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The objective of this study was to investigate the determinants of rape among minors in the Kolda region.A retrospective, cross-sectional, descriptive and analytical was conducted from 23 December 1992 to 31 December 2011, based on the charts of rape victims under the age of 18 years. Sampling was complete. Bivariate and multivariate analyses were performed using Epi Info 3.3.2 and R 2.9.2 software, respectively.The study included 162 cases of sexual assault. The mean age of victims was 12.3 +/- 3 years (range: 4-17 years). The mean age of perpetrators of sexual assault was 26.4 +/- 9.5 years and minors accounted for 13% of perpetrators. 54.9% of victims, were raped. Victims of sexual assault knew the perpetrator in 66% of cases and were attacked in broad daylight in 53.4% of cases. The perpetrators were drunk at the time of sexual assault in 15.3% of cases. The assault took place in the bush (14.8%). Twenty eight percent (28%) of rapists were jailed and 38.6% of them were jailed for between 5 and 10 years. Sexual assault in the bush [adjusted OR = 3.46 (1.02-11.77)] and intoxication of the perpetrator at the time of sexual assault [adjusted OR = 3.47 (1.04-11.61)] were associated with a high risk of rape. In contrast, victims who knew their assailants were at a lower risk of rape [adjusted OR = 0.09 (0.03 to 0.24)].Extension of this study to the national scale would provide health and judicial authorities with an overview of sexual assault among minors, to allow more effective prevention at the national level.

Access to health care remains a major problem in Senegal, particularly among vulnerable groups such as the elderly. In 2006, the Senegalese government introduced a national plan for the provision of free health care known as "Plan Sésame" to improve access to care. The purpose of this study was to examine the current state of the "Plan Sésame" in national hospitals four years after its implementation (2006-2009).A qualitative study using individual interviews was conducted between 15 March and 14 May 2010 among five target populations: hospital directors, health care providers, managers of the "Plan Sésame" in hospital admission services, management accountants, and beneficiaries. Content analysis was used.Between 2006 and 2008, hospital attendance rates increased every year. However, attendance rates began to decrease in 2009, except in the main hospital. The state has been left with a growing debt because of issues surrounding the reimbursement of expenses related to the "Plan Sésame'. As a result, national hospitals have been forced to restrict certain services included in the "Plan Sésame" and even to withdraw free health care for the elderly. These difficulties are likely to undermine the sustainability of the "Plan Sésame"The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

The objective of this study was to examine the socio-demographic profile andnp pagenum="048"/treatment of women suffering from obstetric fistula (OF) in southeastern Senegal. Conducted between August 2007 and January 2008, the study focused on women treated in regional hospitals in Tambacounda and Kolda. The data were collected using questionnaire-based interviews and analyzed using the Epi Info 3.3.1 software package. The patients (mean age of occurrence of OF: 24) were mostly from rural areas (86%), illiterate (89%), and excised (93%). The main cause of the condition cited by the participants was long working hours (42%). The study found that the participants were more likely to have no income-generating activity (84% compared to 22%) and to be divorced (19% compared to 2%) after (as opposed to before) the OF. The study also highlighted the prevalence of psychological disorders (62%), withdrawal (22%), abandonment by friends and/or family (16%) or by the husband (7%), and decreased effectiveness in household chores (4%). The average time between the occurrence of OF and the first consultation was 50.7 (± 55.3) months. The study found that 44% of the participants were waiting for an operation, 35% had undergone unsuccessful surgery, 14% had been treated and cured, 6% had recently undergone surgery, and 1% had suffered a recurrence. Good access to services was found to be necessary for effective treatment, although high-quality obstetric care and increased awareness were identified as the most important factors for the prevention of OF in southeastern Senegal.