Mali: Country Profile
Mali is a vast Sahelian and a landlocked country in interior of Western Africa with a population 20 million people. It is now well recognized that approximately 60% of known diseases, and 75% of emerging human diseases, are of animal origin and that changes in ecosystems have a profound impact on animal and human health. As part of the implementation of the 2005 International Health Regulations (IHR), Mali joined the Global Health Security Agenda (GHSA) and adopted the “One Health” approach. The One Health National Platform is organized around a Steering Committee, a multi-sectoral Coordination Committee, a Permanent Secretariat and thematic groups. It involves a dozen departments and has more than 44 functional focal points. GHSA investments in each country are guided by the results of a Joint External Evaluation (JEE) which was conducted in Mali in 2017. The results revealed that, despite progress in many areas of in many areas of health security, challenges remain in preventing, detecting, and responding to diseases with epidemic potential and emerging infectious threats. One Health stakeholders participated in a structured, consultative zoonotic disease prioritization process to identify priority investments based on criteria such as the epidemiological profile in the country and the potential impact of an outbreak. As a result, they have developed and disseminated standardized communication materials and messages related to specific priority zoonotic diseases (PZDs).
Priority Zoonotic Diseases
The prioritization workshop identified five PZD clusters: hemorrhagic fevers (Ebola Virus Disease, Lassa fever, Marburg virus disease, Rift Valley fever, Crimean Congo hemorrhagic fever), zoonotic influenza including avian influenza, anthrax, bovine tuberculosis, and rabies.
Ebola Virus Disease (EVD) is an infection caused by a virus of the filovirus family to which the Marburg virus also belongs. Humans are contaminated either by direct contact with infected bats (a rare event), or by handling infected animals found dead or sick in forests (a more frequent event). Human-to-human transmission is also possible and occurs through direct contact with the blood, secretions, organs or biological fluids of infected individuals. EVD appeared in Mali from Guinea in 2014.
Lassa fever is a serious disease transmitted injection or inhalation of secretions (urine, feces, blood) of infected mice and rats (“multimammate” or Mastomys type). it is manifested by fever, muscle pain, generalized weakness, diarrhea, and bleeding from orifices.
Rift Valley Fever (RVF) is a viral infection that spreads most commonly to humans from livestock or wild animals via mosquitoes. It can also be spread through direct contact with blood or bodily fluids of animals such as sheep, goats, or camels. RVF can cause spontaneous abortion in animals, and assisting with abortions is a common exposure. Farmers, abattoir workers, and veterinary or laboratory staff are high risk groups. Mosquito control and wearing protective equipment when exposed to blood or bodily fluids of infected animals are the main prevention methods.
Crimean Congo Hemorrhagic Fever (CCHF) is a viral disease involving fever, muscle pain, dizziness, gastrointestinal issues, and ultimately hemorrhagic symptoms. The virus is tick-borne and spreads by way of domestic and wild animals such as sheep, cattle, goats, ostriches and hares. Human-to-human transmission can occur, and risk groups include health care providers, workers in abattoirs, and livestock handlers. Tick prevention and control is the main preventative measure.
Avian influenza is an infection by an influenza virus that can affect almost all species of birds, wild or domestic. It can be highly contagious, especially in chickens and turkeys, and can lead to extremely high mortality, especially in factory farms. The avian influenza virus sometimes infects other animal species, including pigs.
Anthrax is a bacterial infection that typically affects animals and can pass from animals and animal products to humans, with limited human-to-human transmission. In endemic settings, anthrax affects primarily cattle, goats, sheeps and the spores can remain in soil for years. It can spread to humans through open wounds on the skin, ingestion, or inhaling the spores. Anthrax is not well known, and very few people indicate that they had heard the name of the disease but were not clear on the modes of transmission.
Bovine tuberculosis is caused by the bacterial species Mycobacterium bovis and causes bovine tuberculosis in farm animals (and tuberculosis in other wild animals). In 2016, according to WHO estimates, 147,000 new cases of zoonotic TB were reported in humans, including 12,500 deaths.
Rabies remains a widespread disease across the globe, responsible for tens of thousands of deaths worldwide each year. It is a viral infection transmitted by contact with saliva of infected mammals, mainly through bites and scratches and in most places, commonly through dogs. Children are particularly vulnerable to rabies. Rabies is known as the “Dog Madness Disease” in Bambara “Woulou Fa”. Rabies has the disadvantage of being a very persistent, non-emerging disease since it does not generally attract public attention. There is a national plan for rabies control in Mali developed by the multidisciplinary and multisectoral working group (DNSV, DNS, DNEF).
One Health Landscape
Summary of existing Breakthrough ACTION research
With funding from USAID, Breakthrough ACTION conducted a literature review on emerging diseases of epidemic potential (DEP) in Mali. The review included qualitative, quantitative, and evaluation studies conducted among West African populations since 1980 related to communication interventions for the relevant disease groups. The review took place from February to May 2019. Organisations involved in the mapping study were invited to share publications on DEP during the period 2013 -2018. PubMed and Medline were the main search engines for publications in scientific journals.
Several themes emerged from reviewing the journal articles and grey literature.
Review of viral fevers in Mali
The presence of viral hemorrhagic fevers in Mali is a reality today. Prevention and response are linked to a good knowledge of the epidemiology of these diseases. The identification of the pathogen is also an essential link in the management of epidemics due to these diseases. Certain diseases appear to be increasing in prevalence in Mali, such as viral hemorrhagic fevers. Some of these diseases are transmitted from person to person through direct or indirect contact with symptomatic patients.
- Lassa fever appeared in Mali in 2009 in humans. Since then, several studies have been conducted on rodents with seroprevalence sometimes reaching 50% in southern Mali. In humans, the prevalence ranged from 14.5 to 44% and an incidence of 6.3%.
- For Crimean Congo Hemorrhagic Fever, the authors found a human seroprevalence of 4.5%. In cattle, serological traces were found throughout the country ranging from 15% to 95%.
- Mali has experienced two separate incursions of Ebola virus disease from Conakry, Guinea. Diagnosis of the 103 suspected cases was performed at the SEREFO/UCRC laboratory with 10 cases being positive for Ebola virus.
- Dengue was present with a seroprevalence ranging from 40% to 93%.
- One human case of Rift Valley Fever was identified in Mali in 2017, but the disease is present in cattle mainly in the northern regions of the country.
As part of the Integrated Control of Zoonoses in Africa (ICONZ) research network, a mass vaccination campaign against dog rabies was conducted in two communes of Bamako, Mali, in September 2014.
A mixed method study (quantitative and qualitative) was developed to assess intervention effectiveness to inform future scalability.
A survey was conducted in 36 dairy herds in 19 sites. The prevalence within the herds was estimated at 94.44% and that this prevalence varied according to the age and breed of the animals. Bovine tuberculosis persists in dairy cattle herds in the peri-urban area of Bamako District.
To ensure better control of the disease, Mali must create the necessary conditions for the rigorous application of the “test and slaughter” technique through incentives for sanitized farms. In order to prevent cases of human contamination, slaughterhouse controls and public awareness of the health risks associated with the consumption of raw meat, milk and dairy products must be strengthened.
Bovine tuberculosis is a major constraint at the refrigerated slaughterhouse in Bamako (2.50% of total seizures in 2010). Mycobacterium bovis is the main mycobacterial species isolated in culture and its prevalence rate varies according to the breed, sex and age of the animals. In order to better control bovine tuberculosis at the refrigerated slaughterhouse in Bamako, it is essential to implement a national program to control this disease in the farms from which the animals originate.
Middle East Respiratory Syndrome (MERS)
A high percentage (up to 90%) of dromedary camels in the Middle East, Central and East Africa have antibodies to Middle East respiratory coronavirus syndrome (MERS-CoV). Dromedary camels in northern Mali are exposed to MERS-CoV or MERS-CoV-like virus, with nearly 90% of animals having reactive antibodies. This broadens the distribution of MERS-CoV westward and, combined with data from other regions, indicates that most areas of Africa with camels likely have a high frequency of exposure to MERS-CoV.
Surveys were conducted in 2009-2011 in a study area covering approximately 98% of the Malian poultry. Two main recommendations to limit the risk of disease transmission were made:
- Commercial farms: introduce mandatory farm registration and accreditation, increase technical competence and access to credit for farms with low biosecurity, and support poultry producer associations;
- Village poultry: Promoting better quarantine and management of sick and dead birds. Such detailed knowledge of the country-specific characteristics of poultry production systems is essential to the development of more effective disease risk management policies.
Read the literature review here.
In 2019, the Breakthrough ACTION project conducted qualitative, formative research to explore the structural, socio-cultural, and individual determinants of risk, prevention, and response behaviors related to the five priority zoonotic disease groups in Mali. The study was conducted in Bamako, Diéma (Kayes region) and Yanfolila (Sikasso region) through 24 group discussions, 24 individual interviews, 15 community mapping exercises and 15 direct observations. In general, the results showed a significant number of risk behaviors among all the target populations, even though risk perception often remains very low. While some people engage in risky behaviors, others regularly observe measures to prevent zoonotic diseases. The risk behaviors can be summarized as follows:
- Not using protective measures when interacting with animals to avoid the risk of contamination;
- Failure to wash hands with soap in certain circumstances, such as after helping an animal give birth, after touching animal blood, after touching sick animals, or before and after milking a cow;
- Failure to disinfect poultry houses with bleach;
- Selling sick animals or their meat;
- Eating the meat of potentially sick or dead animals;
- Not enforcing quarantine of sick or newly arrived animals;
- Not vaccinating dogs;
- Not using veterinarians when needed and self-medicating
- Self-medication in terms of animal and human health.
- Farmers do not boil milk before drinking it. The practice is less common in rural areas (reduction in quantity/change in taste) than in urban areas
On the other hand, the determinants that explain these risk behaviors are of an individual, sociocultural and structural nature. For example, lack of knowledge of the consequences and low perception of the risk are obstacles to the practice of handwashing with soap after helping an animal give birth, touching animal blood or after touching sick or dead animals or before and after milking cows.
Cultural habits and lack of financial resources prevent many stakeholders from quarantining sick or newly arrived animals or keeping them out of the pens. The majority of individuals interviewed do not disinfect their poultry houses due to lack of financial resources. For fear of loss of income, farmers and butchers prefer to sell sick animals or their meat or eat their meat rather than perform a sanitary slaughter or bury dead animals. Structurally, veterinarians do not properly control and stamp meat, exposing the population to the risk of contamination by potential zoonotic diseases. In addition, the lack of space and the high number of herds favor proximity breeding.
Read the formative research report here.
Case study on SBC response
Breakthrough ACTION Mali has used the findings of the PZD formative research in a wide variety of ways to shape its SBC approach. One key intervention made possible through the use of the research findings has been the development and implementation of the country’s first dedicated One Health communication campaign, Keneya Josenw (Pillars of Health) which was implemented in 2021 and aimed to build awareness of all of the country’s priority zoonotic diseases along with general One Health awareness using a range of channels and approaches. The formative research findings helped the Keneya Josenw design team to understand current knowledge, attitudes and practices around these lesser-studied diseases in order to tailor messaging and address prevalent barriers to key cross-cutting prevention behaviors. In a post-exposure mixed-methods study following the campaign, between 77% and 95% of respondents expressed agreement that they were ready to practice specific PZD prevention behaviors; between 83% and 96% of respondents indicated that they would adopt specific measures if faced with a suspected zoonotic disease. Alongside the general campaign, the behavioral research has also informed targeted SBC efforts amongst marginalized groups, with an aim towards enhancing inclusiveness of preparedness and response. Since 2021, Breakthrough ACTION has collaborated with the Malian Federation of People Living with Disabilities to produce adapted communication materials for the hearing- and visually-impaired and has trained association members around the priority zoonotic diseases so that they can raise awareness in their respective networks.