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BackgroundMalaria remains a public health problem in many African countries. In Senegal, the Southern region had the highest malaria incidence and malaria-related deaths. The relationship between vector density and malaria transmission remains poorly understood in some specific areas. The aim of this study was to characterize the current entomological and transmission parameters with special emphasis on the Anopheles gambiae complex in the malaria pre-elimination area of Mlomp south-western Senegal.MethodsThe study was conducted from July 2020 to February 2021 in Djicomol and Cadjinolle in the commune of Mlomp region of Ziguinchor, Senegal. Sampling was carried out using Human Landing Catches (HLC) and Pyrethrum Spray Catches (PSC). Ovaries were dissected to determine female parity rate. Infection status, blood meal sources and species molecular identification were determined using Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase Chain Reaction (PCR) techniques respectively.ResultsA total of 6956 mosquitoes of the An. gambiae complex were collected, of which 6739 were by HLC (96.88%) and 217 by PSC (3.12%). The mean human biting rate was 36.98 bites/person/night (b/p/n) indoors and 43.25 b/p/n outdoors. Female biting activity was more frequent during the second half of the night. Mean parity rates were 24.83% indoors and 18.94% outdoors. The human blood index was estimated at 76.09%. Overall, An. gambiae sensu stricto (s.s.) was the most common species (75.08%). No female An. gambiae was found to be infected with Plasmodium falciparum in the sub-sample tested, thus no malaria transmission was recorded in Mlomp during the study period.ConclusionsThe results alert malaria control programme to develop additional strategies for controlling these vectors, which show exophagic behaviours to effectively combat malaria.

Background Drug resistance is one of the greatest challenges of malaria control programme in Mali. Recent advances in next-generation sequencing (NGS) technologies provide new and effective ways of tracking drug-resistant malaria parasites in Africa. The diversity and the prevalence of Plasmodium falciparum drug-resistance molecular markers were assessed in Dangassa and Nioro-du-Sahel in Mali, two sites with distinct malaria transmission patterns. Dangassa has an intense seasonal malaria transmission, whereas Nioro-du-Sahel has an unstable and short seasonal malaria transmission. Methods Up to 270 dried blood spot samples (214 in Dangassa and 56 in Nioro-du-Sahel) were collected from P. falciparum positive patients in 2016. Samples were analysed on the Agena MassARRAY ® iPLEX platform. Specific codons were targeted in Pfcrt , Pfmdr1 , Pfdhfr , and Pfdhps, Pfarps10, Pfferredoxin, Pfexonuclease and Pfmdr2 genes. The Sanger’s 101-SNPs-barcode method was used to assess the genetic diversity of P. falciparum and to determine the parasite species. Results The Pfcrt _76 T chloroquine-resistance genotype was found at a rate of 64.4% in Dangassa and 45.2% in Nioro-du-Sahel ( p  = 0.025). The Pfdhfr_51I - 59R - 108N pyrimethamine-resistance genotype was 14.1% and 19.6%, respectively in Dangassa and Nioro-du-Sahel. Mutations in the Pfdhps _S436 - A437 - K540 - A581 - 613A sulfadoxine-resistance gene was significantly more prevalent in Dangassa as compared to Nioro-du-Sahel ( p  = 0.035). Up to 17.8% of the isolates from Dangassa vs 7% from Nioro-du-Sahel harboured at least two codon substitutions in this haplotype. The amodiaquine-resistance Pfmdr1 _N86Y mutation was identified in only three samples (two in Dangassa and one in Nioro-du-Sahel). The lumefantrine-reduced susceptibility Pfmdr1_Y184F mutation was found in 39.9% and 48.2% of samples in Dangassa and Nioro-du-Sahel, respectively. One piperaquine-resistance Exo _E415G mutation was found in Dangassa, while no artemisinin resistance genetic-background were identified. A high P. falciparum diversity was observed, but no clear genetic aggregation was found at either study sites. Higher multiplicity of infection was observed in Dangassa with both COIL ( p  = 0.04) and Real McCOIL ( p  = 0.02) methods relative to Nioro-du-Sahel. Conclusions This study reveals high prevalence of chloroquine and pyrimethamine-resistance markers as well as high codon substitution rate in the sulfadoxine-resistance gene. High genetic diversity of P. falciparum was observed. These observations suggest that the use of artemisinins is relevant in both Dangassa and Nioro-du-Sahel.

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.

Background Our recent studies have shown headache disorders to be very common in the central and western sub-Saharan countries of Benin and Cameroon. Here we report headache in nearby Mali, a strife-torn country that differs topographically, culturally, politically and economically. The purposes were to estimate headache-attributed burden and need for headache care. Methods We used cluster-random sampling in seven of Mali’s eleven regions to obtain a nationally representative sample. During unannounced household visits by trained interviewers, one randomly selected adult member (18–65 years) from each household was interviewed using the structured HARDSHIP questionnaire, with enquiries into headache in the last year and, additionally, headache yesterday (HY). Headache on ≥ 15 days/month (H15+) was diagnosed as probable medication-overuse headache (pMOH) when associated with acute medication use on ≥ 15 days/month, and as “other H15+” when not. Episodic headache (on < 15 days/month) was recorded as such and not further diagnosed. Burden was assessed as impaired participation (days lost from paid and household work, and from leisure activity). Need for headache care was defined by criteria for expectation of benefit. Results Data collection coincided with the SARS-CoV-2 pandemic. The participating proportion was nonetheless extremely high (99.4%). The observed 1-year prevalence of any headache was 90.9%. Age- and gender-adjusted estimates were 86.3% for episodic headache, 1.4% for pMOH and 3.1% for other H15+. HY was reported by 16.8% with a mean duration of 8.7 h. Overall mean headache frequency was 3.5 days/month. Participants with pMOH lost more days from paid (8.8 days/3 months) and household work (10.3 days/3 months) than those with other H15+ (3.1 and 2.8 days/3 months) or episodic headache (1.2 and 0.9 days/3 months). At population level, 3.6–5.8% of all time was spent with headache, which led to a 3.6% decrease in all activity (impaired participation). Almost a quarter (23.4%) of Mali’s adult population need headache care. Conclusion Headache is very common in Mali, as in its near neighbours, Benin and Cameroon, and associated with substantial losses of health and productivity. Need for headache care is high – a challenge for a low-income country – but lost productivity probably translates into lost gross domestic product.

Introduction Neurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND. Methods We conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments. Results 3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25–0.35, p  < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively). We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly “sometimes” (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor “take into account” our existence. Conclusion Our work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients.

Background In 2006, the National Malaria Control Program in Mali recommended artemisinin-based combination therapy as the first-line treatment for uncomplicated malaria. Since the introduction of artemisinin-based combination therapy, few reports are available on the level of resistance of Plasmodium falciparum to the most common anti-malarial drugs in Mali. Methods From 2016 to 2017, we assessed the ex-vivo drug sensitivity of P. falciparum isolates in Kéniéroba, a village located in a rural area of southern Mali. We collected P. falciparum isolates from malaria-infected children living in Kéniéroba. The isolates were tested for ex-vivo sensitivity to commonly used anti-malarial drugs, namely chloroquine, quinine, amodiaquine, mefloquine, lumefantrine, dihydroartermisinin, and piperaquine. We used the 50% inhibitory concentration determination method, which is based on the incorporation of SYBR ® Green into the parasite’s genetic material. Results Plasmodium falciparum isolates were found to have a reduced ex-vivo sensitivity to quinine (25.7%), chloroquine (12.2%), amodiaquine (2.7%), and mefloquine (1.3%). In contrast, the isolates were 100% sensitive to lumefantrine, dihydroartermisinin, and piperaquine. A statistically significant correlation was found between 50% inhibitory concentration values of quinine and amodiaquine ( r  = 0.80; p  < 0.0001). Conclusions Plasmodium falciparum isolates were highly sensitive to dihydroartermisinin, lumefantrine, and piperaquine and less sensitive to amodiaquine ( n  = 2), mefloquine ( n  = 1), and quinine ( n  = 19). Therefore, our data support the previously reported increasing trend in chloroquine sensitivity in Mali.

Hypertension is a common comorbidity in COVID‐19 patients. However, little data is available on mortality in COVID‐19 patients with hypertension in sub‐Saharan Africa (SSA). Herein, the authors conducted a systematic review of research articles published from January 1, 2020 to July 1, 2021. Our aim was to evaluate the magnitude of COVID‐19 mortality in patients with hypertension in SSA. Following the PRISMA guidelines, two independent investigators conducted the literature review to collect relevant data. The authors used a random effect model to estimate the odds ratio, or hazard ratio, with a 95% confidence interval (CI). Furthermore, the authors used Egger's tests to check for publication bias. For mortality analysis, the authors included data on 29 945 COVID‐19 patients from seven publications. The authors assessed the heterogeneity across studies with the I2 test. Finally, the pooled analysis revealed that hypertension was associated with an increased odds of mortality among COVID‐19 inpatients (OR 1.32; 95% CI, 1.13–1.50). Our analysis revealed neither substantial heterogeneity across studies nor a publication bias. Therefore, our prespecified results provided new evidence that hypertension could increase the risk of mortality from COVID‐19 in SSA.

A previous survey of African medical journals identified the need to assist journals and public health researchers to make publications more openly accessible. This article reports a subsequent survey to describe knowledge of, barriers to and interest in capacity building for open publishing of public health research in Africa. An online questionnaire collected information from 91 respondents in 16 African countries. The respondents were authors (75%) or reviewers (53%) of research articles, journal editors (40%) or journal publishers (19%), with overlap between them, and experience with both traditional and open access publications. Fewer than half of the respondents appreciated benefits of ready availability, added citations and transparency of open publishing. Some respondents chose incorrect answers. There was interest in open publishing using preprints and open reviews, and a majority would like access to free online courses and mentoring opportunities. This study notes a huge potential for equipping researchers in Africa with the skills to understand and use online publishing and provides guidance for future capacity building via access to online resources and mentoring. This is relevant for any discipline, such as public health, where local solutions based on local research findings are important.

Background Lymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali. We studied the epidemiology and clinical presentation of lymphedema in three previously LF-endemic health districts of Mali after at least five consecutive rounds of mass drug administration (MDA) with albendazole and ivermectin. Methods From 2016 to 2018, we used passive and active case finding methods to identify lymphedema cases in three health districts with high pre-MDA LF prevalence: Kolondieba (66%), Bougouni (44%) and Kolokani (34%). Results Three hundred and thirty nine cases of lymphedema were identified, 235 (69.32%) through active case finding. Their median age was 56 years (range 2–90) and 286 (84.36%) were women. Lymphedema was reported in 226 (78.5%) people aged 41 years and older compared to 73 (21.5%) people below the age of 41 years (Chi 2  = 17.28, df = 5, p  = 0.004). One hundred and seventy five cases of lymphedema were found in Kolondieba (66 per 100,000 people), 116 in Bougouni (19 per 100,000) and 48 in Kolokani (16 per 100,000). Stage III lymphedema was observed in 131 (38.64%), stage II in 108 (31.86%), stage IV in 46 (13.57%), stage I in 23 (6.78%), stage V in 21 (6.19%) and stage VI in ten (2.95%). In the three study districts, lymphedema affected the legs in 281 (82.89%), the arms in 42 (12.39%) and both in 16 (4.72%) (Chi2 = 13.63, p  = 0.008). Conclusion Health districts in Mali with the highest pre-MDA LF prevalences had the highest prevalence of lymphedema. Efforts to actively identify lymphedema cases should be scaled up in previous LF-endemic areas, and should be supplemented by a morbidity management and disability prevention plan at the peripheral health system level.

The biting and resting behaviours of Anopheles species, which are human malaria vectors, are specifically linked to ecological and climatic requirements that characterize certain geographical settings, such as forests and humid savannah areas where favourable conditions for malaria mosquitoes are found. In southern Senegal, the outdoor resting behaviour of Anopheles gambiae s.l. populations is suspected to be a major problem in malaria control, given that indoor-based control tools are currently deployed across the country. A longitudinal study was conducted to investigate the population dynamics, trophic preferences and resting behaviours of Anopheles gambiae s.l. in mainland and island areas in south-western Senegal. Indoor and outdoor resting mosquitoes were collected from September 2020 to November 2021 using Pyrethrum Spray Catches and Prokopack aspirators, respectively. Field-collected mosquitoes were morphologically identified using conventional dichotomous keys, and in the laboratory, the mosquito blood meal source and molecular species identification were determined using enzyme-linked immunosorbent assays and polymerase chain reaction, respectively. Out of 765 Anopheles collected, 181 were from the mainland, and 584 were from the island. Anopheles gambiae s.l. was the predominant species (91.1%), with seasonal variation. The indoor resting densities did not significantly differ (P = 0.082) between the mainland (0.41 females per room) and island (4.09 females per room) areas. In mainland areas, the human blood index (HBI) was significantly greater (P = 0.035) in indoor resting females (76.2%) than in outdoor resting females (47.6%), whereas in island areas, the HBI was generally lower, with no significant difference (P = 0.51) between indoor (25.1%) and outdoor (31.1%) resting populations. Endophilic populations had greater HBIs in mainland areas than in island areas (P = 2.63 × 10 ), whereas no significant difference was observed for exophilic populations (P = 0.13). These findings provide a preliminary basic understanding of the feeding and resting behaviours of Anopheles gambiae s.l. populations in mainland and island areas for evidence-based malaria control programmes.