Internally displaced persons in Mali facing the COVID 19 pandemic: A qualitative study

Introduction

The COVID-19 pandemic has exacerbated an already existing security crisis leading to massive population displacements that have been taking place since 2012.

Purpose of research

This study aims to explore the representations of internally displaced persons (IDPs) about the existence of COVID-19 and their knowledge about its signs, symptoms, modes of transmission and prevention measures.

Methods

The study was qualitative and exploratory. Individual and group interviews were used to collect data from 52 IDPs in six sites in Bamako and Segou. All interviews were recorded and transcribed. Thematic content analysis and N-Vivo software were used.

Results

The majority of IDPs believed in the existence of COVID-19 and had good knowledge of the signs, symptoms, modes of transmission and prevention measures against the disease. However, this was not sufficient for the adoption of public health measures. Among those who believed in its existence, some thought that it was a disease of the white and rich. Finally, a group of participants believed in conspiracy theories and claimed that the government and humanitarian organizations were only trying to make money through these campaigns.

Conclusion

To our knowledge, this is the first study in Mali to explore IDPs’ beliefs and knowledge about COVID-19. These results could inform policies, strategies, and interventions to combat COVID-19 in IDP sites and in the general population.

Challenges to the implementation and adoption of physical distancing measures against COVID-19 by internally displaced people in Mali: a qualitative study

Background

For almost a decade now, Mali has been facing a security crisis that led to the displacement of thousands of people within the country. Since March 2020, a health crisis linked to the COVID-19 pandemic also surfaced. To overcome this health crisis, the government implemented some physical distancing measures but their adoption proved difficult, particularly among internally displaced people (IDPs). The objective of this study is to identify the challenges relating to the implementation and adoption of physical distancing measures and to determine the main mitigation measures taken by IDPs to adjust to these new policies.

Methods

An exploratory qualitative research was conducted in Bamako and Ségou, two of the ten regions of Mali. The study counted 68 participants including 50 IDPs, seven administrative and health authorities, and 11 humanitarian actors. Sampling was guided by the principle of saturation and diversification, and data was collected through semi-structured individual interviews (n = 36) and focus groups (n = eight). Analysis was based on thematic content analysis through NVivo software.

Results

The main challenges identified concerning the implementation and adoption of physical distancing measures include the proximity in which IDPs live, their beliefs and values, the lack of toilets and safe water on sites, IDPs habits and economic situation, humanitarian actors’ lack of financial resources and authority, and social pressure from religious leaders. Implemented mitigation measures include the building of new shelters or their compartmentalization, the creation of income-generating activities and food banks, psychosocial support, promoting awareness of IDPs, and nightly police patrols and surveillance to discourage IDPs from going out. Finally, a call for action is suggested for the actors involved in IDPs support and management.

Conclusions

The study demonstrates the difficulty for IDPs to follow most of the physical distancing measures and informs about the risk of disease spreading among IDPs with its potential consequences. It also shows the inability of mitigation measures to control the outbreak and suggests actions to be considered.

[Endoscopic surgery and covid 19 disease: case report]

The objective of this work is to raise the issue of contamination of covid 19 disease during endoscopic endonasal surgery for pituitary tumor. This is a 32-year-old patient with a body mass index at 49,38 seen in an outpatient clinic for headache, erectile dysfunction and gynecomania, a CT scan revealed a pituitary macroadenoma. The preoperative workup was unremarkable including the rapid polymerase chain reaction (PCR) test was negative. The endonasal approach was decided for surgery. The tumor was removed by aspiration. The postoperative course was straightforward until the fifth day when the patient presented a dry cough with a fever at 38 ° 5 associated to respiratory discomfort. The thoracic CT-scan showed "ground glass" opacities located at peripheral and bilateral, and essentially posterior suggesting covid 19 disease. A second test was performed. Before the result, the anticoagulant treatment associated with third generation cephalosporin was done. The test results came back after 72 hours and was positive. Azithromycin, hydroxychloroquine, and oral vitamin C have been used for 11 days. The outcome was favorable and the patient was discharged from the hospital on the twelfth day after the negative PCR test.

[Accidental household poisoning of the child at the Gabriel Toure university hospital center in Bamako]

INTRODUCTION

Household accidental child poisonings are frequent pediatric medical emergencies in developing countries.

OBJECTIVE

To study the epidemiological, etiological, clinical and therapeutic aspects of acute accidental domestic poisoning in children aged 0 to 15 years admitted to the pediatric emergency department of Gabriel Toure.

METHOD

This was a prospective, descriptive study that ran from January 1, 2014 to December 31, 2014. All patients aged 0 to 15 years admitted to pediatric emergencies for acute intoxication were included.

RESULTS

A hundred cases of acute accidental poisoning were collected. Children under five accounted for 94%. The majority of mothers was housewives and had custody of children (83%). Forty-nine percent of the mothers were unschooled. The place of storage of the product was indoor in 96% of cases. The product was taken by the child himself (88%). A gesture at the scene of the accident was reported in 68% of cases, the ingestion of milk (72%) and water (10%) were the first acts used. The hospital was the first resort (72%). The time between taking the product and admission to hospital was 1 to 5 hours in 58% of cases. Vomiting (37 cases), agitation (17 cases) and respiratory distress (16 cases) were the most common symptoms. Domestic products (48%) followed by drugs (33%) ranked first among the families of poisons. Caustic soda (18%) and bleach (17%) were the most commonly found intoxication products. The evolution was good with a cure without sequelae (93%).

CONCLUSION

Accidental acute intoxications to household products are common in Mali. The hospital admission deadline is still long; the actions taken by patients at the accident site often aggravate their states but are largely done by the parents before the use of health care.

[Prevalence Of Tooth Decay In Children From Age 3 To 14 At The Department Of Odontology Of Militairy Hopital Of Bamako (IHB) In Mali]

This was a cross-sectional, descriptive study lasting 8 months from 20 January to 20 September 2013, carried out in the Department of Dentistry of the Bamako IHB Military Hospital. Thus, out of 263 children surveyed, 178 cases of tooth decay were recorded, ie 67.68%. Females accounted for 97 cases or 54.49% with a sex ratio of 1.2; the 3- to 6-year age group accounted for 72 cases, or 40.45%. School children accounted for 85.39% of cases. The children who brushed represent 168 cases or 94.38%. Those who brushed once were the most represented with 145 cases or 86.30%. Almost all patients had consulted for swelling and pain. The group of lower right and left lower temporal molars were the most represented with respectively 24.71% and 28.09%. Temporary teeth were 103 (71.0%) were mainly the most affected. Stage 3 caries known as pulp according to the classification of early childhood caries represented 145 cases, ie 81.46%. The lower jaw represented 142 cases, ie 77.76%. Oral health plays an important role in children to maintain oral functions. It is necessary for eating, developing speech and a positive self-image. It is therefore time to focus on education campaigns, information for behavioral change in oral hygiene and the use of anti-caries adjuvants in children.

Blockade of Dickkopf (DKK)-1 induces fusion of sacroiliac joints

OBJECTIVE

To study whether Dickkopf (DKK)-1, an inhibitor of wingless (Wnt) signalling, is involved in the fusion of sacroiliac joints.

METHODS

Mice transgenic for tumour necrosis factor (TNFtg mice), which develop bilateral sacroiliitis, were treated with vehicle, anti-TNF antibody or anti-DKK1 antibody. Sacroiliac joints were analysed for histological signs of inflammation, bone erosion, osteoclast formation and ankylosis. Moreover, expression of collagen type X, beta-catenin and DKK-1 was assessed by immunohistochemistry.

RESULTS

There were no signs of spontaneous ankylosis of the sacroiliac joints in TNFtg mice. TNF blockade effectively reduced inflammation, bone erosion and osteoclast numbers in the sacroiliac joints, but did not lead to ankylosis. Blockade of DKK1 had no effect on inflammatory signs of sacroiliitis, but significantly reduced bone erosions and osteoclast counts. Moreover, DKK1 blockade promoted expression of collagen type X, the formation of hypertrophic chondrocytes and ankylosis of sacroiliac joints.

CONCLUSION

DKK1 influences inflammatory remodelling of sacroiliac joints by prevention of joint ankylosis. This may indicate an important role of the Wnt signalling pathway in the structural bone changes of axial joint disease. Although this model does not reflect the entire spectrum of ankylosing spondylitis in humans, it helps to explain the pathophysiological processes of sacroiliac joint ankylosis, which is a hallmark of the spondyloarthritides.