WO RLD HEALTH ORGANIZATION Global Task Force on Cholera Control CHOLERA COUNTRY PROFILE: MALI Last update: 26 August 2009

General Country Information: The Republic of Mali is located in western Africa, and borders Algeria, Niger, Burkina Faso, the Côte d'Ivoire, Guinea, Senegal and Mauritania. Mali is divided into eight regions and one district, and further subdivided into 49 cercles. Bamako, the capital, is the largest city of Mali.

Mali became a French overseas territory in 1880 and was known as French Sudan along with neighboring countries). In September 1960, it gained its independence from France.

Mali's population consists of diverse Sub-Saharan ethnic groups. In the northern areas live the Tuaregs, desert nomads, related to the North African Berbers. The Tuaregs traditionally have opposed the central government. In June 1990, seeking greater autonomy, armed attacks in the north led to clashes with the government army. During that time some 150,000 people, mostly Tuaregs and Moors had fled and found refuge in Mauritania, Algeria, Niger and Burkina Faso. In April 1992, the government and most opposing factions signed a pact to end the fighting and restore stability in the north. The peace agreement was celebrated in 1996 in Timbuktu during an official and highly publicized ceremony called Flamme de la Paix -- peace flame. The last camp site in Mauritania was closed by the end of June 1996 and by March of 1997, some 100,000 Malian refugees had gone back to their country.

The latest United Nations Human Development Report (2006) ranks Mali as 175th country in the world out of 177.

Cholera Background history: MALI - OFFICIALLY NOTIFIED CASES AND DEATHS (CFR) TO WHO 1970 - 2008 7000 60 The first outbreak in Mali was in 1970 when the current Cases Deaths pandemic hit the African continent. CFR 6000 50

The years 1984/1985/1986 were marked by important 5000 epidemics with very high case fatality rates ranking from 40 8% to 22%. 4000 30

CFR% In 1995, 1996 and 2000, major outbreaks occurred 3000 20 involving respectively 2191, 5723 and 1885 cases with 231, AND OF DEATHS NB CASES 2000 761 and 51 deaths. (Case fatality rates, CFR of 10.5%, 10 13.3% and 2.7%) 1000

In 2003, the outbreak started in August and was to 0 0 5 7 6 8 7 9 8 7 7 8 8 9 9 06 0 971 973 982 984 993 995 004 continue unfolded until August 2004, accounting for 4'298 1970 1 1972 1 1974 19 1976 19 1978 1979 1980 1981 1 1983 1 1985 19 1987 19 1989 1990 1991 1992 1 1994 1 1996 19 1998 19 2000 2001 2002 2003 2 2005 20 2007 20 YEAR cases and 324 deaths. (CFR: 7.53%)

The first cases were recorded in the Segou region and the outbreak quickly spread to the neighboring regions following the course of the Niger river: Bamako, Koulikoro, Mopti, Segou, Timbuktu, Gao, Sikasso. Ultimately the epidemic also spread further into neighboring country Niger in May 2004 in the Tillabéri Region.

Outbreaks in Mali generally start during the rainy season (June to late october).

In 2005, the first cholera cases reported on 20 June 2005 occurred in the cercle of Kayes (Kayes region). The overall number of cases until January 2006, was 903, with 66 deaths and a CFR of 7.3%. The affected provinces were Kayes and Koulikoro with no clear link between the two. The cases reported in the cercle of Nara (Koulikoro region) in October most certainly came from neighboring Mauritania (Timbedra) with a transmission along the main road from Mauritania to Bamako.

In 2006, Mali reported 7 cases of cholera with no death and in 2007, Mali reported zero cholera case.

Between 14 September and 28 December 2008, Mali reported 153 cholera cases including 5 deaths (CFR 3.27%) in the Kayes district (part of Kayes region). At least 22 villages were affected.

1 of 2 WO RLD HEALTH ORGANIZATION Global Task Force on Cholera Control CHOLERA COUNTRY PROFILE: MALI Last update: 26 August 2009

Weekly evolution of cholera cases and deaths in Kayes region from week 38 until week 51 2008

45

Cases 42 40 Deaths

35

30

25 CASE/DEATH 20

15 16 16 13 10 10 10 10 8 8 7 5 5 4 2 2 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 -5 WEEK

WHO Support Actions • 2003/2004:D WHO provided technical support to MoH for outbreak response (ECHO funding) • Direct country support through the West Africa Initiative to control cholera and other epidemic diarrhoeal diseases (established in 1996)

Demographic and Socio-Economic Data:

Geography Total surface 1 240 192 km2 (landlocked) Capital Bamako (population in Bamako: 1 690 471) Regions 8 (+ one capital district) Official Language French (Bambara is the largest spoken language) Environment Climate Tropical with marked dry season; hot and dry (February to June); rainy, humid, and mild (June to November); cool and dry (November to February) Rainy season June to late October Floods and droughts Recurring droughts; occasional Niger River flooding Desertification Deforestation and desertification are major concerns Natural resources gold, phosphates, kaolin, salt, limestone, uranium, gypsum, granite, hydropower Demographics Population 13 518 000 Religions 90% Muslim, 1% Christian and 9% indigenous religions Ethnic groups Mande (incl. Bambara, 50%), Fulani (17%), Senufo and Bwa (12%) , Songhai (6%), Tuareg and Moor (10%), other (5%) Migrants Mainly refugees from Mauritania (6 185) and Côte d'Ivoire (2 704), 2004 Economy Industry Food processing, construction, phosphate and gold mining Farming Cotton, millet, rice, corn, vegetables, peanuts; cattle, sheep, goats Health Per capita total 39$ Indicators expenditure on health Life expectancy birth (yrs) Males: 44 Females: 47 Child mortality (per 1000) Males 230 Females 208 Communicable Located in meningitis belt; Malaria one of principle causes morbidity and mortality (> 30% of all OPDs) Diseases HIV prevalence (2005): 1.7% Risk Factors Population with access to improved water source 50% (2004) for Cholera Population with access to proper sanitation facilities 46% (2004) Chronic Malnutrition 28% (2001-2003) Sources for Document: WHO, UNHCR, UNICEF, UNDP

The Cholera Task Force country profiles are not a formal publication of WHO and do not necessarily represent the decisions or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or areas or its authorities, or concerning the delineation of its frontiers or boundaries.

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