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In Mali, despite the existence of a national vaccination policy, coverage of neonatal tetanus remains low. According to the Demographic and Health Survey (DHS) IV Mali, the rate of births protected against neonatal tetanus is 56%., The objective of this study was to investigate the status of tetanus toxoid (TT) in women of reproductive age (WRA) in the municipality V of Bamako District., The study was conducted in Mali in the municipality V of the Bamako District. This was a cross-sectional study conducted from July to October 2006. The target population was composed of women of reproductive age and health care providers. A total of 262 people, including 200 women of childbearing age and 62 health care providers were interviewed., The age group 14-23 years accounted for 39% of WRA. Among the WRA, 27.4% did not know that tetanus vaccination is to prevent maternal and neonatal tetanus. Most of WRA, or 61.8%, thought that a single dose of TT was enough to be protected. Among WRA surveyed, 76.2% were vaccinated where 66.7% had received between 2 and 10 doses of TT. Women who received no dose of TT were nulliparous and primiparous. The main reasons given by women who had not received vaccination were lack of knowledge (47.6%), lack of time (14.3%) and neglect (23.8%). The health personnel interviewed spoke of running out of TT stocks less than a week after receiving new orders, in 7/11 health centers. Strengthening Behaviour Change Communication (BCC) for tetanus vaccination and immunization schedule compliance will increase tetanus vaccination coverage. To avoid stockouts, we recommend a regular and sufficient reorder of TT in health centers., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Heavy smoking causes 4 million deaths worldwide, more than 70% being in the developing countries. The purpose of our study was to determine the prevalence of heavy smoking and to identify the factors which influence it in school settings in Bamako. We carried out a cross-sectional investigation in April 2009, in 8 randomly selected schools in a town of Bamako, with a sample of 328 pupils over 11 years of age., The investigation included 328 pupils, among them, 72.3% were boys. The age of the pupils varied between 12 and 23 years. The age group 12-15 ans was the most represented with 66.2%. It appears that 47.6% of the pupils smoked cigarettes at least once. We found that 14% of the pupils (46/328), all boys, were regular smokers. Among these heavy smokers, 37% smoked more than 5 cigarettes per day and 52% had consumption period of more than 12 months. The factors supporting the heavy smoking were: father smoker (22.56%), other family member smoker (56.4%), smoker teachers (52.7%). The main motivations which pushed the pupils to smoke were promiscuity (63%) pleasure (22%) and snobbery (13%). While 85.9% of the pupils knew the harmfulness of the tobacco, 38.7% learned it at school, but 76,5% were unaware of the existence of a law on tobacco sale and consumption in Mali., The prevalence of heavy smoking among pupils was of 14% in an inciting environment. We recommend intensifying the communication for behavior change and applying the tobacco law., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objectives: - To determine the epidemiologic profile and private clinics of the cases of maternal mortality at the centre de santé Roi Baudouin., - To identify the etiologies of the cases of maternal death at the centre de santé Roi Baudouin; - To determine the assumption of responsibility of the cases of maternal death at the centre de santé Roi Baudouin., Material and Methods: It was about a longitudinal descriptive retrospective study relating to 308 cases of maternal death from January 1998 to December 2005 at the centre de santé Roi Baudouin; de Guédiawaye, in suburbs of Dakar. We had included in the study all the patients died during the time of the gravido-puerperality during the study period. The studied parameters related to the socio-epidemiologic data, the clinical data on the pregnancy and the childbirth, the quality of the assumption of responsibility, the causes of maternal death and the forecast neonatal. The data were analyzed with the software Epi information-version 6., Results: The ratio of maternal death was of 615.8 per 100.000 live births. The Middle Age of the deaths was 28.4 years with extremes of 14 and 52 years. The average gestity was of 4 with extremes of 1 and 25. As for the parity, it was of 3.9 with extremes of 1 and 22. The multipares were the section most concerned, followed first calf cows. A woman on four had made more than 3 antenatal consultations. The majority of our patients were evacuated (53.6%), but only 18.2% of the patients had profited from a medicalized transport. The reasons for evacuation were dominated by the vasculo-renal haemorrhages (49%) and syndromes (19%). The majority of the patients (n=234) had been confined, that is to say 76% of the cases; by natural way (45%) and Caesarean (32%). The patients had died of direct obstetrical causes in 80%, the indirect causes accounted for only 17,5%. The obstetrical causes death were dominated by the abrupto placentae, the haemorrhage of the postpartum and the uterine rupture. The maternal death was associated in more half of the cases of a fetal death (51.3%). The maternal age, the parity, the quality of the antenatal consultations, the hemorrhagic pathology coupled with the way of childbirth influenced occurred of maternal death., Conclusion: Maternal mortality remains a major concern at the centre de santé Roi Baudouin. The reduction of this mortality passes by operation correct 24 hours a day hours of the other ONEC centers of the area of Dakar, the availability of blood and its derivatives and the creation of a functional service of intensive care., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Our study aimed to assess the impact of free caesarean section on emergency obstetric care. This was a descriptive cross-sectional study that took place over a period of eight months during the period of June 1 st , 2007 to January 31 th , 2008. The study included 262 parturients admitted from August 1 st , 2004 to July 31 th , 2006. Among the 262 parturients 43.13% were recorded before and 56.87% after the implementation of the free of charge caesarean. Caesarean section was performed in 46.90% of parturients before and at 60.40% after the implementation of the free of charge caesarean. The age group 20 to 35 years was the most represented with 58.40%. Complications were present in 37.74% of women delivered by cesarean section before the implementation of the free of charge caesarean and in 20% after its implementation. The infection was seen in 70% of women delivered by cesarean section before the implementation of the free of charge caesarean and 61.11% after its implementation. Among deaths, 5.66% were recorded before and 1.11% after the implementation of the free of charge caesarean. The heavy bleeding was seen in 37.50% cases. Stillbirths recorded before the implementation of the free of charge caesarean were 62.83% and after its implementation, they were of 20.13%. In 18.81% of stillbirths were associated with fetopelvic disproportion., The implementation of the free of charge cesarean helped increase the frequency caesarean section and the reduction of stillbirth in the health district of San., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: To evaluate the outcomes of the surgical treatment of ulcerous pyloro duodenal stenosis at Dakar., Patients and Methods: We carried out a retrospective study including 160 medical records of patients presenting an ulcerous pyloroduodenal stenosis from January 2000 to December 2006. After a mean follow up of 16 months, surgical outcomes were evaluated including mortality and morbidity. The functional results were evaluated using Visick Classification., Results: The mean age of our patients was 42 years and 6 months (range: 17-20 years). Our population included 126 men (78,7%) and 34 women (21,3%). Oeso-gastro-duodenal fibroscopy was performed in 136 patients (85%) whereas barium meal was carried out in 82 patients (51,25%). Surgical approach was laparoscopy in 132 cases (82%) and laparotomy in 28 cases (18%). All patients underwent a troncular vagotomy. In addition a gastroentero anastomosis was performed in 89,2% of cases, a pyloroplasty in 10% of cases and an antrectomy in 0,6% of cases. Mortality rate was 0%. The morbidity rate was 10% including parietal suppuration, diarrhoea and hiccups. Functional outcomes were as follows: Visick I in 91% of cases, Visick II in 6,3% of cases and Visick III in 2,7%., Conclusion: Ulcerous pyloro duodenal stenosis is a frequent complication of ulcer disease. Its treatment is surgical based on a vagotomy with gastric discharge. The outcomes are satisfactory in our context.