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Region of Mopti Republic of Mali
Regional Direction A People- A Goal- A Faith
From the health of Mopti
REPORT OF THE CASE INVESTIGATION MISSION
UNUSUAL DISEASE IN HEALTH AREAS OF
DOUNA, NIAGASSADIOU AND TIGUILA
COMMON OF MONDORO, CIRCLE OF DOUENTZA
INTRODUCTION
The Chief Medical Officer of the Douentza Health District addressed the Regional Director
of health a narrative report highlighting cases of unusual diseases
since 15 March 2018 in the health areas of Douna, Niagassadiou and
Tiguila. This disease is manifested by the following signs:
lower limbs, myalgia, functional impotence, dyspnea sometimes followed by
death. This report lists 224 cases of illness, including 161 cases in Douna, 20 to
Niagassadiou and 43 cases in Tiguila with 35 deaths (20 in Douna, 6 in Niagassadiou and
9 at Tiguila). Following this situation, the Regional Directorate of Health dispatched
an investigation mission on August 05, 2018 in the village of Mondoro chef
place of the municipality where some patients could be moved to the center
village because the security situation did not allow the
mission to reach the villages directly concerned. The mission was
organized with the technical support of partners: WHO, UNICEF, OCHA and
logistical and security assistance from MINUSMA and FAMA on site.
This investigation was carried out by a multidisciplinary team composed of:
- the regional health department of Mopti,
- the regional management of social development and solidarity economy of Mopti,
- the Somin? DOLO Hospital in Mopti,
- the reference health center of Douentza,
- WHO.
The team was accompanied by the second deputy mayor of the municipality of
Mondoro. (See the nominative list attached)
I. SITUATIONAL ANALYSIS
- Analysis of the security context:
Since 2012, after the outbreak of armed rebellion in northern Mali; the
security has never been fully found in the town of Mondoro. The
mayor of that commune was assassinated in front of his home in Douentza on 28
January 2017. Since that date, no authority can visit this
common and all technical service agents have fallen back into the city
Douentza because of growing insecurity.
The intercommunal conflict between Dogons and Fulani has contributed to aggravate
this already existing situation in the municipality having seriously affected all
sectors of socio-economic life.
- Analysis of the socio-economic context:
? In the field of agriculture: Agricultural productions are
usually insufficient and do not cover the nutritional needs of the
populations. This situation is exacerbated by insecurity which
populations to access their fields to cultivate. Cereal stocks are
exhausted and people do not have the opportunity to stock up on food
food.
? In the field of animal husbandry: pastoralists have left the municipality because of
removal of animals and inaccessibility to grazing areas because of
insecurity. This led to a lack of livestock products (milk,
meat), which are the main sources of protein for the populations.
? Commercial activity: is also affected by the worsening of
insecurity situation. Weekly fairs are no longer frequented
especially by the populations coming from the villages of Douna, Niagassadiou
and Tiguila. The barter system which consists in exchanging the products of
agriculture against those of livestock no longer works.
The lack of road infrastructure connecting the villages of the commune between
they, the existence of improvised explosive devices and robberies of any kind
make any movement in the area by road dangerous.
In this context, any initiative to assist the population is almost
impossible by the road.
? In the field of health: the municipality has 4 health centers
community in the villages of Mondoro, Niagassadiou, Douna and Tiguila.
Due to the insecurity, the qualified personnel of the CSCom Niagassadiou,
Douna and Tiguila left their posts to withdraw to Douentza and the centers are
held by caregivers.
No health activities can be properly carried out in this commune
because of the insecurity aggravated by the inter-communal conflict.
Humanitarian actors have difficulties in assisting these populations by
the risk of exposure to improvised explosive devices.
So people in the villages of Douna, Niagassadiou and Tiguila
mostly Dogons are cut off from the rest of the world since about Six (6)
month. According to the local authorities (mayors and notables) no movement is
possible outside the villages of these areas because of the presence of
improvised explosives and armed men who are ready to shoot any
someone who is intercepted outside the villages. In a word a blockade was imposed
to these areas by armed men.
...
Arrival on the field the investigation team found on the spot 53 patients coming
villages of Douna and Niagassadiou.
The methodology adopted was to select 10 patients whose condition was judged
serious (3 men, 4 children and 3 women).
Overall, the reasons for consultation were similar for all
sick, namely the swelling of the lower limbs, painful with
lameness.
History of the disease: the onset of the disease would be around 3 to 4 months
towards the beginning of the month of Lent marked by the gradual
alteration of the general condition, swelling of the lower extremities followed
arthralgia and functional impotence without fever.
On-site investigations revealed patients with a condition
altered general condition (anorexia, asthenia, weight loss), with edema
painful lower limbs guarding the scoop, functional impotence,
stomatitis-gingivitis and with conjunctival paleness, signs of
malnutrition ranging from Kwashiorkor to marasmus in children (hair
fine, relaxed, brittle, discolored, sometimes blond). Two children had Tests
Rapid Diagnosis of Malaria positive. Faced with these symptoms,
patients have benefited from symptomatic and specific treatments. Table
was marked in children with sadness, apathy and nervousness.
In the social antecedents, there are difficulties to live
because of insecurity, food shortage in these areas. No notion of
Infectious syndrome has been reported. Episodes of diarrhea have been reported
at some patients.
Some pictures
Reported deaths had similar tables to those described above. At this
224 cases were reported by the community including 35 deaths.
In summary :
Clinical investigations have revealed an edematous syndrome
painful, clinical signs of malnutrition, oral signs of gingivostomatitis,
cutaneous syndrome of malnutrition and signs of irritation in
children without any infectious syndrome.
Actions undertaken on site:
- case management;
- Blood sampling for biological examinations (NFS, VS, protidemia,
complete ionogram, biochemistry etc.);
- Advice provided to the populations (take care of the sick, respect the
individual and collective hygiene measures, nutritional advice)
- Endowment of the Mondoro CSCom in drugs and consumables.
CONCLUSION:
August 05, 2018, following information on the occurrence of an illness
unusual affecting women and children in the villages of Douna,
Niagassadiou and Tiguila, Mondoro Commune, Douentza Health District,
an investigative team was deployed in the field.
The findings observed during this investigation led to
the
hypothesis of malnutrition in the community following a shortage
related to the intercommunal conflict in Mondoro commune.
In the face of insufficient supply of living due to insecurity, all
populations in Mondoro commune are at risk of
severe acute malnutrition and its complications due to vitamin B1 deficiency
and live C.
...
https://www.humanitarianresponse.in...port_dinvestigation_mondoro-fv_07-08-2018.pdf
https://www.humanitarianresponse.in...investigation-des-cas-de-maladie-inhabituelle
