BACKGROUND: West African countries including Mali experience large numbers of rural-urban temporary migration by young female domestic servants(YFDS). Age (10-19 years), ignorance and stigma –including by healthcare professionals- hinder access to healthcare services. There is a potential risk of urban-rural “bridging” for infectious diseases including HIV/STIs, among other public health challenges. We aimed providing preliminary results of a study focusing on the YFDS neglected population.
METHODS: ANRS-0005s/2DM2K is an ongoing study launched in February-2023 in Bamako (approval 2022/79/CE/USTTB). The NGO-ARCAD-Santé-PLUS provides medical consultations, integrated in the community-based activities of the NGO-ADDAD (defending domestic servants’ rights). YFDS are offered with comprehensive package including nutritional status evaluation; counseling/testing/confirmation for HIV/STIs/HBV/HCV. Personalized support is provided for testing/confirmation of suspected tuberculosis. Sexually active YFDS are offered with pregnancy tests and vaginal swabs. Routine data is collected including medical information and cross-sectional survey is proposed to YFDS >11 years old.
RESULTS: Up to May 7, 2023, community-based activities concerned 300 YFDS with median[IQR] age 17[15-19]years. 53% have no education, 68% without rest day, median monthly wage was 21[17-25]USD; for 54% it was the first contact with ADDAD. Medical consultation concerned 197 YFDS (66%): 8%, 25% and 57% were affected by stunting, overweight and anemia respectively. One case of HIV (0.51% versus 0.9% national) was confirmed and HBV prevalence was 5.1% 95%CI[2.0-8.2] (8.7% national). No HCV was detected and 2 suspected cases of TB are waiting for confirmation. 53%(n=105) were sexually active (19 known pregnancies, 10 discovered during consultation). Acceptability of vaginal swabs was 68%(n=71). Analyses revealed 9 candidiasis (albicans, glabrata, dubliniensis) (13%), 2 streptococcus agalactiae B (3%), and 7 HPV cases (10%). Among 164 YFDS (83% out of 197) accepting the cross-sectional survey, 11% declared sexual violence and 18% declared having had suicidal intentions.
CONCLUSIONS: Our results shed light to a neglected population with important public health challenges including the dissemination of infectious diseases. Long-term food insecurity leading to the triple burden of malnutrition, pregnancies, and poor mental health also highlight the urgent need of healthcare services adapted to YFDS. Preserving the confidence social environment of YFDS is a key lever to improve their access to healthcare services.

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