Purpose: The rational use of medicines remains a major challenge in healthcare systems in resource-limited countries. Beyond quantitative indicators, understanding the perceptions, representations, and experiences of prescribers is essential for explaining their prescribing practices. Methods: An exploratory qualitative study was conducted from March to July 2023 in the Community Health Centers (CSCom) and the Reference Health Center (CSRef) of Commune I of Bamako. Semi-structured individual interviews were conducted with prescribers selected through purposive sampling for this study. Inductive thematic analysis was conducted according to Braun and Clarke’s approach. Results: The analysis revealed five major themes: (1) plural representation of rational prescription, often reduced to compliance with protocols; (2) tension between therapeutic norms and clinical realities; (3) ambivalent perception of drugs in INNs; (4) the weight of structural and socio-economic constraints; and (5) needs expressed in terms of training and support. Prescription appears to be a permanent compromise between scientific ideals and field constraints. Conclusion: Prescribers’ perceptions revealed a partial appropriation of the concept of rational prescriptions. The practices observed can be explained more by systemic constraints than by a lack of knowledge. Future interventions should incorporate the lived experiences of the prescribers.

BackgroundIn Mali, a lack of qualified human resources in primary health care and sexual and reproductive health and rights (SRHR) is one of the greatest barriers to the population’s access to standard health services. Frontline professional training must be strengthened to respond to the needs of the population, particularly those of women and girls. Training must be conducted using an interdisciplinary and adapted approach to promote gender equality. ObjectiveThis study aims to identify the SRHR training needs among the community, educational actors, and primary health care providers. MethodsA concurrent mixed methods design was adopted, using 2 methods. A quantitative method, through a cross-sectional analytical survey, will be conducted at the community level with university community health centers (CSCom-U) users and adolescents in CSCom-U health areas, as well as at the health education institution and community health centers levels with teachers, students, and interdisciplinary professional groups within the CSCom-U and district hospital maternity. Descriptive and inferential analyses will be conducted to process quantitative data. This research is at the stage of data analysis and interpretation. A qualitative method, based on 3 sources of data (focus groups, individual semistructured interviews, and document analysis), which involved the same targets as the quantitative component, with additional community actors such as Community Health Associations (Associations de santé communautaire) and Women’s Service User Communities. A thematic analysis of the qualitative data using a mixed deductive and inductive method will be performed. Results: Field data collection took place from March to April 2022. Quantitative data from 3153 participants are being analyzed using SPSS. Qualitative data from 11 interviews and 27 focus groups were processed with Qualitative Data Analysis Miner. Data analysis is still ongoing. ConclusionsThis study will provide a better understanding of adolescents and SRHR user’s service needs in terms of health services availability and quality and SRHR knowledge, issues related to student training quality, the level of adequacy between the training offered and the actual needs of the service recipients, and the level of preparation and ability of teachers to provide quality teaching taking gender equity into account. The recommendations drawn from this assessment will propose concrete actions to improve women and girls’ health services provided by professionals, and to better adapt the future health professionals’ profiles to the needs of communities, particularly those of women and girls. International Registered Report Identifier (IRRID)DERR1-10.2196/64796

Introduction :Antenatal care is the service provided to pregnantwomen to ensure the best health conditions for women and the fetusduringpregnancy. An adolescent is one whosechronologicalageisbetween 10 and 19 years, and herpregnancyisconsideredworldwide as a high-riskpregnancy, as follow-up isless good in thisage group. Consequently, the reduction of complications requires a tripleapproach: medical, psychological and social. The main objective of ourstudywas to determine the practice of medicalfollow-up of teenagepregnancy in Mali in 2023. Methodology :Thiswas a quantitative, cross-sectional, participatorystudyamong adolescent girls, conductedbetween March and April 2023 in five health areas of Mali. All data collected in the fieldwere sent daily to the KoboCollectaccount and extracted in Excel format. Analyses werecarried out on socio-demographic variables and the practice of medical monitoring of adolescent pregnancy. Results :Duringoursurvey, 92 girls hadexperiencedpregnancy out of a total of 621, i.e. 14.81% of cases. The 15-17 age group was the mostrepresented, accounting for 61.7% of cases.The rate of use of prenatal consultation services was 74%. In ourseries, 12 girls (13% of cases) had abortions, 42% of whomreportedvoluntarytermination of pregnancy, and only 33% hadreceived post-abortion care. Conclusion :Our work shows that the experience of pregnancywas a reality for teenage girls, and the majorityusedprenatal consultation services. It wouldbenecessary to considercomprehensivesexeducation for this group with specificneeds.

Introduction : Client satisfaction is an important dimension of quality care. Patients are closely linked to healthcare providers. This relationship deserves to be evaluated for the sustainability of quality care. The objective of our study was to assess the satisfaction of women in labor in a community setting. Method : This was a cross-sectional study of women's satisfaction with services offered during childbirth. The health areas covered by the Local Community Health Education Project for Women and Girls in Mali were included. The sampling was a multi-stage cluster design. Data were collected from individual interviews and analyzed using SPSS 22. Individual informed consent was obtained from each participant prior to the interview. Results: A total of 953 women were interviewed out of 953 selected, representing an overall frequency of 100% of cases. The participants had an average age of 28.24 years, and 28.1% had no formal education. Women were satisfied in 96.32% of cases ; dissatisfied in 2.1%, and indifferent in 1.86%. The reasons for dissatisfaction were primarily the brutality of the gestures and lack of compassion in 31% of cases, the lack of listening skills in 28.1%, and the lack of confidentiality of the women in labor in 13.6%. Conclusion : The services offered during labor were highly appreciated. Raising awareness among midwives about behavior change would improve the quality of care in the delivery room.

Introduction: Family planning is a “way of spending and living, in order to improve the health of the family. It saves the lives of adolescents. In this work, the authors studied the knowledge and practices of adolescents in relation to family planning in five health areas in Mali in 2022, the objective of which was to describe the knowledge and practices of adolescents in relation to family planning. Methodology: This was a cross-sectional, quantitative study, the survey of which was conducted between March and April 2022 in five health areas in Mali and targeted single adolescents aged 15 to 19. We used a structured questionnaire administered in individual interviews, the data of which were collected using KoboCollect. The analysis was done with SPSS 22 software. Results: During our survey, 1,404 young adolescents were targeted. We recorded a participation rate of 92% of cases (n= 1287). Although an equal distribution between girls and boys was planned for the present survey, boys were more numerous than girls (51.7% vs 48.3%). Except for the male condom, all other family planning methods were better known by girls than boys. Indeed, 29% of girls said they did not know any family planning method compared to 37% of boys. Despite good knowledge of family planning methods, more than 77% of girls and boys did not use any family planning method. Boys used condoms more (21.4%) due to ease of access (47%), lower cost (44%) and no need for assistance in its administration (18%). They mainly obtained their supplies from pharmacies (52%); from shops (40%) and only 10% obtained their supplies from the health center. As for girls, they used implants more (15.1%) because of their longer duration in (30%) and their availability (17%). Conclusion: Despite the good knowledge of family planning methods by adolescents in Mali, more than 77% of girls and boys did not use any family planning method. If they managed to use it, boys preferred condoms and girls implants (15.1%).

Introduction: Sexuality is the set of behaviors relating to the satisfaction of the sexual instinct. It involves the personality as a whole in adolescence. According to the 2018 demographic and health survey in Mali, it appears that 36% of adolescents have started their reproductive life; 8% had their first sexual intercourse at 15 years old. In this work, we studied adolescent sexuality in five health zones in Mali in 2022. Methodology: This was a cross-sectional, analytical survey whose survey was conducted between March and April 2022 in five health zones in Mali and targeted single adolescents aged 15 to 19. The sampling was probabilistic. Data were collected using a structured questionnaire administered in an individual interview. Results: In total, 1287 adolescents were interviewed, 51.7% of whom were boys. The average age was 16.86 years for girls and 17.55 years for boys. They had secondary education in 31% of boys and 28% of girls. The average age of first sexual intercourse was 16 years for both girls and boys. In 10% of respondents had had early sexual intercourse between 10 and 14 years old. 80% of respondents had at least one sexual intercourse in the last 6 months, among which non-use of condoms was 70% among girls and 46% among boys. Conclusion: Sexual practice among unmarried adolescents was common. Precautions against the risks of sexual intercourse were weak. Sex education is necessary in order to provide adolescents with a set of measures aimed at protecting sexual practices.

Introduction: Les psychotropes se designent comme toute substance qui agit sur lactivite cerebrale. Ils sont beaucoup utilises dans les troubles mentaux. Lobjectif de notre travail etait dapprecier la prescription des psychotropes en medecine de premiere ligne au Mali. Methodologie: Il sagissait dune etude observationnelle, descriptive, multicentrique etendue sur une periode de 4 mois en 2021au Mali dans trois zones dont un en zone urbaine, un en zone semi-urbaine et un en zone rurale. Les parametres etudies etaient : Le profil socio demographique, le profil des agents de sante prescripteurs de psychotrope la prescription de psychotrope et le diagnostic de trouble de sante mentale. Resultats: Au cours des quatre mois, 108 864 patients avaient ete consulte par les 19 personnels de sante sur un total de 25 sollicites avec un taux de participation a letude de 76% des cas. LAge moyen de nos patients etait 28 ans avec une predominance feminine. Nous avions retrouve 1 116 diagnostics de trouble mental, soit une frequence de 1,02% domine par lanxiete dans 52% de cas, la depression dans 1,8% des cas et le stress post-traumatique dans 4,1% des cas.La minorite de nos patients recevaient un traitement psychotrope soit une frequence de 0,7 % de cas.Quatre-vingt-seize pourcents (96% des cas) de la prescription des psychotiques etaient associes a dautres classes de medicaments, surtout les antipaludiques et des medicaments pour le syndrome ulcereux. Aucune association de psychotrope netait prescrite dans notre etude. Cents pourcents (100% des cas) des prescriptions des psychotropes avaient comme voie dadministration per os avec une duree de traitement ne depassant pas les deux semaines. Conclusion: Notre etude avait montre la pluridisciplinarite du personnel de sante qui prenait en charge les troubles mentaux en medecine de premiere ligne. Elle nous permit de reconnaitre la necessite de renforcement de competence dans la prescription des psychotropes dans les centres de sante au Mali.

Introduction: STIs have a profound impact on sexual and reproductive health worldwide. The risks of transmission are linked to age and sexual behaviour. The aim of this study was to assess young adults' knowledge of STIs/AIDS in order to prevent the risks. Materials and Method: We conducted a descriptive cross-sectional qualitative study of 170 randomly selected people in the health area of the Korofina-Sud and Salembougou community health centre (ASACOKOSSA). Results: The most common STIs were HIV (98.8%), urinary tract infections (92.9%), gonorrhoea (88.2%), genital mycoses (87.7%), syphilis (77.6%) and papillomavirus (74.7%). Although condoms, fidelity and abstinence were known as means of protection in 58.8%, 32.9% and 13.5% respectively, erroneous knowledge existed and risky behaviour was adopted. Conclusion: The family was far from being a place for sex education for young single people. Awareness-raising initiatives seemed to be needed to help parents talk to their unmarried young adults about sexuality, so that they could pass on the right information.

Abdominal trauma is a shock of any type exerted on the stomach. Traumatic lesions of the abdomen are very frequent and very varied. It can be closed or open. According to the world report on the prevention of injuries in children established in 2004, the sex ratio is between 3/1 and 5/1 in favor of boys. The objective was to write the epidemiological, clinical and therapeutic characteristics of abdominal trauma in children under 0 to 15 years old.

Introduction: Impalement wounds are defined by foreign objects usually steel bars or a wooden object, piercing a body cavity in part or from one end to another and always remaining in place. Thoraco- abdominal impalements are cases of rare trauma in our exercise context. We report a case of thoraco-abdominal impalement in an 11-year-old patient as well as our therapeutic attitude in our exercise context. Observation: this is an 11-year-old student, with no medical and surgical history, received in emergency for thoraco-abdominal trauma following a play activity in the family home. Discussion: Penetrating thoraco-abdominal wounds are most often caused by gunshot wounds. Impalement is a potentially serious lesion that can be immediately life-threatening and depends on the organs affected. Our case study concerns a patient victim of a domestic accident following a playful activity within the family home. The injuring agent was a concrete rod positioned within the home without any security measures and which was used to tie up sheep intended for domestic breeding. Management of impalements must comply with rules so as not to aggravate the lesions. Conclusion: Thoracoabdominal impalement injuries are potentially serious and can be life-threatening. Its management is a challenge in countries with limited resources like ours. Good coordination of medico-surgical care allowed optimal management of the patient.

Adnexal torsion is a spontaneous rotation of the ovary and sometimes the fallopian tube around its axis which can interfere with arterial supply and lead to ischemia It is a rare complication of an ovarian cyst, which can occur at any age, from the fetal period to adulthood. The mature cystic teratoma accounts for 20% of all ovarian tumors and is seen especially in young girls and therefore is most often benign. It's a surgical emergency. We report here two cases of adnexal torsion operated at the level of the pediatric surgery unit of the Hospital of Mali The two girls are 14 and 13 years old, nulligest and normoregulated with recurrent abdominal pain admitted for acute pelvic pain. On palpation, an abdomino-pelvic mass of a firm and painful consistency is noted. An abdominopelvic ultrasound was performed in both cases and revealed torsion of the left adnexa on the left ovarian cyst in the first and on the right in the second. The surgical procedure performed was manual detorsion and cystectomy in both cases. The anatomopathological examination concluded with a dermoid cyst In the two girls and their postoperative course was simple.

Introduction: A child is defined as “any human being under the age of 18, unless majority is reached earlier due to the legislation applicable to them. In reality, initial care is also found in multipurpose or adult emergency departments. In France (Seine-Saint-Denis), out of 390 children rescued by the Emergency Medical Assistance Service (SAMU) in 2004, 77% of child deaths were medicalized by the Regional Emergency Medical Service (SMUR). all-rounders of the department. As a result, at the hospital in Mali, many children are referred to the emergency department, while there is no pediatrician in the SAU and the technical platform is not well suited to their care,hence the objective of this work.. Methods and Materials: We conducted a prospective, longitudinal study over a period of 12 months from January 1, 2019 to December 31, 2019 at the emergency department of the hospital in Mali. The study involved patients aged zero (0) to fifteen (15) years The parameters studied were socio- demographic and clinical variables Results: During the study period, we collected 458 children aged 0 to 15 out of 6517 visits to the service, i.e. a frequency of 8.12%. The age group of 10 to 15 years was the most representative with 39% of cases. The male sex represented 58% of cases with a sex ratio of 1.36. The patients were uneducated in 10% of the cases, the workers represented 28.8% among the fathers and 54.8% of the mothers were housewives. Children belonging to families with more than three children accounted for 50.9% of cases and 39.5% of patients lived outside Bamako, the capital. Our study shows that 53.9% of patients were admitted between 8 a.m. and 4 p.m., 54.8% of patients came to the service by taxi, vehicle or motorbike and admissions by referral/evacuation represented 60.3% of case. AVP accounted for 48.7% of cases After the initial examination on admission, 36% of patients were classified as category three according to the Clinical Classification of Emergency Patients (CCMU3). Conclusion: The grounds for recourse of children from 0 to 15 years old to the general-purpose SAU of the Hospital of Mali are multiple. Accidents remain the most frequent reason for recourse in the service.

Traumatic injuries of the upper limb quite frequently cause acromioclavicular lesions including acromioclavicular disjunction (ACD). In our context, its management is problematic regarding the indications of surgical treatment on one hand and the choice of the surgical technique on the other hand. Among the many techniques available, that of Weaver-Dunn is one of the most popular for its simplicity of realization and its efficiency. In this respect it seems the most appropriate because of the socio-economic conditions of the population because it does not require a double intervention in this case the removal of osteosynthesis equipment. In this series, we report 3 cases of at least stage 3 DACs, all treated with this technique with good functional results.

Posterior urethral valves (UPVs) are congenital obstructive membranous folds that represent the main cause of bilateral renal obstruction and dysuria in children and infants. The seriousness of this malformative uropathy lies in the importance of its impact on the upper urinary tract with a significant risk of end-stage renal failure. The objective of this work is to report our experience on the management of this pathology, for this we carried out a retrospective and descriptive study over a period of 5 years, from January 2018 to December 2022, including all hospitalized patients or seen in consultation at the pediatric surgery unit of Hôpital du Mal. The parameters studied were demographic, clinical, radiological and therapeutic variables. We collected 10 patients, an average of 2 patients per year and a frequency of 0.38%. The infant age group was the most represented, i.e. 80% of cases. The average age of our patients was 9.1 months with extremes of 2 days and 48 months. The most common reason for consultation was dysuria with 60% of cases. Overflow urination was the most frequent functional sign. Fever was present in 90% of cases. Abdominal distension was present in nearly half of our patients and acute urinary retention in 30% of cases. All our patients underwent cytobacteriological examination of urine. It was positive in 4 patients, i.e. 40% of cases. THE. Coli was the majority germ. All our patients performed retrograde urethrocystography (UCR) and objectified a dilation of the posterior urethra in all patients. Surgical treatment concerned all our patients. The FOGARTHY technique was used in 9 patients and a vesicostomy was performed in one patient. In the immediate therapeutic follow-up, 1 patient died in intensive care, 3 patients presented with sepsis, one of whom subsequently died. After an 8-month follow-up, the consequences are simple in all our patients.

Neonatal abdominal surgical emergencies include acquired or congenital conditions of the digestive tract of the newborn, which manifest themselves from birth to the end of the first month of life (0 to 28 days). We carried out a retro-prospective and descriptive study over three (3) years, from June 1, 2018 to May 31, 2021, the main purpose of which is to study the therapeutic and evolutionary aspects of neonatal abdominal surgical emergencies in the pediatric surgery department of the Mali Hospital.

A relatively rare congenital malformation, hematocolpos is the progressive accumulation of menstrual blood in the vaginal cavity at puberty. It is often the consequence of a hymen imperforation. It is clinically manifested by cyclic pelvic pain and primary amenorrhea and, more rarely, by a pelvic mass syndrome. The diagnosis is primarily clinical. Ultrasound and magnetic resonance imaging (MRI) are additional tests to confirm hematolcolpos and exclude other associated genitourinary malformations. Treatment consists of a hymenotomy to drain the hematocolpos. The age of discovery of hematocolpos varies from 13 to 14 years. We report a case of hematocolpos secondary to hymenal imperforation diagnosed in a 17-year-old girl with periodic pelvic pain, primary amenorrhea and a pelvic mass. A first ultrasound trap had evoked a large ovarian cyst but the repeat pelvic ultrasound in our hospital confirmed the diagnosis of hematocolpos.

Introduction: iron deficiency is the most widespread nutritional deficit worldwide and is estimated to affect 1 billion people. The objective of our work was to determine the value of esophagogastroduodenoscopy in the diagnosis and management of iron deficiency anaemia at the Sikasso hospital.

Anal fissure is a superficial attack of the anal canal between the skin-mucosa junction, located preferentially at the anal commissure. The objective of this study is to highlight the epidemiological and clinical profile of primary anal fissures in the hospital of Sikasso. This was a cross-sectional study that took place from February 2018 to January 2020 and included patients admitted to the hospital of Sikasso for primary anal fissure. Other cases of anal fissures were not included in this study. A total of 71 patients were collected during the study period. The mean age of our patients was 42.12 years (extremes 20 and 60 years) and a male/female sex ratio of 1.95. The symptoms were dominated by proctalgia (84%) followed by rectal pain (24%), constipation (12%), anal discharge (8%) and anal pruritus (0.71%). On proctological examination, the following were noted: presence of a sentinel mark (32%), sensitivity to palpation (45%), and moderate (56%), posterior (88%), anterior (8%), and lateral (0.71%) location. The fissure was at its first episode in 52% of cases (37 patients) and had recurred in 48% of cases (34 patients). Reflex sphincter hypertonia was noted in 26 patients (36%). The associated pathologies were internal hemorrhoids (45%), erythematous rectitis (0.71%) and rectal polyps (0.71%). The management was based on hygienic-dietary, medical and surgical aspects. Healing of the lesions was observed in 56% of cases after four weeks of medical treatment. The short and medium term satisfaction rate after surgery in 17 patients was 95%. Primary anal fissure is a common proctological pathology in Sikasso. Surgery remains the most effective, curative and definitive treatment, even if medical treatment associated with hygienic and dietary measures plays a major role in healing. Surgery is often ignored by the patient and surrounded by taboo in our environment.

Gastrochisis is a herniation of the abdominal viscera through a full-thickness hole in the abdominal wall, usually located to the right of the umbilical cord insertion. It is estimated at 1/4000 to 1/10000 births, but there are significant geographical variations, with a high mortality rate in developing countries [1, 3, 4]. We report a case operated on at the Fousseyni Daou hospital in Kayes in 2019. This female child was born at home in septic conditions and was referred to us for care. The aim of this study was to determine the difficulties related to the management of laparochisis, especially with atresia, but also to describe the therapeutic and evolutionary aspects.