapted lines. Analysis of genomic identity by descent to explore relatedness among clones revealed co-occurring non-identical sibling parasites, illustrative of the natural genetic structure within endemic populations.
Contact burns involving the joints of the lower limbs are rare. When these burns are of the fourth degree, their treatment becomes a real challenge because they can damage important anatomical elements in statics and locomotion such as muscles, tendons, and bones. The functional prognosis of the lower limbs can be seriously compromised. We report the case of a steel worker, victim of a work accident that caused burns and deep wounds to the knee and contralateral ankle, with section of the patellar and Achilles tendons. Immediate surgical treatment with debridement of the burned and severed tissues and direct suture of the injured tendons, combined with a long period of rehabilitation, allowed the patient to return to his workstation.
Background: Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting. Methods: We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings. Results: The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound score < 3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23 ± 5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of - 0.38, p < 0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patients' age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score. Conclusion: Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality.
Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24–72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-
Abstract Background Soil is a basic natural resource for the existence of life on earth, and its health is a major concern for rural livelihoods. Poor soil health is directly associated with reduced agricultural land productivity in many sub-Saharan countries, such as Mali. Agricultural land is subjected to immense degradation and the loss of important soil nutrients due to soil erosion. The objective of the study was to diagnose the spatial distribution of soil erosion and soil nutrient variations under different land use in two agroecological zones of Southern Mali using the Geographical Information System (GIS) software, the empirically derived relationship of the Revised Universal Soil Loss Equation, in-situ soil data measurement and satellite products. The soil erosion effect on agricultural land productivity was discussed to highlight the usefulness of soil and water conservation practices in Southern Mali. Results The results of the land use and land cover change analysis from 2015 to 2019 revealed significant area reductions in water bodies, bare land, and savanna woodland for the benefit of increased natural vegetation and agricultural land. There was significant variation in the annual soil loss under the different land use conditions. Despite recordings of the lowest soil erosion rates in the majority of the landscape (71%) as a result of field-based soil and water conservation practices, the highest rates of erosion were seen in agricultural fields, resulting in a reduction in agricultural land area and a loss of nutrients that are useful for plant growth. Spatial nutrient modelling and mapping revealed a high deficiency and significant variations (p
Older cancer patients are disproportionally affected by the Coronavirus 19 (COVID-19) pandemic. A higher rate of death among the elderly and the potential for long-term disability have led to fear of contracting the virus in these patients. This fear can, paradoxically, cause delay in diagnosis and treatment that may lead to a poor outcome that could have been prevented. Thus, physicians should devise a policy that both supports the needs of older patients during cancer treatment, and serves to help them overcome their fear so they seek out to cancer diagnosis and treatment early. A combination of telemedicine and a holistic approach, involving prayers for older cancer patients with a high level of spirituality, may improve vaccination rates as well as quality of life during treatment. Collaboration between health care workers, social workers, faith-based leaders, and cancer survivors may be crucial to achieve this goal. Social media may be an important component, providing a means of sending the positive message to older cancer patients that chronological age is not an impediment to treatment.
There are many claims to the benefits of open access publishing in general and for Africa in particular. This study aimed to describe the characteristics of scholarly journals expected to publish articles on public health from a number of African countries. Using African Journals Online and African Index Medicus, 174 journals from 13 African countries were identified. The six countries above the group’s median gross domestic product (GDP) published 145 journals, while the seven countries at or below the median GDP published 29 journals. Two thirds of the journals were freely available to download, but only a third had a Creative Commons licence, and most were not indexed. Around half of the journals levied full article processing charges (APCs) – journals from countries at median GDP or below were less likely to charge APCs than those from countries above the median GDP. One of the key findings is that only a few journals were indexed, limiting the ability of potential readers to find the results of research performed in local settings. The results suggest a need to assist journals and researchers to make the work they publish more accessible to the audience who might want to use the results.
In this paper, we empirically explore the dynamic relationship between fertility, employment, and the demographic dividend in an African incipient demographic transition country namely, Mali. More precisely, we adopt a dynamic macro-econometric modeling approach to deal with the issue from 1990 to 2019. Our results indicate that employment has a direct and permanent positive effect on the demographic dividend in Mali as found by the literature. However and contrary to the conventional view in the literature, we interestingly find that fertility has a positive and significant long-run effect on the demographic dividend in Mali, although it seems to have non-significant short-run effects. Two persistent driving forces help to explain this fertility puzzle: (i) the desire of Malians to have a large family coupled with households’ low living standards, and (ii) the dominance of the informal economy. As families willingly grow, the situation progressively puts pressure on households and particularly on women to engage in informal employment to meet their additional needs. The increase in informal employment has in turn positive effects on the demographic dividend. This finding provides crucial policy implications for Malian policymakers, notably in terms of rethinking policies towards capturing an efficient demographic dividend through enhancing labor productivity in the informal economy, rather than focusing on fertility reduction policies.
Context: Adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is debated as benefits are inconstant. Molecular signatures for DCIS have been developed to stratify the risk of local recurrence (LR) and therefore guide the decision of RT. Objective: To evaluate, in women with DCIS treated by BCS, the impact of adjuvant RT on LR according to the molecular signature risk stratification. Methodology: We conducted a systematic review and meta-analysis of five articles including women with DCIS treated by BCS and with a molecular assay performed to stratify the risk, comparing the effect of BCS and RT versus BCS alone on LR including ipsilateral invasive (InvBE) and total breast events (TotBE). Results: The meta-analysis included 3478 women and evaluated two molecular signatures: Oncotype Dx DCIS (prognostic of LR), and DCISionRT (prognostic of LR and predictive of RT benefit). For DCISionRT, in the high-risk group, the pooled hazard ratio of BCS + RT versus BCS was 0.39 (95%CI 0.20-0.77) for InvBE and 0.34 (95%CI 0.22-0.52) for TotBE. In the low-risk group, the pooled hazard ratio of BCS + RT versus BCS was significant for TotBE at 0.62 (95%CI 0.39-0.99); however, it was not significant for InvBE (HR = 0.58 (95%CI 0.25-1.32)), Discussion: Molecular signatures are able to discriminate high- and low-risk women, high-risk ones having a significant benefit of RT in the reduction of invasive and in situ local recurrences, while in low-risk ones RT did not have a benefit for preventing invasive breast recurrence. The risk prediction of molecular signatures is independent of other risk stratification tools developed in DCIS, and have a tendency toward RT de-escalation. Further studies are needed to assess the impact on mortality.
IntroductionIn rainfed agricultural systems, sustainable and efficient water management practices are key to improved agricultural productivity and natural resource management. The agricultural system in sub-Saharan Africa (SSA) relies heavily on the availability of rainfall. With the erratic and unreliable rainfall pattern associated with poor and fragile soils, agricultural productivity has remained very low over the years. Much of the SSA agricultural land has been degraded with low fertility as a result of ongoing cultivation and wind and water erosion. This has resulted in an increased food shortage due to the ever-increasing population and land degradation. Better agricultural and nutritional security are further hampered by the lack of reliable access to the available water resources in the subsurface hydrological system.Methods This study used socio-economic data from 112 farm households and Boolean and Fuzzy methods to understand farmers' perceptions and identify suitable areas to implement Solar Based Irrigation Systems (SBISs) in the agro-ecologies of Bougouni and Koutiala districts of southern Mali.Results and discussionResults revealed that the usage of SBISs has been recent (4.5 years), majorly (77%) constructed by donor-funded projects mainly for domestic water use and livestock (88%). With regards to irrigation, vegetable production was the dominant water use (60%) enabling rural farm households to gain over 40% of extra household income during the dry season. Results further showed that 4,274 km2 (22%) of the total land area for the Bougouni district, and 1,722 km2 (18%) of the Koutiala district are suitable for solar-based irrigation. The affordability of solar panels in many places makes SBISs to be an emerging climate-smart technology for most rural Malian populations.
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.
Currently, microencapsulation has become a viable method of nutrient delivery for the food industry. This work microencapsulated the bioactive compounds extracted from two neglected species (Balanites aegyptiaca and Ziziphus mauritiana) by freeze-drying. A combination of wall materials (whey protein and pectin; soy protein and maltodextrin) was chosen to prepare the microcapsules. The phytochemical and physicochemical characterization of the microcap-sules was then carried out. The encapsulation yield ranged from 82.77% to 96.05% for Balanites and Ziziphus, respectively, whereas the efficiency was 76.18 ± 1.39% and 80.93 ± 1.71%. The stimulated in vitro gastrointestinal test showed that encapsulation increased the bioavailability of the bioactive compounds. The total carotenoids were the most bioavailable compounds with 85.89 ± 0.06% for Ziziphus and 70.46 ± 1.10% for Balanites, followed by total flavonoids for Zizyphus with 63.27 ± 1.56%. Furthermore, regardless of species or wavelengths, the HPLC analysis resulted in the identification of 17 bioactive metabolites. The predominant one was epicatechin, whose level ranged from 231.52 ± 5.06 to 250.99 ± 3.72 mg/100 g DW in Ziziphus and 91.80 ± 3.85 to 116.40 ± 4.09 mg/100 g DW in Balanites. In estimating the enzyme inhibition and antioxidant power, both studied fruits showed antidiabetic, inflammatory, and antioxidant effects. These findings suggest that natural bioactive compounds are abundant in the fruits of Z. mauritiana and B. aegyptiaca and could be a valuable source for the food and pharmaceutical industries.
Background: Despite recent advances in the development of more sensitive technologies for the diagnosis of tuberculosis (TB), in resource-limited settings, the diagnosis continues to rely on sputum smear microscopy. This is because smear microscopy is simple, cost-efficient and the most accessible tool for the diagnosis of TB. Our study evaluated the performance of light-emitting diode fluorescence microscopy (LED-FM) using auramine/rhodamine (auramine) and the fluorescein di-acetate (FDA) vital stain in the diagnostic of pulmonary TB in Bamako, Mali. Methods: Sputum smear microscopy was conducted using the FDA and auramine/rhodamine staining procedures on fresh samples using LED-FM to evaluate the Mycobacterium TB (MTB) metabolic activity and to predict contagiousness. Mycobacterial culture assay was utilized as a gold standard method. Results: Out of 1401 TB suspected patients, 1354 (96.65%) were retrieved from database, which were MTB complex culture positive, and 47 (3.40%) were culture negative (no mycobacterial growth observed). Out of the 1354 included patients, 1343 (95.86%), were acid-fast bacillus (AFB) positive after direct FDA staining, 1352 (96.50%) AFB positive after direct Auramine, and 1354 (96.65%) AFB positive with indirect auramine after digestion and centrifugation. Overall, the FDA staining method has a sensitivity of 98.82%, while the sensitivity of Auramine with direct observation was 99.48%, and 99.56% with the indirect examination. Conclusion: This study showed that, using fresh sputum both auramine/rhodamine and FDA are highly sensitive methods in diagnosing pulmonary TB and could be easily used in countries with limited resource settings.
Non-governmental organizations play a vital part in the achievement of the Sustainable Development Goals as defined by the United Nations. These Goals also include targets related to noncommunicable diseases. However, non-governmental organizations have played a limited role in this area despite such diseases causing the bulk of morbidity and mortality worldwide. Through their activities, non-governmental organizations should aim to strengthen health systems, yet they often only support these for a single disease. Mali, like many other low- and middle-income countries, is facing an increasing burden of diabetes and a health system not adapted to address this challenge. Santé Diabète, a non-governmental organization based in Mali since 2003, has been working specifically on diabetes, and has developed a wide range of activities to improve the national health system. This paper describes changes in the diabetes environment in Mali between 2004 and 2018 based on two health system assessments carried out using a Rapid Assessment Protocol. Over this period, the health system was strengthened with regard to financing and access to medical products. Leadership and governance, service delivery and health workforce were all improved but still partially rely on sustained support from Santé Diabète. The key lesson from this study is that to be effective in changing the management of noncommunicable diseases in a low- and middle-income country, non-governmental organizations need to play a variety of roles, many of which may change over time. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
The linguistic reality in Bamako, Mali, has made it commonplace that most interactions are performed in a language combining Bambara and French. The reason is certainly that Bamako, as some researchers suggest, is an ethnic and linguistic melting pot. This “hybrid” language seems to have downgraded the notion of language delimitations, hence affecting consequently the identity of each language. In other words, Bambara seems to be an excuse for escaping the successful use of French while interactions in Bambara are significantly dominated by French. It is believed that such a situation favours none of the two languages at play. Already, initial observation has made it possible to assert that the most perceptible manifestations of code-switching in this particular context are intrasentential and extrasentential. To confirm this claim, the present paper will adopt a conversation analytical approach, based on the recording of naturally occurring language.
Study region Regions of Bamako, Kati and Kangaba, southwestern Mali Study focus Machine learning-based mapping of borehole yield. Three algorithms were trained on an imbalanced multiclass database of boreholes, while twenty variables were used as predictors for borehole yield. All models returned balanced and geometric scores in the order of 0.80, with area under the receiver operating characteristic curve up to 0.87. Three main methodological conclusions are drawn: (a) The evaluation of different machine learning classifiers and various resampling strategies and the subsequent selection of the best performing ones is shown to be a good strategy in this type of studies; (b) ad hoc calibration tools, such as data on borehole success rates, provide an apt complement to standard machine learning metrics; and (c) a multiclass approach with an unbalanced database represents a greater challenge than predicting a bivariate outcome, but potentially results in a finer depiction of field conditions. New hydrological insights for the region Alluvial sediments were found to be the most productive areas, while the Mandingue Plateau has the lowest groundwater potential. The piedmont areas showcase an intermediate groundwater prospect. Elevation, basement depth, slope and geology rank among the most important variables. Lower values of clay content, slopes and elevations, and higher values of basement depth and saturated thickness were linked to the most productive class.
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