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Mali is a country with an approximate area of 1240 thousand sq. km. (UNO, 2001). Its population is 13.408 million, and the sex ratio (men per hundred women) is 98 (UNO, 2004). The proportion of population under the age of 15 years is 49% (UNO, 2004), and the proportion of population above the age of 60 years is 4% (WHO, 2004). The literacy rate is 26.7% for men and 11.9% for women (UNESCO/MoH, 2004).

The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 4.3%. The per capita total expenditure on health is 30 international $, and the per capita government expenditure on health is 12 international $ (WHO, 2004). The main language(s) used in the country is (are) French. The largest ethnic group(s) is (are) Dogon, and the other ethnic group(s) are (is) Voltaic and Touareg. The largest religious group(s) is (are) Muslim.

The life expectancy at birth is 43.9 years for males and 45.7 years for females (WHO, 2004). The healthy life expectancy at birth is 38 years for males and 38 years for females (WHO, 2004).

EPIDEMIOLOGY

Carta et al (1997, 1999) conducted a two-level community study to estimate the prevalence of mental disorders with the help of the Questionnaire pour le Dépistage en Santé Mentale (QDSM), a 23-item screening questionnaire derived from the Self-Reporting Questionnaire (SRQ). In the first phase of the study, 466 randomly selected subjects from the major tribes were evaluated by means of the QDSM. In the second phase, all subjects who were ‘positive’ at the screening, as well as a sample who were ‘negative’ were examined by means of a semistructured interview. The estimated prevalence of psychiatric cases was 6.4%. A significant risk was associated with age and education. The common somatic diseases associated with psychiatric disorders were genitourinary tract disorders, tuberculosis and cardiac disorders. True et al (2001) assessed 42 mother-infant (10-12.5 months) pairs from a rural setting. The distribution of the Strange Situation classifications was 67% secure, 0% avoidant, 8% resistant and 25% disorganized. Infant attachment security was significantly related to the quality of observed mother-infant communication. Mothers of disorganized infants had significantly higher ratings of frightened or frightening behaviours.

MENTAL HEALTH RESOURCES

Mental Health Policy A mental health policy is present. The policy was initially formulated in 1983. The components of the policy are treatment and rehabilitation. Decentralization is a component of the policy.

Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1983.

National Mental Health Programme A national mental health programme is present. The programme was formulated in 1983.

National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1985.

Mental Health Legislation The 1938 decree of Gouverneur Général de l’AOF concerning the mentally alienated and the French legislation of 1838 were replaced by the new legislation. The latest legislation was enacted in 1990.

Mental Health Financing There are budget allocations for mental health. The country spends 0.02% of the total health budget on mental health. The primary sources of mental health financing in descending order are out of pocket expenditure by the patient or family, tax based, social insurance and private insurances. The country does not have disability benefits for persons with mental disorders.

Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. Regular training of primary care professionals is carried out in the field of mental health. In the last two years, about 48 personnel were provided training. There are community care facilities for patients with mental disorders.

Psychiatric Beds and Professionals

  • Total psychiatric beds per 10 000 population
  • Psychiatric beds in mental hospitals per 10 000 population
  • Psychiatric beds in general hospitals per 10 000 population
  • Psychiatric beds in other settings per 10 000 population
  • Number of psychiatrists per 100 000 population
  • Number of neurosurgeons per 100 000 population
  • Number of psychiatric nurses per 100 000 population
  • Number of neurologists per 100 000 population
  • Number of psychologists per 100 000 population
  • Number of social workers per 100 000 population
  • 0.2
  • 0
  • 0.1
  • 0.05
  • 0.06
  • 0.01
  • 0.15
  • 0.02
  • 0.02
  • 0.01

The number of personnel are insufficient.

Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy, promotion, prevention, treatment and rehabilitation.

Information Gathering System There is mental health reporting system in the country. Mental disorders are classified under ‘other disorders’. The country has no data collection system or epidemiological study on mental health.

Programmes for Special Population There are no programmes for special population.

Therapeutic Drugs

The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, levodopa. Trihexiphenydyl is used. Availability of drugs is inadequate. 


Source: World Health Organization Mental Health Atlas