•Community-based epidemiology study.•Screening epilepsy using trained community health workers (CHWs).•Only 10% of all the community cases were known by the Health system.•82.9% (1645/1985) of ...confirmation rate of the suspected cases reported by CHWs by neurologist.
In Mali, the burden of epilepsy is underestimated due to socio-cultural barriers that keep most people with epilepsy out of the local health facilities. The objective of this study was to evaluate the performance of trained community health workers (CHWs) in identifying epilepsy cases (active case detection) as compared to the passive cases detection (PCD) during outpatient visits at the community health centers in the health districts (HDs) of Kolokani, Kayes, Kéniéba, Sikasso, Kadiolo, and Tominian.
A two-phase cross-sectional study was conducted from February to December 2019. In phase 1, trained CHWs conducted a census in 1017 villages organized into 174 community health centers which are part of the six study HDs to identify suspected epilepsy cases (SEC). Investigators used a modified epilepsy screening questionnaire from a validated standard questionnaire with the following three (3) questions: (i) Does or did the subject have a loss of consciousness and/or a loss of urine and/or drooling? (ii) Does or did the subject have an uncontrollable shake or abnormal movements of limb(s) (convulsions), with sudden onset and duration of a few minutes? (iii) Has or had the subject ever been told that he or she has epilepsy? During phase 2, neurologists confirmed the supposedly SEC (censed by the CHWs) in the first 30 villages with the highest number of SEC in each HD that were reported during phase 1.
Of a total of 4830 SEC, 422 (10%) were identified by PCD during routine outpatient visits and 4408 (90%) through the active case detection (ACD) using the trained CHWs. The majority of SEC reported by the CHWs (PCD) were confirmed by neurologists, i.e. 82.9% (1645/1985). Phenobarbital was available in only 26 (14.9%) of the 174 surveyed health centers. Confirmed cases of epilepsy were reported in all the 174 health centers with prevalence varying from 91/100,00 to 285/100,000.
Active case detection of epilepsy using trained CHWs is an effective approach for epidemiological studies of epilepsy in the community settings as compared to the passive approach.
Diabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. ...The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults.
Over a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16.
A total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes.
A third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.
Schizophrenia is a relatively common disease worldwide with a point prevalence of around 5/1000 in the population. The aim of this present work was to assess the demographic, clinical, familial, and ...environmental factors associated with schizophrenia in Mali.
This was a prospective descriptive study on a series of 164 patients aged at least 12 years who came for a follow-up consultation at the psychiatry department of the University Hospital Center (CHU) Point G in Mali between February 2019 and January 2020 for schizophrenia spectrum disorder as defined by DSM-5 diagnostic criteria.
Our results revealed that the male sex was predominant (80.5%). The 25-34 age group was more represented with 44.5%. The place of birth for the majority of our patients was the urban area (52.4%), which also represented the place of the first year of life for the majority of our patients (56.1%). We noted that the unemployed and single people accounted for 56.1 and 61% respectively. More than half of our patients 58.5% reported having reached secondary school level. With the exception of education level, there was a statistically significant difference in the distribution of demographic parameters. Familial schizophrenia cases accounted for 51.7% versus 49.3% for non-familial cases. The different clinical forms were represented by the paranoid form, followed by the undifferentiated form, and the hebephrenic form with respectively 34, 28 and 17.1%. We noted that almost half (48.8%) of patients were born during the cold season. Cannabis use history was not observed in 68.7% of the patients. The proportions of patients with an out-of-school father or an out-of-school mother were 51.2 and 64.2%, respectively.
The onset of schizophrenia in the Malian population has been associated with socio-demographic, clinical, genetic and environmental characteristics.
In resource-limited countries, epilepsy prevalence is underestimated and little is known about its risk factors.
This study aimed to determine the prevalence and risk factors for epilepsy in six ...health districts (HDs) in Mali.
A community-based cross-sectional and nested case-control study was conducted in 180 villages with the highest number of suspicious epilepsy cases (SECs) in the six study HDs. The SECs were observed as part of a Phase 1 screening conducted by community health workers. For the nested case-control study, one case was matched with at least one control based on residence and age. A case of epilepsy was a person diagnosed with convulsive epilepsy after clinical assessment by a neurologist. A control was a person diagnosed as normal after neurological assessment by a neurologist. Data were collected on sociodemographic characteristics, familial and medical history of epilepsy, consanguinity, place of delivery, preterm birth, length/type of delivery, and history of meningitis and cerebral malaria. A univariate and multivariate binomial logistic regression model was used to analyse factors associated with epilepsy.
A total of 1,506 cases of epilepsy and 2,199 controls were enrolled in six HDs. The mean prevalence of epilepsy was 2‰, with the highest in Kenieba (3‰), a previously meso-endemic-onchocerciasis HD, and the lowest in Kadiolo (1.5‰), a hypo-endemic-onchocerciasis HD. Age (adjusted odds ratio aOR = 1.02 95% confidence intervals CI 1.02-1.03), history of cerebral malaria (aOR = 11.41 95% CI 8.86-14.85), history of meningitis (aOR = 1.95 95% CI 1.16-3.29), living in the HD of Tominian (aOR = 1.69 95% CI 1.29-2.22), delayed delivery (aOR = 3.21 95% CI 2.07-5.07), and dystocia (aOR = 3.37 95% CI 2.03-5.73) were all significantly associated with epilepsy.
The prevalence of epilepsy (3‰) in a previously meso-endemic-onchocerciasis HD was much lower than the prevalence (13.35‰) documented in onchocerciasis endemic areas in 2,000. This decrease epilepsy prevalence in the previously meso-endemic region was induced by onchocerciasis, and the reduction was due to an effective community direct treatment with ivermectin programme. Cerebral malaria and obstetrical complications were the main risk factors for epilepsy and interventions improving malaria prevention/treatment and optimizing prenatal and obstetrical care need to be implemented to reduce incidence.
Diabetic polyneuropathy (DPN) with or without neuropathic pain is a frequent complication of diabetes. This work aimed to determine the prevalence of diabetic polyneuropathy, to describe its ...epidemiological aspects, and to analyze the therapeutic itinerary of patients with DPN.
This was a cross-sectional, descriptive study performed synchronously over six months at two major follow-up sites for patients with diabetes in Mali. DPN was diagnosed based on the Michigan Neuropathy Screening Instrument (MNSI). The neuropathic nature of the pain and the quality of life of patients were evaluated by the DN4 and the ED-5D scale, respectively. We used three (3) different questionnaires to collect data from patients (one at inclusion and another during the follow-up consultation) and from the caregivers of patients with DPN.
We included 252 patients with diabetes, and DPN was found to have a healthcare facility-based prevalence of 69.8% (176/252). The sex ratio was approximately three females for every male patient. The patients were mostly 31 to 60 years of age, 83% had type 2 diabetes, and 86.9% had neuropathic pain Approximately half of the patients (48.3%) had autonomic neuropathy and they reported moderate to intense pain, which was mainly described as a burning sensation. The patients exhibited impaired exteroceptive and proprioceptive sensations in 51.7% of cases. The patients smoked tobacco in 3.4% of cases, while 36.6% of the patients were obese and had dyslipidemia. The caregivers clearly indicated that appropriate medications were not readily accessible or available for their patients with DPN.
The healthcare facility-based prevalence of DPN with or without neuropathic pain was high in our cohort. These inexpensive and easy-to-use tools (MNSI, DN4) can be used to adequately diagnose DPN in the African context. In Mali, screening and early treatment of patients at risk of DPN should allow for a reduction of the burden of the disease, while caregivers need to be adequately trained to manage DPN.
We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) ...or resistance testing.
We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm.
Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm(3). Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P < 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P < 0.0001) and darunavir (P = 0.06).
Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings.
According to the taxonomy of the International Association for the Study of Pain (IASP 2011), neuropathic pain (NeuP) is defined as “pain caused by a lesion or disease of the somatosensory nervous ...system”. NeuP is currently well-defined clinically, despite a high degree of etiological variation, and it has become a significant public health problem. This work aimed to study the situation regarding NeuP in current practice in Mali, as well as to analyze the therapeutic environment of the patients.
This was a retrospective and cross-sectional study, carried out in two phases: (1) compilation of the files of patients according to the ICD-11, over a period of 24 months (2) a second prospective phase regarding the Knowledge, Attitudes, and Practices (KAP) of general practitioners and neurologists in regard to NeuP. The focus of the first phase of the study was the files of the patients who had undergone a consultation at the Gabriel Touré UHC. The second phase of the study focused on the general practitioners (Community Health Centers (comHC) of Bamako) and neurologists (Malian or not).
Over the period of the study, 7840 patients were seen in consultation in the Department of Neurology, of whom 903 for NeuP, thus amounting to a NeuP frequency of 11.5%. Women accounted for 58.9% (532/903), with a sex ratio of 1.4. Using a comparative normal law, the difference in frequency was statistically significant between males and females (p < 10−7) and between two age groups (p 〈10−3). The 49–58 years of age group was represented the most. Diabetic NeuP (21%), lumbar radiculopathies (14%), HIV/AIDS NeuP (13%), and post-stroke NeuP (11%) were the most represented. The survey among the carers revealed: a need for training, a low level of compliance with the therapeutic guidelines, and the use of traditional medicine by the patients.
This work confirms that NeuP is encountered frequently in current practice, and its optimal management will involve specific training of carers and improvement of access to the medications recommended in this indication. In light of this issue, we revisit the debate regarding the concept of essential medications and the relevance of taking into account effective medications for the treatment of NeuP.
•NeuP pain, irrespective of its type (diabetic NeuP, lumbar radiculopathies, pain linked to HIV, and pain linked to stroke), is encountered frequently in our current neurology practice in Mali.•Failed to comply with the NeuP treatment guidelines, thus highlighting the need for better training of health professionals involved in NeuP management in Mali.•Amitriptyline is the only validated drug that is readily available and affordable for most patients with NeuP.•Other effective drugs to treat NeuP should be on the list of essential drugs. Optimal management of NeuP in Africa also needs to take into account the local socio-cultural context and practices regarding pain.
Migraine is a debilitating but benign disease that can affect the quality of life of patients, disrupt the emotional relationships and impact on educational and vocational activities. The aim of our ...work was to study the epidemiology and impact of migraine in schools in the urban district of GAO in Mali.
This is a cross-sectional study among students in the city of Gao. The survey was conducted in 11 schools, each of which represented a cluster. The study involved 733 students and diagnosis of migraine was made according to the 2004 IHS criteria except the criterion for the number of crises.
The overall prevalence of migraine in school was 17.3% (95% CI 14.6% to 20%). The headache prevalence among students was 20% (95% CI 16.91% to 23.09), it was significantly higher 23.0% in girls than in boys 14.8% (p<0.01). About its impact on school life, 63.8% of students had experienced absenteeism due to migraine from 1 to 14days in the last quarter preceding the survey with a limiting concentration in 19.2% of students with migraine.
In conclusion, migraine is common among students of Gao, it is more important in female. It has a negative impact on academic performance. It is therefore necessary to control its management to reduce the extent of the disease in this environment.
•Students participating were 69.7% (511/733) male and 30.3% (222/733) female.•First degree family history of headaches was very common in students with migraine (78% total with 57% on the maternal side and 17% on the paternal side).•About two thirds of patients that suffer of migraine report their attacks to be triggered by specific external circumstances or internal variation, the remaining third felt that their attacks occur suddenly without apparent reason.
Les céphalées constituent un motif fréquent de consultation en neurologie, les étiologies primaires le plus souvent, mais parfois secondaires. Nous rapportons le cas d’une jeune patiente ayant ...consulté pour des céphalées à bascule.
Patiente de 28 ans consulte pour céphalées pulsatiles à bascule exacerbées par les mouvements de la tête, cervico occipitales évoluant depuis 3 ans. Parfois, une gêne surtout nocturne qu’elle utilise les oreillers avec un encombrement oropharyngée avec sensation de son inhabituelle à la déglutition. L’examen clinique a permis de mettre en évidence une triade associant : douleur cervicale, sensation de corps étranger dans la gorge. La TDM cérébrale était sans anomalie ceci justifia la réalisation d’une TDM cervicale, elle a mis en évidence une hypertrophie de l’apophyse styloïde bilatérale avec une adénite latérocervicale bilatérale (Fig. 1).
Le syndrome d’Eagle (ES) est dû à une ossification anormale de l’appareil stylo-hyoïdien. La cause n’est pas bien connue. Elle peut être idiopathique, congénitale ou acquis. Les symptômes sont variés mais dominées par une symptomatologie douloureuse. Le traitement est surtout chirurgicale associée à un traitement symptomatique car les céphalées avec leur cortège des signes d’accompagnement.
Les céphalées restent un motif assez fréquent de consultation ; devant toute présentation atypique, les explorations doivent être réalisées afin d’éliminer une cause secondaire dont la prise en charge reste la prière angulaire du traitement.
La schistosomiase quoi que rare dans certaines régions du monde reste endémique en Afrique en général et au Mali en particulier. Nous rapportons le premier cas autochtone à Bamako.
Une jeune patiente ...de 17 ans, élève, droitière, vivant à Bamako (capitale du Mali) sans antécédent médico-chirurgical connu, a été admise pour paraparésie d’installation subaiguë. Le début de sa maladie remonterait à une semaine environ avant son hospitalisation marquée par une dysurie, puis s’installa très rapidement des troubles de la marche d’allure aggravante, motivant son admission. L’examen notait un syndrome neurogène périphérique des deux membres inférieurs, une anesthésie en selle, un signe de Babinski bilatérale. Le reste de l’examen clinique était sans particularité. L’IRM médullaire montrait un élargissement et une anomalie de signal du cône médullaire apparaissant en isosignal T1, hypersignal T2 et STIR, avec rehaussement intense et homogène après injection de Gadolinium, la lésion étendue de T11 à L1, en rapport avec une masse qui a fait évoquer un épendymone myxopapillaire infiltrant du cône terminal, posant l’indication d’une prise en charge chirurgicale. L’examen anatomopathologique de la pièce opératoire a mis en évidence un granulome bilharzien intramédullaire. Un traitement, associant Pranziquantel (40mg/kg en une prise), Corticothérapie (1mg/kg/jour pendant 1 mois), la kinésithérapie, a permis d’obtenir une évolution favorable.
Les myéloradiculites en rapport avec une infection à Schistosoma mansoni restent rares. Les cas publiés dans la littérature sont décrits chez des patients vivant dans un écosystème favorable. Les cas urbains restent exceptionnels. La clinique, l’imagerie et surtout l’étude anatomopathologique a permis d’établir le lien entre la myéloradiculite et l’infection à Schistosoma mansoni. Le mécanisme de l’atteinte médullaire est hématogène.
Les atteintes médullaires à Schistosoma mansoni quoi que rare restent possibles en zone d’endémie. Nous attirons par cette observation l’attention des praticiens sur cette possibilité. Le traitement fait appel aux antiparasitaires.
PDF
