Mali-Folkecenter

A study was conducted across the Benin territory to assess the knowledge of small ruminant farmers about the Peste des Petits Ruminants (PPR) disease. The study involved 1381 farmers from 45 communes across all departments using a structured questionnaire to understand socio-economic characteristics, the genotype of farmers, and knowledge and practices in case of suspicion of PPR. Three distinct and homogeneous groups (G1, G2 and G3) were formed, with a chi-square test to compare the calculated frequencies. The majority of the farmers were young men (93.8%) and small animal handlers (<20 ovins and caprins). The Djallonké ovines and caprins were the most used by the G1 and G2 farmers due to their availability and affordable price. In the G3 group, animals were mainly confined to wood-based habitats (32.84%), and zootechnic performance was the main criteria for their choice. Local and occasional food availability was the main source of food for the three groups, resulting in a low to average knowledge of the disease signs and practices. The G3 farmers had a very good knowledge of the disease, practising the recommended measures (vaccination: 56.37%) and quarantine.

As the geopolitical context becomes increasingly complex, journalists and researchers face major challenges in conducting investigations in conflict zones. The Sahel, particularly the countries of the Alliance of Sahel States (Burkina Faso, Mali and Niger), an African region particularly affected by instability and violence, is a perfect example. In order to overcome these difficulties, new remote investigation methods have been developed, enabling us to continue documenting and analyzing crisis situations despite restricted access to the field. This paper will focus on these new investigative techniques with a view to understanding and substantiating the facts.

We thank the authors for their thoughtful comments1 regarding our publication reporting the ‘Marked improvement in HbA1c following introduction of biosimilar insulin to treatment regimen of children and youth with type 1 diabetes in Mali: A randomised controlled trial’.2 We agree with the authors that the interpretation of the improvement in HbA1c observed in the intervention group of this clinical trial requires consideration of several important factors. It is very difficult to differentiate the potential impacts of them individually, and many are interrelated, making it additionally challenging. Firstly, at baseline, 70% of participants in both the intervention and control groups were being treated with twice-daily injections of pre-mixed insulin, and 30% with two to four daily injections of human insulin (6% on a human insulin basal bolus regimen). Participants randomised to the intervention arm, who received the new insulin, were thus simultaneously changed to a basal bolus regimen with four daily injections (once daily biosimilar insulin glargine and three daily bolus injections of short-acting human insulin). In contrast, 70% of participants in the control group continued to receive the twice-daily regimen. Therefore, could the observed improvement in HbA1c be accounted for by the basal bolus regimen itself, with/without the use of biosimilar insulin glargine? A sub-analysis of 12 participants in the intervention group who were on a human basal bolus insulin at baseline found their mean (SD) HbA1c decreased from 99 (29.5) mmol/mol (11.2 (2.7) %) at baseline to 61 (8.7) mmol/mol (7.7 (0.8) %) at the 12 month study visit (p < 0.001), a similar reduction in mean HbA1c as reported for the whole group. With respect to the differing total daily insulin dose corrected for weight at the start of the clinical trial, despite the two groups having similar HbA1c, we accept that the basal bolus regimen may have improved compliance in those in the intervention arm. However, the magnitude of the change in HbA1c and the consistent difference in total daily dose observed between groups across all study visits would indicate that other factors were involved. An additional potential explanation for the improvement in HbA1c raised by Manne-Goehler et al. is the impact of insulin delivery mode on glycaemic control. During the trial, biosimilar insulin glargine was administered once daily via a reusable insulin pen device, and the use of pens was described as a benefit when participants were asked to provide feedback at the end of the study. While recognising that reduced pain, improved accuracy and ease of administration from using insulin pen devices are known to improve adherence,3 we disagree that this is likely to have played a significant role in improving HbA1c in this study. Participation in the intervention group also included three daily injections via needle and syringe, and therefore, a higher number of daily injections for most participants in this group who were on twice daily injections previously. Regarding the frequency of self-monitoring of blood glucose (SMBG), to be eligible for participation in the study, participants had to agree to conduct ≥2 SMBG tests daily and part of the shared diabetes education provided to all study participants at the start of the study, including the need to perform SMBGs 3–4 times per day (fasting, pre-meals, pre-bedtime, and two 2 am checks for the first 2 weeks). Following this, participants in both groups had their SMBGs reviewed by the study healthcare providers, with dose adjustments and reinforcement of education provided as needed. These reviews were conducted at the same frequency for participants in both study groups after the first week (during which only intervention group participants received a phone call between day 3 and day 7). When examined by study group and visit, the mean frequency of SMBGs was similar (3 SMBGs/day) in both groups from the 6-month study visit. We agree with the authors that the ideal study to determine the impact of introducing biosimilar insulin glargine would have a control group already on a basal-bolus regimen, thus accounting for some of the points raised. However, this clinical trial was conducted when biosimilar insulin glargine became newly available in the real-world setting of Mali. Finally, the mean HbA1c of (65 mmol/mol) 8.1% observed in the intervention arm at the end of the study is quite remarkable; we are not aware of an HbA1c of this level being achieved in a public health setting in sub-Saharan Africa. The authors declare no conflicts of interest.

Introduction: Significant disparities remain between high-income countries and low- and middle-income countries (LMICs) in access to pacemaker therapy. In LMICs, the high cost of devices and limited healthcare infrastructure lead to preventable deaths. Addressing this inequity requires innovative and ethical solutions. Pacemaker reuse by retrieving, testing, re-sterilizing, and re-implanting devices, offers a cost-effective, sustainable, and ethical alternative. Despite robust evidence demonstrating its safety, reuse remains limited due to regulatory and legal concerns. Fears of infection, device failure, and liability have hindered broader adoption, even though properly reprocessed pacemakers have been shown to be safe. Objective: To describe a 50-year humanitarian program led by a French NGO, which has distributed re-sterilized pacemakers to LMICs and trained local providers in cardiac pacing. Methods: STIM Développement is a French NGO promoting access to cardiac rhythm management in LMICs through medical training and the distribution of reprocessed pacemakers to patients in need. Devices were collected post-mortem and sent to the NGO by various hospitals. Each underwent strict quality control, including 1) visual inspection, 2) programmer interrogation to assess battery life and detect malfunctions, and 3) review of implant date and voltage to estimate remaining longevity. Sterilization followed an FDA-approved protocol: cleaning with pipe cleaners, isopropyl alcohol bath, overnight soak in enzyme solution (1:128 concentration), 70% ethanol wipe, air drying, gas-permeable packaging, and 8-hour ethylene oxide gas sterilization. Devices were shipped based on demand, often with training support for local medical teams. Results: From 1974 to 2024, 18,615 pacemakers were distributed to 29 countries. Distribution peaked in the early 2000s (600 units/year) but declined to around 150/year due to legal and regulatory challenges. Early recipients included India, Romania, and several African nations. Infection rates remained negligible, with no adverse events reported in recent FDA-monitored trials. Conclusion: Pacemaker reuse is a safe, effective, and scalable strategy to address unmet needs in LMICs. Wider adoption requires international regulatory harmonization, legal safeguards, and public awareness. The recent FDA approval of re-sterilization protocols may help renew global efforts and expand access to this life-saving therapy.

ABSTRACT Background The epidemiological characterization of the proctological diseases and the determination of the correlations between the different age group and sex and the proctological diseases may reveal critical information on the distribution of proctological diseases and establish pilot data for age- and sex-specific determinant research, which could lead to adapt preventive and treatment strategies from the decision-makers. We aimed in this study to describe the epidemiological aspects of proctological diseases in digestive endoscopy Unit of internal medicine department at the University Hospital Center of the Point G. Methods A cross-sectional study with retrospective data collection was conducted between January 01, 2011 to December 31, 2018 from patients who underwent the anorectoscopy in the digestive endoscopy Unit of internal medicine Department at the University Hospital Center of the Point G during the study period. Results Globally, 1771 reports of anorectoscopy were considered for analysis. The male accounted for 66.2% of cases with a sex-ratio of 1.9. The mean age was 41,17 ± 15,98 years and the extreme ages were 2 years and 75 years. Hemorrhoidal diseases represented 67.3% of cases followed by anitis and anal fissure with 11.7% of cases and 10.3% of cases respectively. The age group under 24 years was 2.03 times and 3.93 times significantly associated with anitis and rectal prolapse (47 cases; OR= 2.03; 95% CI= 1.42 – 2.90; p=0.000) and (8 cases; OR= 3.93; 95% CI= 1.61 – 9.57; p=0.005) respectively. Anal fistula and anal fissure occurred more frequently in age group of 25 – 44 years (36 cases; OR= 1.65; 95% CI= 1.01 – 2.71; p=0.044) and (91 cases; OR= 1.38; 95% CI= 1.02 – 1.88; p=0.038) respectively. The age group of 45 – 59 years was more significantly associated with hemorrhoidal diseases (256 cases; OR= 1.32; 95% CI= 1.02 – 1.70; p=0.032). Anorectal tumor was 1.92 times more likely to be found in of group of 60 – 79 years (23 cases; OR= 1.92; 95% CI= 1.18 – 3.13; p=0.007). Males were 1.65 times more likely than females to develop hemorrhoidal diseases (834 cases vs. 358 cases; OR= 1.65; 95% CI= 1.35 – 2.03; p=0.000). Anal fistula were 2.63 times more likely to be found in males than in females (55 cases vs. 11 cases; OR= 2.63; 95% CI= 1.36 – 5.06; p=0.002). Conclusion This study shows that the distribution of proctological diseases remains disparate. Anitis and rectal prolapse were significantly associated with the age group under 24 years; the anal fistula and anal fissure with age group of 25 – 44 years; the hemorrhoidal diseases with age group of 45 – 59 years; and the anorectal tumor with age group 60 – 79 years. Males were more likely than females to develop hemorrhoidal diseases and anal fistula.

ABSTRACT This article explains why local perceptions of international interventions in Mali have changed so drastically over time. Based on an analysis of data collected in the Mali-meter surveys and op-eds published in the local news media from 2012 to 2022, we argue that the duration of the missions plays an important role in people's increasing disillusionment with international assistance. The longer international interventions last, the more their legitimacy among local actors diminishes and the higher people's initial hopes for a positive impact of these missions, the more critical they become if the interventions fail to deliver on their promises.

Despite its low integration into breeding programs in Africa, vegetable cultivation is increasingly seen as contributing to the achievement of several Sustainable Development Goals, including gender equality and women’s empowerment. Seeking evidence of this, we analyze a genetic intensification activity offering improved tomato and African eggplant varieties to women and men farmers in southern Mali. We use a sustainable intensification assessment framework (SIAF), with a mixed methods approach, to conduct a gender analysis of this activity in five sustainability domains. Results and recommendations underline that breeding initiatives need to be accompanied by measures that transform the gender relations in which production is embedded. Equity emerges as a precondition for sustainable vegetable farming.

This article is aimed at demonstrating how the Constitution of the United States has failed to safeguard and protect the basic and inalienable rights of the American citizen, the African American in particular. It also analyzes and interprets the dreams of the American citizens through the perspective of Hughes in his poems. Indeed, at the elaboration and the implementation of the Constitution of the United States with its additional amendments in the 18th century, one of the basic tenets was justice and the protection of all the American citizens regardless of race and gender; however, in the American societies of the 20th century, the inalienable rights of some Americans, mainly Blacks were not granted or protected. Theoretically, critical race theory is used to analyze and interpret the data of the study. The qualitative method is employed in the process of collecting the study’s data. The results of the study have shown that the inalienable rights of the African Americans advocated by the Constitution of the United States and its related amendments were not reflected in society. Indeed, despite their citizenship, their inalienable civil rights were not fully protected, as the majority of them lived on the margins of society. In addition, they were prevented from attending high-profile schools and exercising some occupations reserved for the Whites. The results finally reveal that the dream of the ordinary African Americans was the restoration and the realization of the human rights principles inscribed in the Constitution of the United States through its additional amendments. This would guarantee justice and equal rights for all American nationals regardless of their gender and skin color.

Cancer-related pain (CRP) is a complex, multidimensional challenge in oncology that undermines quality of life, psychological well-being, and treatment adherence. This narrative, mechanism-informed review synthesizes pathophysiology, classification systems, and multidisciplinary management strategies to provide clinical insights and research priorities. It connects nociceptive, neuropathic, and mixed pain mechanisms to practical interventions, emphasizing peripheral and central sensitization in chronicity. Major frameworks, including the WHO analgesic ladder, International Classification of Diseases, 11th Revision, Edmonton Classification System for Cancer Pain, and European Pain Federation standards, are appraised alongside assessment tools such as the Visual Analogue Scale, Brief Pain Inventory, and Hospital Anxiety and Depression Scale, with examples of their clinical application. Management is framed within a flexible, mechanism-based, multimodal model that integrates pharmacologic, adjuvant, interventional, and psychosocial approaches, delivered through coordinated, multidisciplinary teams. Evidence for complementary modalities, such as acupuncture and mindfulness-based stress reduction, remains preliminary and heterogeneous, requiring further high-quality trials, whereas opioid-based pharmacologic approaches and structured psychosocial interventions such as cognitive behavioral therapy are supported by more robust, established evidence. Similarly, innovations like AI-driven monitoring and pharmacogenomics hold promise but are still in the early validation phase, underscoring the need to distinguish between evolving and well-established domains of cancer pain management. The principal actionable priorities are to adopt mechanism-based classification, embed multidisciplinary collaboration, expand multimodal access in low-resource settings, and rigorously validate emerging pharmacogenomic and digital health innovations before widespread clinical integration.

Postharvest loss (PHL) remains a critical challenge in sub-Saharan Africa, particularly in Nigeria, where it exacerbates food insecurity and economic vulnerabilities. This study investigates the adoption of postharvest packaging technologies (PHPTs), focusing on reusable plastic crates (RPCs) for tomato harvesting and marketing, and examines farmers’ adoption decisions with market channel choices. Using a dataset of 1,704 tomato farmers, we address the potential endogeneity between RPCs adoption and the choice of market channels through a recursive bivariate probit model. The findings indicate that farmers engaged in long-distance sales are more likely to adopt RPCs, motivated by the potential for higher price premiums and reduced losses during transit. However, there are significant barriers to RPCs’ adoption, including high acquisition costs and limited availability in rural areas. The study findings also underscore the importance of irrigation practices, membership in farmers’ associations, and proximity to major output markets as key drivers of RPCs’ uptake. These insights are critical for informing targeted interventions to improve access to and adoption of PHPTs, thereby reducing PHL and strengthening the resilience of smallholder tomato farmers in Nigeria.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-15618-0.