Introduction: COVID-19 is an acute respiratory syndrome caused by the novel coronavirus, SARS-CoV2. This infectious disease is a zoonosis, the origin of which is still debated, which emerged in December 2019 in Wuhan, in the province of Hubei in China. The spread of SARSCoV-2 in China led to a pandemic, declared on March 11, 2020 by the WHO. From March 25, 2020, Mali recorded its first two epidemics with two (2) confirmed cases. The objective of our study was to assess individual attitudes and practices in the face of barrier measures during the Covid-19 crisis in Commune V and VI of the District of Bamako. Method: A cross-sectional study with prospective collection was carried out from December 1, 2021 to February 1, 2022. The target population of our study was people aged at least 18 years or older. Data were processed and analyzed using SPSS version 20.0 software. Result: A total of 200 people were surveyed. The most represented age group was people aged 18 to 28 with 54%. The male sex predominated in 69% of cases. 68% of our respondents believed in the existence of coronavirus disease. Hand washing, the use of hydro-alcoholic gel and the wearing of masks were respected respectively at 69.5%; 60.5% and 54.5%. Conclusion: For better prevention against this epidemic, it is important to raise public awareness to respect the barrier measures recommended by the WHO.

The aim of this study was to assess dosing errors when administering ivermectin (IVM) according to height, using a measuring cup with reference to the manufacturer's recommended dosage according to weight. For this purpose, a secondary analysis of the database of a community trial conducted in the health districts of Bougouni and Kolondièba was carried out. This made it possible to assess the proportions of participants who received underestimated doses, and to identify the factors associated with underestimation of IVM dose when using the toise. In all, 8.6% of participants (258/3011) received an underestimated dose. Of these, the most represented age group was the under-10s, with 63.18% (163/258), and the over-20s, with 25.19% (65/258). There was a significant correlation between missing dose quantities and height (r=17.1%, p=0.00593), as well as age (r=14.2%, p=0.02227). Participants under 10 years of age were 2.62 times (OR= 2.62; 95% CI: 1.58 - 4.43) more likely to be under-dosed than those aged 10 and over. Having a height of 120 cm or more made a participant 22.5 times (OR= 22.5; 95% CI: 13.5 - 38.4) more likely to be underdosed compared to those with a height ranging from 90 to 119 cm. These results suggest that it is crucial to make adequate adjustments to ensure a favorable response in CT participants in areas receiving MVI.

Objectif : La transmission mère-enfant du VIH durant l’allaitement est un problème de santé publique. Le but de cette étude était d’évaluer l’intérêt du suivi thérapeutique pharmacologique des femmes allaitantes sous ARV et leurs enfants à Bamako. Méthodes : Les patientes ont été recrutées du 1er septembre 2015 au 30 septembre 2016 suite à l’obtention de leur consentement éclairé. Les mères et leur enfant ont été suivis dans le service de pédiatrie du CHU Gabriel Touré. Les charges virales plasmatiques ont été réalisées à l’UCRC de Bamako. La détermination des concentrations plasmatiques des médicaments a été réalisée au laboratoire de Pharmacocinétique de Toulouse. Les données ont été saisies et analysées sur le logiciel SPSS version 20. Résultats : L’âge moyen des mères était de 29ans±75 [19-41ans]. A J0, une seule des patientes avait une charge virale plasmatique détectable soit 3,33%(6610copies/ml) et 73,91% des mères avaient un taux de CD4 supérieur à350cellules/mm3. Après 6mois, nous avions trouvé 3 mères qui avaient une charge virale détectable (200copies/ml ; 72copies/ml et 4777 copies/ml) et 86,36% des mères avaient un taux de CD4 supérieur à350cellules/mm3. Les concentrations plasmatiques médianes mères du lopinavir, de l’efavirenz à 3 mois étaient respectivement de 5770ng/ml ; 3505ng/ml et à 6 mois de 5850ng/ml ; 3245ng/ml. Tous les nourrissons avaient une PCR négative à 3 mois et 6 mois de suivi. Conclusion : La mesure des paramètres biologiques constitue un maillon essentiel dans la prise en charge des femmes allaitantes VIH positif au Mali.

OBJECTIVE:The aim of our study was to evaluate the frequency, type, and risk factors associated with adverse drug reactions (ADRs) in HIV-positive children with adherence to antiretroviral therapy (ART) at the Unit of Care and Accompaniment for People Living With HIV (USAC) of Bamako.METHODS:A cross-sectional study was conducted at USAC of Bamako from May 1, 2014, to July 31, 2015. We included children aged 1 to 14 years with at least 6 months of ARV treatment initiated at USAC, with or without ADRs. Data collection was based on information collected from parents and clinical/biological assessments.RESULTS:Median age of participants was 36 months and female sex was predominant (54.8%). Poor adherence during the study was observed in 15% of cases. Of patients in the study, 52% had a CD4 count less than 350 cells/mm3 at the time of adverse events. In bivariate analysis, we found that participants with adherence to ART tended to be younger than those with non-adherence to ART (36 vs 72 months, p = 0.093). In multivariable analysis, prophylactic treatment was the only factor marginally associated with ART adherence in HIV patients (p = 0.09). No other adverse biological effects or clinical conditions were associated with ART adherence in this study.CONCLUSIONS:In this study we found that ADRs were frequent in HIV-positive patients but less frequent in ART-adherent HIV-positive children. Therefore, it is essential to regularly monitor children receiving ARVs to detect and treat the complications associated with these therapies according to ART adherence.

A liquid chromatography tandem mass spectrometry (LC-MS/MS) method has been validated for quantification of three antiretroviral drugs (efavirenz [EFV], lopinavir [LPV], and ritonavir [RTV]) from human breast milk. The samples were extracted employing protein precipitation method using methanol as precipitating agent. The supernatant was evaporated and reconstituted before injecting into the chromatograph and separated on a biphenyl column. Calibration curves for the three tested antiretroviral drugs were linear (r ≥ 0.999) over the range examined. The inter- and intra-day coefficients of variation (CV) were ≤15% for efavirenz, lopinavir, and ritonavir. Mean recovery ranged from 96% to 105% and no major matrix effects were observed. This validated LC-MS/MS method was efficiently applied to determine EFV, LPV, and RTV concentrations in breast milk from Human Immunodeficiency Virus (HIV)-positive breastfeeding mothers. This assay requires a simple sample processing method with a short run time, making it well suited for high-throughput routine clinical or research purposes.

In order to improve therapeutic compliance and prevent antimalarial drug resistance, we conducted this study to evaluate the knowledge of physicians and pharmacists in Kayes on the management of adverse effects of antimalarial drugs. Methods: A cross-sectional study was conducted from July to November 2017 among physicians and pharmacists selected by simple random sampling and practicing in the Kayes region for more than one year. The survey was based on a questionnaire proposed by the national pharmacovigilance center. In addition to a descriptive analysis of the results, a logistic regression analysis was performed to assess potential factors that could be associated with knowledge. Results: Among 151 physicians and pharmacists participated in the study, less than 40% had better knowledge about the management of antimalarial drug adverse events. Physicians and pharmacists working in government facilities were more likely to have better knowledge compared with those working in other facilities (OR=8.38; 95% CI: 2.48-28.30). In addition, pharmacists were more likely to have better knowledge than physicians (OR=3.48; 95% CI: 1.21-12.19). Conclusions: The frequency of good knowledge of the management of adverse drug reactions to antimalarials is insufficient, although membership in government structures and profession seem likely to improve it.

RESUME Introduction. Le paludisme constitue la premiere cause de mortalite infantile. La chimio prevention du paludisme saisonnier (CPS) est recommandee par l’Organisation Mondiale de la Sante depuis 2012 et appliquee la meme annee. Nous avons mene ce travail avec pour objectif d’evaluer l’impact de la CPS sur la mortalite et la morbidite du paludisme des enfants de 3-59 mois a Dire, zone de conflit. Materiels et methodes. Il s’est agi d’une etude descriptive transversale de type evaluatif de juillet octobre 2018 dans quatre centres de sante de Dire (CSREF, CSCOM central de Dire, CSCOM de KIRCHAMBA, CSCOM de BOUREM SIDI AMAR). Les enfants ayant recus la CPS et leurs accompagnants ont ete inclus. Les donnees ont ete collectees a partir de registres des centres et des interviews des gardiens d’enfants puis comparees a celles de 2011 sans CPS. Resultats. Trois cent dix enfants de 3 -59 mois dont 10% positifs au TDR/GE, 34% des participants possedaient des cultures intra-domiciliaires. Une reduction de 41% d’incidence et 15% de mortalite comparees a l’incidence de 2011. Le vomissement representait 69% des effets secondaires et la moyenne de couverture en 2013 etait de 96,9%. Une reduction d’incidence de 41% et de mortalite de 15% ont ete notes comparativement aux donnees de 2011. Conclusion. La CPS et les autres interventions de lutte contre le paludisme ont permis de reduire le poids de la maladie. Ces donnees suggerent de maintenir les campagnes de CPS dans les zones a d’acces limite. Les recherches sur la gestion des effets indesirables sont necessaires. ABSTRACTIntroduction. Malaria is the leading cause of infant mortality. WHO recommended in 2012 the implementation in countries with high endemics, of intermittent preventive treatment distribution campaigns in children under 5 years and pregnant women at the start of the transmission season? The objective of our study was to assess the impact of SPC on mortality and morbidity from malaria in the Dire health district during conflict. Materials and methods. We conducted a cross-sectional and retrospective study in four health centers in Dire (The CSREF, the central CSCOM of Dire, the CSCOM of KIRCHAMBA and the CSCOM of BOUREM SIDI AMAR) from July to October 2018. Children aged 3- 59 months having received the CPS and their consenting companions were included in this study. The data (from 2013 to 2016) were then compared to that of 2011 without CPS. Results. A total of 310 children and their careers were included, 10% of whom were TDR / GE positive, 97% of the participants used MILD, 34% had intra-home cultures. A 41% reduction in incidence and 15% average mortality compared to the incidence in 2011. Vomiting accounted for 69% of side effects and the average coverage in 2013 was 96.9%. A reduction in incidence of 41% and mortality of 15% were compared to the data of 2011. Conclusion. CPS and other malaria control interventions have reduced the burden of the disease. These data suggest maintaining SMC campaigns in areas with limited access. Research on the management of side effects is needed.

RESUMEIntroduction. Le paludisme est un probleme majeur de sante publique au Mali. Nous avons effectue une etude pilote sur la faisabilite du test rapide de diagnostic du paludisme (TDR) en officine privee de pharmacie chez les patients demandeurs de conseils d’antipaludiques. Methodes. Nous avions effectue une etude transversale descriptive allant du 1er juillet 2017 au 31 octobre 2017. Un consentement ecrit a ete obtenu avant l’inclusion. Les donnees ont ete saisies et analysees sur le logiciel SPSS version 21. Resultats. Au total 101 patients ont ete inclus dont 47patients ont acceptes le test TDR et 54 patients ont refuse le test TDR. Le premier recours aux soins etait l’officine de pharmacie 40,4%. Les signes cliniques des patients etaient domines par la fievre 23%. Le TDR etait positif dans 38% des cas. Le cout median des antipaludiques sur conseils etait de 2870FCFA. Parmi les patients, 39 ont trouve une guerison soit 83%, un cas de transfert a l’hopital et 7 cas de perdus de vue. Conclusion. La faisabilite du TDR en officine etait bonne. L’utilisation du test permet de rationaliser les conseils des medicaments antipaludiques en officine.ABSTRACTIntroduction. Malaria is a major public health problem in Mali. We carried out a pilot study on the feasibility of the rapid diagnostic test for malaria (RDT) in private pharmacies in patients seeking antimalarial advice. Methods. We performed a descriptive cross-sectional study from July 1, 2017 to October 31, 2017. Write consent was obtained prior to inclusion. Data were entered and analyzed on SPSS version 21 software. Results. A total of 101 patients were included, of which 47 patients accepted the RDT test and 54 patients refused the TDR test. The first resort to treatment was the pharmacy 40.4%. The clinical signs of the patients were dominated by fever 23%. The RDT was positive in 38% of cases. The median cost of antimalarial drugs on advice was CFAF 2,870. Among the patients, 39 found a cure or 83%, one case of transfer to the hospital and 7 cases of lost to follow-up. Conclusion. The feasibility of RDT in pharmacies was good. The use of the test helps to streamline the advice of antimalarial drugs in pharmacies.

The use of antimicrobials without microbiological proof is frequent and contributes to the emergence of resistance. The aim was to identify the organisms isolated during laboratory examinations and the type of antimicrobials consumed by patients hospitalized to Infectious Diseases’ Clinic. This is a cross-sectional and analytical study, carried out from January 1 to December 31, 2017 in the Infectious Diseases Department of Point “G” Teaching Hospital in Mali. All biological specimens from patients during the study period were analyzed. In total, 322 patients benefited from microbiological test, with a mean age of 40.9 ± 12.2 years (range 15 and 74 years) with a sex ratio of 0.93. Only 5.6% of patients were HIV negative. In all participants, a total of 658 microbiological specimen were taken, 224 (34.0%) identified at least one pathogen including bacteria in more than a half of the cases (58.5%). On the report of bacteriological analysis, the most frequently identified organisms were Mycobacterium tuberculosis (42.2%) mainly in sputum; Escherichia coli (24.2%) and Klebsiella pneumoniae (7.8%) commonly in urine and Gardnerella vaginalis (7.0%) exclusively in vaginal secretions. Candida albicans (5/8) and Cryptococcus neoformans (3/8) were the most common fungi while Plasmodium falciparum (96.4%) represented the parasite frequently found in blood. From a therapeutic standpoint, 1143 antimicrobials were prescribed to 322 admitted patients, i.e. 3.55 anti-infectives per patient. Antibiotics (excluding tuberculosis drugs), antiparasitics and antifungals represented respectively 46.2%; 18.8% and 15.1% of anti-infectives. Antibiotic therapy was effective in 274 (85.1%) patients and among them, only 76 (27.7%) cases were based on microbiological evidence. Antibiotics are the most widely used antimicrobials in an infectious disease department. Empiric treatments are common but must be minimized by the search for microbiological evidence.

RESUMEIntroduction. La prise en charge de l’hepatite B n’est pas toujours facile au Mali, la Pharmacie Populaire du Mali (PPM) a adopte une strategie pour rendre le tenofovir disoproxil fumarate accessible aux patients. Le but de l’etude etait d’evaluer la dispensation du tenofovir disoproxil fumarate cp 300 mg a la PPM afin de traiter l’hepatite B au Mali. Materiels et Methodes. L’etude s’est deroulee a la PPM. C’etait une etude retrospective descriptive se deroulant de Septembre 2017 a Aout 2018. Toutes les ordonnances du tenofovir provenant des sites et des prescripteurs retenus par la PPM durant la periode de l’etude ont ete incluses. Les donnees ont ete saisies et analysees par le logiciel SPSS version 25.0. Nous avions obtenu une autorisation de la PPM et un consentement eclaire des patients. Resultats. Au cours de l'etude, 3328 ordonnances ont ete collectees pour 1623 patients pour un total 5538 boites. Les ordonnances etaient totalement servies a 96% et le produit etait disponible durant toute la periode d’etude. La disponibilite etait plus importante en juin avec 2220 boites. Le manque de moyen etait la raison dans 62,3% des cas d’ordonnances non servies. La moyenne du prix des officines privees etait de 15875fcfa. Conclusion. Il y’a un besoin important du medicament pour le traitement de l’hepatite B au Mali. Nous recommandons la continuite de cette experience en allant vers une decentralisation poussee du traitement dans les regions.ABSTRACTBackground. The management of hepatitis B is not always easy in Mali, the Pharmacy Populaire du Mali (PPM) is adopting a strategy aimed at making tenofovir disoproxil fumarate cp 300mg accessible. The aim of this study was to evaluate the dispensing of tenofovir disoproxil fumarate tab 300 mg at the PPM for the treatment of hepatitis B in Mali. Materials and Methods. Our study took place in the PPM. This was a descriptive retrospective study, taking place from September 2017 to August 2018. All prescriptions for tenofovir disoproxil fumarate from sites and prescribers retained by the PPM during the study period were included. Data were entered and analyzed by SPSS software version 25.0. We had obtained authorization from the general management of the PPM and informed consent from the patients. Results. It emerges from this study; 3328 prescriptions were collected for 1623 patients for a total of 5538 boxes. Prescriptions were 96% full and the product was available throughout the study period. Availability was higher in June with 2220 boxes. Lack of resources was the main reason in 62.3% of the missed prescriptions. The average price of private pharmacies was 15,875fcfa. Conclusion. There is a great need for the drug for the treatment of hepatitis B in Mali. We recommend the continuation of this pilot experience, above all by moving further decentralization treatment in the regions.

ABSTRACTObjectif. Il s’agissait d’evaluer la frequence des interactions medicamenteuses decelables cliniquement et/ou biologiquement chez les patients suivis sous traitement antiretroviral au CHU du point G. Methodes. Nous avons realise une etude transversale descriptive, a collecte prospective, etendue sur une periode de huit mois, notamment de mai 2015 a decembre 2015. Elle a concerne les patients sous traitement ARV dans le service des maladies infectieuses du CHU du Point G, qui prennent leurs medicaments dans le service de la pharmacie hospitaliere du CHU du Point G. Un questionnaire a permis de remplir les differentes variables recherchees qui etaient les caracteres sociodemographiques, les types d’interaction medicamenteuse (entre ARV, entre ARV et d’autres traitements), les manifestations cliniques et le grade des effets secondaires clinico-biologiques engendres par ces interactions. L’echantillon etait exhaustif et a ete constitue a partir de tous les patients infectes par le VIH sous traitement ARV. Resultats. Au cours de notre periode d’etude, nous avons collige 231 patients repondant a nos criteres d’inclusion. Le bilan pre-therapeutique etait sans particularite dans 94,8% des cas. Le VIH1 etait largement dominant (95,7% des cas). Les patients sous le schema 2INTI+1INNTI etaient les plus nombreux (86,1%a avec une predominance du TDF/3TC/EFV (77,9%). Le cotrimoxazole 960mg CP etait le medicament predominant (73,58%). Les medicaments conventionnels etaient etaient utilises dans 28,1% contre 26,4% pour les plantes traditionnelles. LPV/r et AZT representaient 47,62% des cas. La seule possibilite d’interaction medicamenteuse de potentialisation etait trimethoprime et 3TC ( 48 cas, 100%). Artemether lumefantrine et LPV/r etaient les seuls presents ( un cas, 100%) avec une possibilite d’interaction de l’inhibition sur le substrat CYP3A4. Conclusion. Notre etude a montre des chiffres appreciables d’observance des patients en termes de bilan pre therapeutique et de bilan du suivi apres trois mois de traitement. Il a aussi montre un pourcentage eleve de patients sous schema 2INTI+1INNTI avec une predominance du TDF/3TC/EFV. La seule possibilite d’interaction medicamenteuse de potentialisation relevee etait trimethoprime et 3TC.RESUMEObjective. To assess the frequency of clinically and / or biologically detectable drug interactions in patients undergoing antiretroviral therapy at the Point G University Teaching Hospital. Methods. This was a cross-sectional descriptive study, that took place in the infectious diseases department of Point G University Teaching Hospital and extended over a period of eight months (May 2015 to December 2015). It concerned all patients on HAART who were takoing their medication in the hospital pharmacy. The sample was exhaustive. Our data of interest were the socio-demographic data, the types of drug interaction (between HAART, between HAART and other medications), the clinical manifestations and the severity of clinical and biological side effects caused by these interactions. Results. During our study period, 231 patients met our inclusion criteria and were recruited. The pre-therapeutic work up was unremarkable for 94.8% of patients. HIV1 was the leading subtype (95.7%). Patients taking 2INTI + 1NNNTI represented 86.1% of cases with a predominance of TDF / 3TC / EFV (77.9%). Cotrimoxazole 960 mg CP was used in 73.58% of cases. Conventional drugs were used in 28.1% while traditional plants were used in 26.4% of cases. LPV/ r and AZT were used in 47.62% of cases. The only possibility of potentiation drug interaction was between trimethoprim and 3TC ( 47 patients, 100%). Artemether lumefantrine and LPV / r were the only potential interaction with a possible inhibition on the CYP3A4 substrate. Conclusion. Our study found high patient compliance in terms of pre-treatment workup, and follow-up after three months of treatment. It also showed a high percentage patients taking the 2INTI + 1NNNTI regimen with a predominance of TDF / 3TC / EFV. The only possibility of potentiation drug interaction was between trimethoprim and 3TC.

RESUMEObjectif. La rage humaine, maladie a declaration obligatoire au Mali, est la dixieme cause de mortalite par maladie infectieuse dans le monde. C’est en 2013 que des cas de rage humaine ont ete hospitalises pour la premiere fois au service des maladies infectieuses du CHU du Point « » de Bamako. L’objectif de ce travail etait de decrire les aspects epidemiologiques, diagnostiques et evolutifs de cas de rage humaine. Population et Methodes. L’etude s’est deroulee dans le service des maladies infectieuses du Centre Hospitalier Universitaire du Point de Bamako au Mali. Il s’agissait d’une etude transversale et descriptive allant du 1er janvier 2013 au 31 decembre 2013. Ont ete inclus dans l’etude les patients ayant presente des signes cliniques compatibles avec la rage suite a une morsure de chien. Resultats. Sur 432 hospitalisations en 2013, cinq cas de rage humaine ont ete enregistres soit une frequence hospitaliere de 1,16%. Trois patients etaient de sexe masculin et deux de sexe feminin. Les lesions de morsure siegeaient au niveau des membres superieurs. Deux patients ont consulte un centre de sante apres l’exposition de risque mais n’ont pas beneficie d’une prise en charge adequate. Tous les patients sont decedes. Conclusion. La rage humaine est une realite en milieu hospitalier au Mali. Le plateau technique ne permet pas un diagnostic etiologique..ABSTRACTObjective. Human rabies, a mandatory notifiable disease in Mali is ranking as the tenth leading cause of infectious disease mortality worldwide. It was in 2013 that cases of human rabies were hospitalized for the first time at the Infectious Diseases department of the University teaching hospital of Point G Bamako. The goal of our study was to describe the epidemiological, diagnostic and clinical features of human rabies cases. Population and Methods. Data was collected prospectively and the diagnosis was based on clinical and anamnesis. Results: From January to December 2013 five (5) patients were included in the cohort, from which three were male and two females. Dog bite was the animal causative agent and the lesions were located in the upper limbs of patients. After exposure to dog bites two patients consulted a health center for risk assessment, but they didn’t receive appropriate care. They came late at the hospital and all patients died. Conclusion. Human rabies is a reality in hospitals in Mali. The technical platform does not allow an etiological diagnosis.

The Malian pharmacovigilance program has been associated with modest growth over the past years. The purpose of this chapter is to assess the current state of pharmacovigilance (PV) in Mali and the adverse drug reactions reported to the National Pharmacovigilance Center of Mali. The profiles and number of adverse drug reactions (ADRs), the degree of toxicity, and the WHO and Naranjo scores are evaluated. We found that three university teaching hospitals in Mali conducted such PV studies. Our results showed that although there is a recognition of the need for PV, the practice was very limited. Only 67.6% of participant practitioners had an accepted knowledge for PV and its methodology. This situation is attributed to the insufficient knowledge about what can or should be reported in PV and a lack of a reliable notification process. Nevertheless, this study highlighted the profile of commonly used ADRs and the problems inherent to systematic reporting.

Introduction : le paludisme est un problème majeur de santé publique au Mali. La chimio prévention saisonnier a une importance particulière d’où son instauration par l’OMS depuis 2012 chez les enfants de 3 à 59 mois à partir du début de la saison de transmission. Cette étude vise à démontrer l’impact de la CPS sur le paludisme dans les districts sanitaires de Kangaba et de Kolokani. Matériels et Méthodes : Notre étude rétrospective a été réalisée de 2013 à 2015 dans les districts sanitaires de Kangaba et de Kolokani en utilisant les bases de données de l’ONG AMCP/ALIMA. Les données de 2014 et 2015 ont été comparés à ceux de 2013. Résultats : Le nombre de cas de paludisme chez les enfants de moins de 5 ans dans la zone couverte par la CPS montre une baisse considérable à Kangaba de 52% en 2014 et 49% en 2015, par rapport à la période de référence étant l’année 2013. A Kolokani la baisse est de 57% en 2014 et 40% en 2015 par rapport à 2013. Par rapport aux décès, une baisse de 50,5% a été enregistrée en 2014 et 60,4% en 2015 par rapport à 2013, soit respectivement 51 et 61 décès en moins comparé à 2013, dans les structures de santé. Conclusion : La CPS avait permis une réduction de la mortalité importante et de la morbidité palustre dans les deux districts sanitaires de Kangaba et de Kolokani

BACKGROUND:Cerebral malaria (CM), a reversible encephalopathy affecting young children, is a medical emergency requiring rapid clinical assessment and treatment. However, understanding of the genes/proteins and the biological pathways involved in the disease outcome is still limited.METHODS:We have performed a whole transcriptomic analysis of blood samples from Malian children with CM or uncomplicated malaria (UM). Hierarchical clustering and pathway, network, and upstream regulator analyses were performed to explore differentially expressed genes (DEGs). We validated gene expression for 8 genes using real-time quantitative PCR (RT-qPCR). Plasma levels were measured for IP-10/CXCL10 and IL-18.RESULTS:A blood RNA signature including 538 DEGs (∣FC | ≥2.0, adjusted P value ≤ 0.01) allowed to discriminate between CM and UM. Ingenuity Pathway Analysis (IPA) and Kyoto Encyclopedia of Genes and Genomes (KEGG) revealed novel genes and biological pathways related to immune/inflammatory responses, erythrocyte alteration, and neurodegenerative disorders. Gene expressions of CXCL10, IL12RB2, IL18BP, IL2RA, AXIN2, and NET were significantly lower in CM whereas ARG1 and SLC6A9 were higher in CM compared to UM. Plasma protein levels of IP-10/CXCL10 were significantly lower in CM than in UM while levels of IL-18 were higher. Interestingly, among children with CM, those who died from a complication of malaria tended to have higher concentrations of IP-10/CXCL10 and IFN-γ than those who recovered.CONCLUSIONS:This study identified some new factors and mechanisms that play crucial roles in CM and characterized their respective biological pathways as well as some upstream regulators.

The 2014-2016 Ebola epidemic in Guinea highlighted the need for more extensive evaluation of laboratories diagnostic capacities and preparedness in anticipation of future emerging viral disease outbreaks. We developed a questionnaire to assess the diagnostic capacities and preparedness of the four major medical laboratories in Guinea and Mali that are responsible for the provision of Ebola, Lassa, and Dengue diagnostics. The questionnaire inquired about the current state and need for equipment and reagents and adequacy of equipment and training received. In Guinea, all three diagnostic laboratories have the capacity and are well-prepared to perform Ebola diagnostics, however, only two have the capacity and trained staff to diagnose Lassa and none are currently prepared to diagnose Dengue infection. In Mali, the University Clinical Research Center (UCRC) laboratory, which was in charge of Ebola diagnostics during the last epidemic, currently has the capacity and is prepared to diagnose Ebola, Lassa, and Dengue infections. Combined, Guinea and Mali appear to have complementary capacity and preparedness to diagnose these Category A Priority Pathogens. While, the equipment, reagents and training efforts should be maintained, the gap in Dengue diagnostic capability in Guinea should be addressed with further equipping and training of additional district laboratories to strengthen the public health response for all viral diseases in these high-risk, yet, low-resource settings.

Background and Purpose The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali. Methods We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring. Results At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different p<0.0001. By M3, seizures (n=90) were <1/month in 26.7%, and lasted less than 1 minute in 16.7%. After a yearlong follow up, all 90 patients reported a good or excellent quality of life. At our urban study site, patients (n=30) were on carbamazepine and valproid acid in 66.67% and monotherapy (carbamazepine) in 33.33%. By November 2018, only six out 30 patients (on bi-therapy) were still taking their medications. Conclusions Epilepsy diagnostic and treatment are a real concern in Mali. Our data showed appropriate AED treatment with close follow up resulted in a better quality of life of patients in rural Mali. We will promote the approach of personalized medicine in AED treatment in Mali.

La prescription de médicaments chez la femme enceinte est une problématique fréquente en Afrique. Le but de cette étude est de décrire la prescription médicamenteuse chez les femmes enceintes au deuxième niveau de la pyramide sanitaire au Mali. Nous avons mené une étude des prescriptions médicamenteuses par l’observation sur 200 femmes enceintes au centre de santé de référence de Koutiala entre le 1er juillet 2015 et le 29 février 2016 en utilisant un questionnaire. Les patientes étaient de niveau d’instruction et de profession divers avec 7 % de niveau d’instruction supérieur. L’âge des gestantes se situait majoritairement entre 15 et 24 ans (54,5 %). Les multi-gestes étaient les plus présentes soit 56,5 %. Les multipares ont été les plus nombreuses avec 38 %. Les pathologies non gynéco-obstétriques étaient importantes (46 %). La consultation prénatale a été le motif de consultation le plus fréquent (54,5 %). Les ordonnances de qualité non conforme ont été les plus représentées (84,5 %). Les médicaments antianémiques/vitamines étaient les plus prescrits (30 %), suivis des antipaludéens (20,4 %). Plus de 85,5 % des médicaments prescrits l’étaient en nom de spécialité. Les ordonnances dont le prix variait entre 1,500 à 3,000 FCFA (2,30 à 4,60 euros), étaient le plus représentées soit (39 % des ordonnances), suivies de celles de plus de 3,100 FCFA (4,75 euros) (33,5 %). Les ordonnances comportant en moyenne 3 à 6 médicaments représentaient 51,5 % des cas. Les médicaments potentiellement dangereux en cas de grossesse concernaient 18 cas. Une petite moitié des prescriptions (38,5 %) n’était pas rédigée par des médecins. Le respect des exigences déontologiques de la bonne prescription chez la femme enceinte assurerait une sécurité à la femme et au futur nourrisson, surtout au Mali où il existe des agents non autorisés dans la prescription médicale. Cette étude montre que les femmes prennent différents types de médicaments pendant leur grossesse. La qualité très moyenne de ces prescriptions nécessite une évolution de la réglementation avec formation des infirmières obstétriciennes au Mali. Drug prescription for pregnant women is a frequent issue in Africa. The purpose of this study was to describe drug prescription for pregnant women at the second level of the health pyramid in Mali. A descriptive study observed 200 pregnant women in the Koutiala Reference Health Center, Mali, from July 1, 2015 to February 29, 2016, using a questionnaire. Patients were of varying educational levels and occupations, 7% with higher education. Age was mainly between 15 and 24 years (54.5%). Among, 56.5% were multigestational and 38% multiparous. Non-gynecological obstetric pathologies were dominant (46%), and prenatal consultation was the most frequent reason for consultation (54.5%). Among 84.5% of prescriptions were non-compliant. 30% of prescriptions were for antianemic drugs and vitamins, followed by antimalarials (20.4%). More than 85.5% of prescribed drugs were brand name. Prescription costs were 1,500 to 3,000 FCFA (€ 2.30–4.60) in 39% of cases, followed by > 3,100 FCFA (> € 4.75) in 33.5%. Among, 51.5% of prescriptions comprised 3-6 drugs. In 18 cases, the prescribed drugs were potentially dangerous in case of pregnancy. Among, 38.5% of prescriptions were not written by physicians. Conformity to good prescription practices for pregnant women would improve safety for the woman and future infant, especially in Mali where there are non-authorized agents involved in the medical prescription process. This study showed that women took various medications during pregnancy. Given the relatively poor quality of prescriptions, we recommend changes in the regulations, with training for obstetric nurses in Mali.

Compliance of HIV treatment is a major challenge for patients for successfultherapyWe undertook a cross-sectional study from 1 April 2010 to November 30, 2010 at thepharmacy department of the university teaching hospital of point G. At the end of our study, we obtained a compliance rate of 66.7% for people living with HIVusing the objective method and 72% by self-fulfilled questionnaire. The mean age of patientswas 30.5 years. Most of them were women. Factors contributing to good compliance wereyoung age, female gender, high education, matrimonial status (widowers). Those related tobad compliance were male gender, residence outside of Bamako, and the presence ofassociated pathologies. Some causes of non-compliance included: forgetting to undertaketreatment du to numerous occupations, side effects, supply shortages, distance from themedicine delivery site. Finally, we established a good concordance (Kappa = 0.80) betweenthe two methods of measures of compliance. Thus we conclude that these methods can beused separately or together.Keywords: Compliance, treatment, antiretroviral therapy, Measurement, Bamako, Mali.

Background: In resource-limited settings, breastfeeding is the healthiest source of nutrition for newborns. For economic/cultural reasons, breastfeeding is the preferred option for the majority of mothers, including HIV-positive mothers. Objective: The objective of this review is to document parameters characterizing antiretroviral therapy (ARV) diffusion into breast milk associated with the estimated ARV amount ingested by breastfed infant and clinical/biological abnormalities. Data Source and Eligibility Criteria: Twenty seven (27) published articles on the aspects of Pharmacokinetic parameters on ARV diffusion into breast milk have shown a large variability without clear interpretation on drugs diffusion. Using PubMed and Embase, we conducted a search to identify all published studies at 2015 that characterized antiretroviral drug diffusion from mother to infant via breast milk. We identified 27 published studies that characterized antiretroviral drug passage from mother to infant (drug concentrations in mother’s milk and breastfed plasma). Information was sufficiently complete for inclusion in the present analysis for only six antiretroviral drugs. Results: Finally, only data for nevirapine and efavirenz were exploitable because some of the studies found null or non-detectable levels, which were not suitable for simulations. Median (IQR) nevirapine CL/F were 0.022 (0.013-0.038) for newborns, 0.121 (0.116-0.125) for children and 0.056 (0.045-0.070) for mothers, all in L/h/kg. Efavirenz CL/F were 0.025 (0.016-0.039) for newborns, 0.273 (0.261-0.285) for children and 0.160 (0.153-0.167) for mothers, also in L/h/kg. Conclusion: Pharmacokinetics parameters of efavirenz and nevirapine are important to be determined in breastfed newborns.