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The
Francophone African Republic of Mali is a landlocked western
African nation bordering Algeria, Niger, Burkina Faso, Ivory
Coast, Guinea, Senegal and Mauritania. Its varied geography
includes parts of the Sahara as well as littoral regions facing
the Nile and Senegal Rivers. The former French colony achieved
independence in 1959 along with Senegal, and established its
current iteration in 1960. Half of this poor country lives below
the international poverty line. Most of the economy revolves
around subsistence agriculture, with cotton being the most
important crop. Nearly 70 percent of Malians live in rural areas,
and about 5 – 10 percent are still nomadic. Mali is heavily
dependent on foreign aid.
Malian life expectancy is very low, even by sub-Saharan African
standards; 50 years for males and 56 for females. As with many
poor sub Saharan African countries, communicable diseases such as
HIV and tuberculosis are serious health concerns. However, Mali’s
HIV infection rate of 10 cases for every 1,000 adults is less than
one quarter of the regional average, although still higher than
the global norm. Tuberculosis is a relatively more serious
concern, with 528 cases per 100,000 people, more than two and a
half times the global average.
Total annual expenditure on health care is about USD66, or 5.6
percent of GDP, and less than half of the African average.
Government spending makes up slightly less than half of total
health expenditure, more than half of which comes from external
funding. Among private health expenditure, 99.5 percent is out of
pocket spending, with the remaining 0.5 percent coming from
private Mali health insurance, which was introduced to the country
in the late 1990s.
Malians’ utilisation of basic health services associated with
antenatal, birth and infant care are low by global standards,
although similar to regional norms. Slightly less than half of all
Malian births are attended by skilled health care personnel.
Mali’s healthcare workforce is seriously understaffed. There are
only 0.5 doctors and 3.0 nurses and midwives per 10,000 people,
representing less than one third of the already low African
regional average. There are only five national and six regional
general hospitals in the entire country. Provision of health care
services is marked by extreme inequity. Figures for poor and rural
residents are much lower than those overall averages stated above.
Public health standards in Mali are extremely low. Only about half
of the population has access to improved drinking water sources,
although this represents steady improvement over the past two
decades. Similarly, improved sanitation facilities are available
to about 40 percent of Malians. While this also represents
improvement, bear in mind that even these existing facilities
would not measure up to developed country standards.
The WHO Global Alert and Response team have issued a number of
advisories on outbreaks of yellow fever and cholera over the past
decade, although the most recent yellow fever alert was released
in 2005. The Malian Ministry of Health and the WHO have drafted
Country Cooperation Strategy for 2010 – 2015. This medium term
strategic plan outlines Malian goals for provision of health care
and cooperation with various multilateral and bilateral agencies
involved. Unfortunately, corruption is a serious problem in Mali;
a former Minister of Health was recently charged with abusing
public funds earmarked for AIDS prevention.
Despite being a landlocked country, Mali has much to offer the
tourist, including the famed trading city of Timbuktu. And Mali is
culturally rich, with world famous musical traditions, cuisine and
fashion. However, there are some risks involved in visiting
sub-Saharan Africa and the US Centres for Disease Control (CDC)
have issued a series of guidelines to advise travellers.
According to the CDC, prospective travellers to Mali should visit
a physician or health clinic specialising in travel medicine four
to six weeks before departure. Routine vaccinations should be
updated or boosted if necessary, and yellow fever vaccinations are
also required. Meningococcal and rabies vaccines may be advised
for some travellers.
Given its climate, Mali is also prone to outbreaks of malaria. The
CDC recommends long sleeved clothing, mosquito netting and insect
repellent with DEET. Prophylactic doses of anti-malarial pills
such as atovaquone, proguanil, doxycycline or mefloquine are
suggested; chloroquine is not effective in Mali. Other insect
borne diseases such as dengue, river blindness and African
sleeping sickness are also common to Mali.
As with most travel destinations, the most common medical problems
for tourists in Mali involve gastrointestinal complaints. Drinking
only bottled water, or if none is available, water treated with
iodine or other purification tablets is suggested. Raw or
undercooked foods should be avoided. Acute cases of diarrhoea,
nausea and vomiting can be treated with over the counter
medication, although if these symptoms persist a physician should
be consulted.
As a poor landlocked country with very limited health care
infrastructure, including understaffed clinics and severe
shortages of medication, travel to Mali may be very risky.
Emergency evacuation is often required for situations requiring
serious medical attention, which can include travel to Europe for
care. To provide for such contingencies, insurance and other
arrangements should be planned in advance.
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