The health of nomads and semi-nomads of the Malian Gourma: an epidemiological approach.

A survey of the health problems of the population of the Gourma was conducted at the request of the Ministry of Planning in Mali. The objective was to describe the health status of the people in this area and to recommend appropriate forms of health care for the semi-arid 6th (Tombouctou) and 7th (Gao) regions of Mali. 3 major population groups were encountered in the Gourma: settled Sonrai agriculturalists who because of increasing aridity have regrouped beside the river and the perennial marshes particularly at Gossi; Kel Tamasheq nomadic pastoralists who survive on untreated milk butter and meat and who were severely affected by the 1973 drought; and Fulani cattle herders who migrate with their herds along established transhumance routes and whose diet consists of millet and milk from their herds. A small number of Moors also were encountered pastoralists who had recently lost their animals during the drought. The inquiry comprised a single cross-sectional survey conducted towards the end of the dry season the difficult period when the nomads congregate around the few remaining marshes and permanent wells. Between April 11 and May 7 1979 8 principal camps were visited and 1995 people examined. A doctor speaking the local language conducted the interview and the clinical examination consisting of: an assessment of the patients general condition and nutritional status; a search for lesions of the skin and eyes; a check for hypertension or enlarged livers or spleens; and other symptoms such as coughing spitting and blood in the urine. As part of the epidemiological component finger-prick blood samples were taken. Stools and urine could only be examined systematically for the school-age children because of the difficulty of obtaining excreta on demand for adults. The assessment of the morbidity of the population reports the following: assessment of poor health status and malnutrition; nutritional status of children under age 5; general assessment of morbid conditions; prevalence of infections; brucellosis; tuberculosis; leprosy; eye infections; parasitic infections; mycotic infections. Data is also reported on infant and child mortality and fertility and sterility. The criteria for the identification of the poor general and nutritional state of the population indicate that children aged 0 to 7 are more disadvantaged than adults 15 to 30. Infant mortality remains high but its main causes could not be identified by interviewing mothers. Tuberculosis endemic syphilis and leprosy are present everywhere in these pastoral populations whose particular ecological circumstances explain their widespread prevalence: a population living together eating and drinking from the same calabash whose almost nonexistent hygiene is due to lack of water. Brucellosis and malaria are endemic in the area. Trachoma seems absent. Urinary bilharzia is only found around the marsh at Gossi. In the Gourma health care improvements should include both general and particular measures adapted to the local epidemiological circumstances.