Date: Mon, 10 Sep 2018 23:07:20 +0200

Bamako, Sept 10, 2018 (AFP) - A six-year-old girl became Mali's first open heart surgery patient on Monday, after a successful procedure performed by a team of Malian and French surgeons that was a first for the African nation.   Fanta Diarra, who was diagnosed with a heart condition when she was just a baby, underwent the operation in what medics hope will be the first of many such life-saving operations for Malians who previously have had to travel overseas for treatment.        "I am happy that I will be operated on. I will be like the other children, I will be able to work, and get married," the bubbly six-year-old told AFP before her surgery.

She is one of some 2,500 children awaiting surgery, of whom about 50 should be operated on by the end of the year at a new cardio-pediatric unit at a hospital in Bamako, opened by the French medical association La Chaine de l'Espoir.      "It's a big day for us. This is the first open-heart surgery, but behind this surgery there are hundreds and hundreds of children who are waiting, so we know this is not the end," said Professor Alain Deloche, a cardiac surgeon and founder of La Chaine de l'Espoir.

The aim is for French surgical teams to perform the operations, while also training Malian surgeons.      "I can see in the eyes of these young Malian surgeons something that looks like pride," he added.    Malian cardio-vascular surgeon, Doctor Baba Ibrahima Diarra, said local teams needed help initially because the operation was new in the country.        But he added: "The final goal is to be independent in time, to be completely autonomous."
Date: Thu 9 Aug 2018
From: Irene Lai irene.lai@internationalsos.com

We have received information from sources in Mali that the illness appears to be due to nutritional deficiencies, and not infectious. Symptoms started 3-4 months ago. Patients are improving with nutrition. A total of 224 cases were reported by the community including 35 deaths.

There is a mission report (in French, full PDF available to download), which includes images of the condition
(<https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/assessments/rapport_dinvestigation_mondoro-fv_07-08-2018.pdf>).

In summary: "Clinical investigations have revealed an oedematous syndrome: painful, clinical signs of malnutrition, oral signs of gingivostomatitis, cutaneous syndrome of malnutrition and signs of irritation in children without any infectious syndrome."
=======================
[ProMED-mail thanks Dr Irene Lai for this useful information. Indeed the pictures in the report points to protein malnutrition, kwashiorkor, which are followed by oedema especially on the legs. The report specifically notes that there are no signs of infection, even though 2 children tested positive for malaria. However, malaria is endemic in the area and a positive test does not link the symptoms to malaria. It is not clear why an epidemic of malnutrition should  occur in central Mali. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Mopti, Mopti, Mali: <http://healthmap.org/promed/p/19563>]
Date: Wed 8 Aug 2018
Source: NiarelaNet [in French, machine trans., edited]
<http://niarela.net/sante/sante-publique-enquete-sur-une-maladie-mysterieuse-qui-a-fait-plus-de-40-morts-a-mondoro>

The mysterious illness reported in Mondoro in Douentza Cercle [Mopti region] has been confirmed by the non-governmental organisation [NGO] Medecins Sans Frontieres. According to the NGO, 204 cases of the disease, including 161 in Douna and 43 Tiguila have been recorded. According to Dr Patrick Inenga samples have been taken from some patients because this pathology has already caused numerous deaths.

According to local officials, this pathology has already killed more than 40 people in the last 3 months and many people would be infected. According to them, the disease is manifested by the appearance of protuberances on the feet that spread gradually over the rest of the body.
=====================
[It is difficult to provide an educated guess of the aetiology with so little information. The sign "protuberances' on the feet" if an infectious disease, could be abscesses and pyoderma. However, pyoderma is not seen in outbreaks. Without ulcers and with a rapid spread and a high mortality, atypical mycobacterial infection such as Buruli ulcer seems less likely.

Bubonic plague is a possibility, but without fever (we do not know but it is not mentioned) and unlikely to start at the feet, but the mortality would be high. If we assume that the condition starts on the feet because of some kind of exposure to the environment, cutaneous anthrax is a possibility, but would require contact with dead animals and the symptoms would be crusted sores. We need to know if livestock mortality has been unusually high over the last few months.

Contact with water could induce swimmer's itch due to invasion of _Schistosoma cercariae_, but in Mali most people would have been highly exposed (Mopti is located in the inland delta of the Niger River) and it does not have a high mortality.

ProMED-mail would appreciate more information from knowledgeable sources in the area; a photo of the condition would be very helpful. - ProMED Mod.EP]

[Maps of Mali: <https://tinyurl.com/ybzstdy7> and <http://healthmap.org/promed/p/64431>.]
Date: Thu, 1 Mar 2018 04:13:19 +0100

Bamako, March 1, 2018 (AFP) - Four UN peacekeepers were killed on Wednesday when a mine exploded under their vehicle in central Mali in a deliberate attack, capping a bloody week for civilians and security forces in the West African nation.   Jihadists have ramped up their activities in central Mali in recent months, targeting domestic and foreign forces in violence once confined to the restive north.

The UN said in a statement that the "explosion of a mine or IED against a MINUSMA vehicle on the Boni-Douentza road" in the Mopti region killed the four peacekeepers and wounded four more.   Secretary-General Antonio Guterres "strongly condemned" the attack, his spokesman Stephane Dujarric said.   "These cowardly acts will not deter MINUSMA's determination to support the Malian authorities in their efforts to protect civilians and accompany the Malian people in their quest for peace and stability," Dujarric added.

The mission, known by the acronym MINUSMA, counts almost 11,000 peacekeepers and has been deployed in Mali since 2013 to counter a jihadist insurgency and general lawlessness.   "MINUSMA is currently upgrading its security presence in central Mali," Mission chief Mahamat Saleh Annadif said. "Cornered, the terrorists are multiplying their attacks."   Six Malian soldiers were killed on Tuesday when their vehicle struck a mine, the army said on Wednesday, and a forest ranger was gunned down in a third incident blamed on jihadists.

- Enquiry into security forces' abuses -
Mali's military is frequently accused of abuses, with families on Wednesday pointing the finger at the army in the killing of seven civilians during an operation in the same area a week ago.   A UN report published this month found that "at least 20 percent" of recorded incidents in 2016 and in the first of half of 2017 that endangered civilian lives involved the Malian authorities -- essentially the security forces.

Nouhoun Sarr, the nephew of one of seven men killed on February 21 after their arrest by the military, said the authorities informed him on Wednesday morning of his uncle's fate.   "They called us to tell us our relatives were killed during the operation, without elaborating," he told AFP.   Yehia Ag Mohamed Ali, a former minister and member of the opposition Sadi party, told AFP: "According to our information, the seven civilians arrested on February 21 by the Malian army in Sokolo were killed by soldiers."

The government said in a statement on Wednesday that the army was "carrying out reconnaissance missions and searches in the Sokolo area, during which civilians unfortunately lost their lives".   "An enquiry has been opened," it added.   Islamic extremists linked to Al-Qaeda took control of the desert north of Mali in early 2012, but were largely driven out in a French-led military operation launched in January 2013.    In June 2015, Mali's government signed a peace agreement with coalitions of armed groups. But the jihadists remain active, and large tracts of the country are lawless.
Date: Wed, 21 Feb 2018 16:41:55 +0100

Paris, Feb 21, 2018 (AFP) - Two French soldiers were killed and another was hurt Wednesday when their armoured vehicle struck a mine in Mali, the French presidency said.   Around 4,000 French troops are deployed in Mali and neighbouring countries to fight jihadist groups that have staged a string of attacks and kidnappings, some targeting Western nationals.   The two soldiers were from a cavalry regiment based in Valence, a city in south-eastern France, President Emmanuel Macron's office said in a statement, which did not say where the attack took place.

Macron sent condolences to the soldiers' families and said the regional counter-terrorism operation had dealt "severe blows" to the enemy, the presidency added.   The deaths bring to 12 the number of French troops killed since the start of Operation Barkhane, which was launched more than three years ago to try to vanquish jihadist groups that overran northern Mali in 2012.   France intervened at Mali's request in early 2013 and succeeded in driving the extremists back into the desert but they continue to mount attacks from their rear bases in the region.
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