BACKGROUND & AIMS: :Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries.

背景与目标： : 对用于评估参与者对在美国和马里进行的疟疾疫苗试验的知情同意的理解的问卷的初步答复进行了统计。总分按年龄，性别，识字率 (如果已知) 和位置进行分析。美国参与者的回答中有92% (92%) 是正确的，马里参与者的回答中有85% 是正确的。在马里，与风险和疫苗类型有关的问题更有可能被错误回答。对于成年参与者，得分较高的独立预测因素是美国的年轻年龄和女性，以及马里的男性。美国的得分高于马里 (P = 0.005)。尽管存在这种差异，但两个站点的参与者总体上还是很了解情况。尽管解释必须是合格的，因为问卷并非旨在作为研究工具，并且在站点之间没有标准化，但这些结果并不支持对发展中国家与发达国家的研究参与者之间系统性低理解的担忧。

BACKGROUND & AIMS: :Pharmaceutical policy in Mali is based on the concept of essential medicines and procurement of generic medicines. Unfortunately, increasing availability of generic medicines via different promotional programs can often be accompanied by their irrational use. This survey was thus designed to evaluate rational prescribing and dispensing of medicines in Mali. A cross-sectional survey was conducted from 1998 to 2005 in 30 primary health centers and 30 private dispensaries; in Bamako and in 6 of the 8 other regions of the country. In each of the visited facilities, 20 prescriptions dispensed at the time of the survey were collected. The average number of medicines per prescription was 3.2+/-1.3 and 2.8+/-1.2 respectively in the public and private sectors. Medicines were prescribed under generic name in 88.2% of the public sector prescriptions and in 30.9% of the private sector ones. Antibiotics were prescribed in 70.4% of the public sector prescriptions and in 50.0% of the private sector prescriptions. In the public sector 33.2% of the prescriptions had injections compared with 14.3% in the private sector (p<0.001). The median price per prescription was lower in the public sector (1575.0 CFA F, or 2.4 Euros, of which 91.3% were actually purchased by the patient) than in the private sector (5317.5 CFA F, or 8.1 Euros, of which 84.6% were purchased). Generic medicines are being used in the public sector but less frequently than in private practice. As therapeutic guidelines are already available, it would be useful to institute interactive information for practitioners through intensive visits by more experienced supervisors. The quality of the prescriptions could thus be optimized.

背景与目标： : 马里的药品政策基于基本药物和非专利药品采购的概念。不幸的是，通过不同的促销计划增加仿制药的可用性通常会伴随其不合理的使用。因此，这项调查旨在评估马里合理的处方和配药。1998年30个初级保健中心和30个私人药房的2005年进行了横断面调查; 在巴马科和该国其他8个地区中的6个。在每个被访问的设施中，收集了调查时分发的20张处方。在公共和私营部门，每份处方的平均药品数量分别为3.2 +/-1.3和2.8 +/-1.2。88.2% 公共部门的处方和30.9% 私营部门的处方都以通用名称开处方。70.4% 公共部门的处方和50.0% 私营部门的处方都开了抗生素。与私营部门的14.3% 相比，公共部门的33.2% 处方注射 (p<0.001)。每个处方的中位数价格在公共部门 (1575.0 CFA F，或2.4欧元，其中91.3% 实际由患者购买) 低于私营部门 (5317.5 CFA F，或8.1欧元，其中84.6% 购买)。公共部门正在使用仿制药，但比私人部门使用的频率低。由于治疗指南已经可用，因此通过经验丰富的主管进行密集访问，为从业人员提供互动信息将很有用。因此可以优化处方的质量。

BACKGROUND & AIMS: :Dysmenorrhea is painful menstrual cramps, which negatively impacts the quality of life of a large percentage of the world's female population in reproductive age. The paper reviews the plants used in the Malian traditional medicine for the treatment of dysmenorrhea. Some medicinal plants were effective for treatments of dysmenorrhea with minimal side effects. Conventional therapy for dysmenorrhea, which usually includes non-steroidal anti-inflammatory drugs (NSAIDs), provides symptomatic relief, but presents increasing adverse effects with long-term use. This article is in the framework of a study supported by International Foundation for Science (IFS) on three medicinal plants used in the treatment of dysmenorrhea in Mali: Maytenus senegalensis Stereospermum kunthianum and Trichilia emetica.

背景与目标： : 痛经是痛苦的月经来潮，对世界上很大一部分育龄女性的生活质量产生负面影响。本文回顾了马里传统医学中用于治疗痛经的植物。一些药用植物可有效治疗痛经，副作用最小。痛经的常规治疗通常包括非甾体类抗炎药 (NSAIDs)，可缓解症状，但长期使用会增加不良反应。本文是在国际科学基金会 (IFS) 支持的一项研究的框架内，该研究涉及马里用于治疗痛经的三种药用植物: meetenus senegaleensis Stereospermum kunthianum和Trichilia emetica。

BACKGROUND & AIMS: :Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.

背景与目标： : 基于青蒿素的联合疗法 (ACTs) 是单纯性疟疾的一线治疗方法。对重复实施给定行为的公共健康益处和安全性的研究很少。我们进行了一项随机试验，比较了2005年7月至2007年7月年马里6月龄及以上无并发症疟疾患者的蒿甲醚-卢美芬特、青蒿琥酯 + 阿莫地喹 (AS + AQ) 和青蒿琥酯 + 磺胺多辛-乙胺嘧啶 (AS + SP).除了使用奎宁的治疗失败外，患者对随后的每次无并发症的疟疾发作均接受相同的初始治疗。总体而言，包括780名患者。AS + AQ和AS + SP组患者发生疟疾发作的风险显著降低; 风险比 (RR) 分别为0.84 (P = 0.002) 和RR = 0.80 (P = 0.001)。所有组的治疗效果相似，95% 以上。尽管所有药物均非常有效且耐受性良好，但AS AQ和AS SP与较少的疟疾发作有关。

BACKGROUND & AIMS: BACKGROUND:The aim of this field trial was to evaluate the efficacy of attractive toxic sugar baits (ATSB) in Mali, where sustained malaria transmission occurs despite the use of long-lasting insecticidal nets (LLINs). ATSB bait stations were deployed in seven of 14 similar study villages, where LLINs were already in widespread use. The combined use of ATSB and LLINs was tested to see if it would substantially reduce parasite transmission by Anopheles gambiae sensu lato beyond use of LLINs alone. METHODS:A 2-day field experiment was conducted to determine the number of mosquitoes feeding on natural sugar versus those feeding on bait stations containing attractive sugar bait without toxin (ASB)-but with food dye. This was done each month in seven random villages from April to December 2016. In the following year, in seven treatment villages from May to December 2017, two ATSB bait stations containing the insecticide dinotefuran were placed on the outer walls of each building. Vector population density was evaluated monthly by CDC UV light traps, malaise traps, pyrethrum spray (PSCs) and human landing catches (HLCs). Female samples of the catch were tested for age by examination of the ovarioles in dissected ovaries and identification of Plasmodium falciparum sporozoite infection by ELISA. Entomological inoculation rates (EIR) were calculated, and reductions between treated and untreated villages were determined. RESULTS:In the 2-day experiment with ASB each month, there was a lower number of male and female mosquitoes feeding on the natural sugar sources than on the ASB. ATSB deployment reduced CDC-UV trap female catches in September, when catches were highest, were by 57.4% compared to catches in control sites. Similarly, malaise trap catches showed a 44.3% reduction of females in August and PSC catches of females were reduced by 48.7% in September. Reductions of females in HLCs were lower by 19.8% indoors and 26.3% outdoors in September. The high reduction seen in the rainy season was similar for males and reductions in population density for both males and females were > 70% during the dry season. Reductions of females with ≥ 3 gonotrophic cycles were recorded every month amounting to 97.1% in October and 100.0% in December. Reductions in monthly EIRs ranged from 77.76 to 100.00% indoors and 84.95% to 100.00% outdoors. The number of sporozoite infected females from traps was reduced by 97.83% at treated villages compared to controls. CONCLUSIONS:Attractive toxic sugar baits used against Anopheles mosquitoes in Mali drastically reduced the density of mosquitoes, the number of older females, the number of sporozoite infected females and the EIR demonstrating how ATSB significantly reduces malaria parasite transmission.

背景与目标：

BACKGROUND & AIMS: :Previous examination revealed a correlation of phytopathogenic data of 'Candidatus Phytoplasma mali' strains and the DNA sequence variability of a type ATP00464 hflB gene fragment. To further investigate such a relationship, all distinct genes previously annotated as hflB in the genome of 'Ca. P. mali' strain AT were fully sequenced and analyzed from a number of representative mild, moderate, and severe strains. The re-annotation indicated that the sequences encode six AAA+ ATPases and six HflB proteases. Each of the nine distinct deduced AAA+ proteins that were examined formed a coherent phylogenetic cluster. However, within these groups, sequences of three ATPases and three proteases from mild and severe strains clustered distantly, according to their virulence. This grouping was supported by an association with virulence-related amino acid substitutions. Another finding was that full-length genes from ATPase AP11 could only be identified in mild and moderate strains. Prediction of the membrane topology indicated that the long ATPase- and protease-carrying C-terminal tails of approximately half of the AAA+ proteins are extracellular, putatively facing the environment of the sieve tubes. Thus, they may be involved in pathogen-host interactions and may compromise phloem function, a major effect of phytoplasma infection. All full-length genes examined appear transcriptionally active and all deduced peptides show the key positions indicative for protein function.

背景与目标： : 先前的检查显示，“假丝酵母菌” 菌株的植物病原学数据与ATP00464型hflB基因片段的DNA序列变异性之间存在相关性。为了进一步研究这种关系，所有先前在 'Ca基因组中注释为hflB的不同基因。对P. mali' 菌株AT进行了完整的测序，并从许多代表性的轻度，中度和重度菌株中进行了分析。重新注释表明该序列编码六个AAA atpase和六个HflB蛋白酶。检查的九种不同的推导AAA蛋白中的每一种都形成了一个相干的系统发育簇。然而，在这些组中，根据其毒力，来自轻度和重度菌株的三种atpase和三种蛋白酶的序列远距聚集。该分组得到了与毒力相关氨基酸取代相关的关联的支持。另一个发现是，ATPase AP11的全长基因只能在轻度和中度菌株中鉴定。膜拓扑的预测表明，大约一半的AAA蛋白的长ATPase和蛋白酶携带的C末端尾巴是细胞外的，假定面对筛管的环境。因此，它们可能参与病原体与宿主的相互作用，并可能损害韧皮部功能，这是植原体感染的主要作用。所检查的所有全长基因均具有转录活性，并且所有推导的肽均显示出指示蛋白质功能的关键位置。

BACKGROUND & AIMS: :Staphylococcus aureus is an important human pathogen, but it appears more commonly in asymptomatic colonization of the nasopharynx than in cases of invasive disease. Evidence concerning the global population structure of S. aureus is limited by the overrepresentation in the multilocus sequence testing database of disease isolates recovered from Western Europe, the Americas, Australia, and Japan. We address this by presenting data from the S. aureus carriage population in Mali, the first detailed characterization of asymptomatic carriage from an African population. These data confirm the pandemic spread of many of the common S. aureus clones in the carriage population. We also note the high frequency (approximately 24%) of a single divergent genotype, sequence type 152 (ST152), which has not previously been recovered from nasal carriage isolates but corresponds to a sporadic Panton-Valentine leukocidin (PVL)-positive, community-acquired methicillin-resistant S. aureus clone noted mostly in Central Europe. We show that 100% of the ST152 isolates recovered from nasal carriage samples in Mali are PVL positive and discuss implications relating to the emergence and spread of this virulent genotype.

背景与目标： : 金黄色葡萄球菌是一种重要的人类病原体，但在无症状的鼻咽定植中比在浸润性疾病中更常见。关于金黄色葡萄球菌全球人口结构的证据受到来自西欧，美洲，澳大利亚和日本的疾病分离株的多位点序列测试数据库中过多代表的限制。我们通过提供马里金黄色葡萄球菌运输人口的数据来解决这个问题，这是非洲人口无症状运输的第一个详细特征。这些数据证实了许多常见的金黄色葡萄球菌克隆在运输人群中的大流行传播。我们还注意到单个不同基因型序列类型152 (ST152) 的高频率 (约24%)，该基因型以前尚未从鼻运输分离株中恢复，但对应于零星的Panton-Valentine leukocidin (PVL) 阳性，社区获得性耐甲氧西林金黄色葡萄球菌克隆主要见于中欧。我们显示从马里的鼻运输样品中回收的100% ST152分离株是PVL阳性，并讨论了与这种强毒基因型的出现和传播有关的含义。

BACKGROUND & AIMS: BACKGROUND:Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria control. Case management guidelines recommend confirmatory testing of suspected malaria cases, then prescription of specific drugs for uncomplicated malaria and for severe malaria. This study aims to describe case management practices for children aged 1-59 months seeking treatment with current or recent fever from public and private, rural and urban health providers in Mali. METHODS:Data were collected at sites in Sikasso Region and Bamako. Health workers recorded key information from the consultation including malaria diagnostic testing and result, their final diagnosis, and all drugs prescribed. Children with signs of severe diseases were ineligible. Consultations were not independently observed. Appropriate case management was defined as both 1) tested for malaria using rapid diagnostic test or microscopy, and 2) receiving artemisinin combination therapy (ACT) and no other antimalarials if test-positive, or receiving no antimalarials if test-negative. RESULTS:Of 1602 participating children, 23.7% were appropriately managed, ranging from 5.3% at public rural facilities to 48.4% at community health worker sites. The most common reason for 'inappropriate' management was lack of malaria diagnostic testing (50.4% of children). Among children with confirmed malaria, 50.8% received a non-ACT antimalarial (commonly artesunate injection or artemether), either alone or in combination with ACT. Of 215 test-negative children, 44.2% received an antimalarial drug, most commonly ACT. Prescription of multiple drugs was common: 21.7% of all children received more than one type of antimalarial, while 51.9% received an antibiotic and antimalarial. Inappropriate case management increased in children with increasing axillary temperatures and those seeking care over weekends. CONCLUSIONS:Multiple limitations in management of febrile children under five were identified, including inconsistent use of confirmatory testing and apparent use of severe malaria drugs for uncomplicated malaria. While we cannot confirm the reasons for these shortcomings, there is a need to address the high use of non-ACT antimalarials in this context; to minimize potential for drug resistance, reduce unnecessary expense, and preserve life-saving treatment for severe malaria cases. These findings highlight the challenge of managing febrile illness in young children in a high transmission setting.

背景与目标：

BACKGROUND & AIMS: :Mosquito net ownership is rising in sub-Saharan Africa but will substantially reduce malaria only if nets are used and the most vulnerable household members sleep under them. We used data from 9 large-scale household surveys conducted in 6 African countries from 2000 to 2004 that enumerated all household members and nets owned, analyzing only net-owning households. Across countries, women of reproductive age and children under 5 (without gender bias) were most likely to use the net; least likely were children of age 5-14 and adult males. Nets commonly covered 2-3 people. If a baby net was used, fewer people used the family net. Pregnant women were more likely to use a net in 2004 than in 2000. In several countries, a sizable minority of nets owned were not used. Understanding intra-household net-use patterns helps malaria control programs more effectively direct their efforts to increase their public health impact.

背景与目标： : 在撒哈拉以南非洲，蚊帐的拥有量正在增加，但只有使用蚊帐并且最脆弱的家庭成员睡在蚊帐下，蚊帐的拥有量才会大大减少疟疾。我们使用了在6个非洲国家2000年2004年进行的9次大规模家庭调查的数据，这些数据列举了所有家庭成员和拥有的网，仅分析了拥有网的家庭。在各国，育龄妇女和5岁以下儿童 (无性别偏见) 最有可能使用网络; 5-14岁的儿童和成年男性的可能性最小。蚊帐通常覆盖2-3人。如果使用婴儿网，使用家庭网的人就会减少。孕妇比2000年更有可能使用净2004年。在一些国家，没有使用相当少的蚊帐。了解家庭内部净使用模式有助于疟疾控制计划更有效地指导其努力，以增加其对公共卫生的影响。

BACKGROUND & AIMS: Abstract: Background:Mali is currently in the midst of ongoing conflicts which involve jihadist groups, rebels, and the state. This conflict has primarily centered in the North of the country. Humanitarian actors delivering services in these geographies must navigate the complex environment created by conflict. This study aimed to understand how humanitarian actors make decisions around health service delivery within this context. Methods:The current case-study utilized a mixed methods approach and focused on Mopti, Mali's fifth administrative region and fourth largest in population. Latent content analysis was used to analyze interview transcripts guided by our research objectives and new concepts as they emerged. Indicators of coverage of health interventions in the area of maternal and child health and nutrition were compiled using Mali's National Evaluation Platform and are presented for the conflict and non-conflict regions. Development assistance estimates for Mali by year were obtained from the Developmental Assistance for Health Database compiled by the Institute for Health Metrics and Evaluation. Administrative data was compiled from the annual reports of Mali's Système Local d'Information Sanitaire (SLIS), Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). Results:Our data suggests that the reaction of the funding mechanisms to the conflict in Mali was a major barrier to timely delivery of health services to populations in need and the nature of the conflict is likely a key modifier of such reaction patterns. Concerns have been raised about the disconnect between the very high administrative capacity of large NGOs that control the work, and the consequent burden it puts on local NGOs. Population displacement and inaccurate estimates of needs made it difficult for organizations to plan program services. Moreover, actors delivering services to populations in need had to navigate an unpredictable context and numerous security threats. Conclusions:Our study highlights the need for a more flexible funding and management mechanism that can better respond to concerns and issues arising at a local level. As the conflict in Mali continues to worsen, there is an urgent need to improve service delivery to conflict-affected populations.

背景与目标：

BACKGROUND & AIMS: :On 16 September 2016, the World Health Organization confirmed a Rift Valley fever (RVF) outbreak in Niger. Epidemiological surveillance was reinforced among the French Armed Forces deployed in Niger and bordering countries: Chad, Mali and Burkina Faso. On 26 October, a probable case of RVF was reported in a service member sampled in Mali 3 weeks earlier. At the time the result was reported, the patient was on vacation on Martinique. An epidemiological investigation was conducted to confirm this case and identify other cases. Finally, the case was not confirmed, but three suspected cases of RVF were confirmed using serological and molecular testing. RVF viral RNA was detectable in whole blood for 57 and 67 days after onset of symptoms for two cases, although it was absent from plasma and serum. At the time of diagnosis, these cases had already returned from Mali to Europe. The infectivity of other arboviruses in whole blood has already been highlighted. That RVF virus has been detected in whole blood that long after the onset of symptoms (67 days) raises the question of its potential prolonged infectivity. Because of exposure to tropical infectious diseases during deployment, military populations could import emerging pathogens to Europe.

背景与目标： : 2016年9月16日，世界卫生组织确认尼日尔爆发裂谷发热 (RVF)。在部署在尼日尔和邻国乍得，马里和布基纳法索的法国武装部队中加强了流行病学监测。10月26日，3周前在马里抽样的一名服务人员报告了可能的RVF病例。报告结果时，患者正在马提尼克岛度假。进行了流行病学调查，以确认该病例并确定其他病例。最后，该病例没有得到证实，但使用血清学和分子检测证实了三个疑似病例的RVF。尽管有两例患者在出现症状后57天和67天的全血中可检测到RVF病毒RNA，尽管血浆和血清中没有RVF病毒RNA。在诊断时，这些病例已经从马里返回欧洲。其他虫媒病毒在全血中的传染性已经得到强调。在症状发作后很长时间 (67天) 在全血中检测到RVF病毒，这引发了其潜在的长期传染性的问题。由于在部署过程中暴露于热带传染病，军事人口可以将新兴病原体进口到欧洲。

BACKGROUND & AIMS: :Humanitarian plastic surgery missions are often a substitute, as plastic surgery training missions are essential for the development of plastic surgery in developing countries. This training must be progressive and adapted to the country's needs. Several simple plastic surgery techniques are sufficient to treat a large number of patients: split-skin grafts, full-thickness skin grafts, Z-plasties, latissimus dorsi myocutaneous pedicle flap.

背景与目标： : 人道主义整形外科任务通常可以替代，因为整形外科培训任务对于发展中国家整形外科的发展至关重要。这种培训必须是渐进的，并适应国家的需要。几种简单的整形外科技术足以治疗大量患者: 皮肤裂移植物，全厚皮肤移植物，Z形成形术，背阔肌肌蒂皮瓣。

BACKGROUND & AIMS: :The objective of this study was to use statistically based experimental designs for the optimization of xylanase production from Alternaria mali ND-16. Ten components in the medium were screened for nutritional requirements. Three nutritional components, including NH(4)Cl, urea, and MgSO(4), were identified to significantly affect the xylanase production by using the Plackett-Burman experimental design. These three major components were subsequently optimized using the Doehlert experimental design. By using response surface methodology and canonical analysis, the optimal concentrations for xylanase production were: NH(4)Cl 11.34 g L(-1), urea 1.26 g L(-1), and MgSO(4) 0.98 g L(-1). Under these optimal conditions, the xylanase activity from A. mali ND-16 reached 30.35 U mL(-1). Verification of the optimization showed that xylanase production of 31.26 U mL(-1) was achieved.

背景与目标： : 这项研究的目的是使用基于统计的实验设计来优化马里链格孢ND-16的木聚糖酶生产。筛选了培养基中的10种成分的营养需求。通过使用Plackett-Burman实验设计，鉴定出三种营养成分，包括NH(4)Cl，尿素和MgSO(4)，可显着影响木聚糖酶的产生。随后使用Doehlert实验设计对这三个主要组件进行了优化。通过使用响应面方法和规范分析，木聚糖酶生产的最佳浓度为: NH(4)Cl 11.34g L(-1)，尿素1.26g L(-1) 和MgSO(4) 0.98g L(-1)。在这些最佳条件下，来自A. mali的木聚糖酶活性ND-16达到30.35 U mL(-1)。优化的验证表明，木聚糖酶的产量达到31.26 U mL(-1)。

BACKGROUND & AIMS: OBJECTIVES:To assess vitamin A supplementation (VAS) coverage of children aged 6-59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali. DESIGN:Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed. SETTING:Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas. SUBJECTS:Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders. RESULTS:At least 80% of the children received the supplement. More 'traditional' communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson chi2 = 5.03; P = 0.025) and fathers' education (Pearson chi2 = 19.02; P < 0.001), possession of a radio (Pearson chi2 = 8.93; P = 0.003) and listening to it (Pearson chi2 = 7.62; P = 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P = 0.004), 'traditional channels' (P = 0.02) and fathers' education (P = 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general. CONCLUSION:National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6-59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in sub-Saharan Africa has stimulated interest to assess whether these programmes can indirectly affect other health priorities. This study assesses whether PMTCT programmes, or components of these programmes, are associated with better obstetrical quality of care and how PMTCT may reinforce existing maternal health programmes. DESIGN:Cross-sectional analysis of data from a cluster-randomized trial called QUARITE. SETTING:Mali and Senegal, West Africa. PARTICIPANTS:Thirty-one referral hospitals and 612 obstetrical patients. INTERVENTION:The exposure of interest was PMTCT measured with a scale containing 10 components describing different prongs of a hospital PMTCT programme. Other variables of interest included: presence of a quality of care improvement programme, hospital resources and patient demographic characteristics. MAIN OUTCOME MEASURE:Obstetrical quality of care measured through a validated chart abstraction tool. RESULTS:Of 45 points, the mean hospital PMTCT score was 26.1 (SD: 6.7). Total PMTCT score was not significantly associated with quality of care, but programme component scores were. After adjustment for known predictors of quality of care, staff training in PMTCT (P = 0.03) and complementary nutritional services (P = 0.03) were significantly associated with better quality obstetrical care. A point increase in scores for either of these components was associated with 40% greater odds of good obstetrical care. CONCLUSIONS:PMTCT training and nutritional components are significantly associated with better quality intrapartum care. Health professionals' training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.

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