[Artificial intelligence in the management of anti-VEGF treatment: the Vienna fluid monitor in clinical practice]. / Künstliche Intelligenz im Management der Anti-VEGF-Therapie: der "Vienna Fluid Monitor" in der klinischen Praxis.

The Vienna fluid monitor is an artificial intelligence (AI) algorithm for the precise localization and quantification of retinal fluid. The algorithm is designed to help clinicians to make objective and accurate decisions in the anti-vascular endothelial growth factor (anti-VEGF) therapy of patients with neovascular age-related macular degeneration. The goal of the implementation is to optimize patient safety, preserve visual function and simultaneously to reduce the treatment burden on the healthcare system and patients.

La pneumopathie aigue bactérienne communautaire du sujet âge en pneumologie au centre hospitalier et universitaire du point-g, Bamako-mali / Community acute bacterial pneumonitis of the subject age in pulmonology at the Point-g hospital and university center, Bamako- Mali

Introduction : Les pneumopathies aiguës bactériennes (PAB) communautaires sont des infections respiratoires basses aiguës, non suppurées, non tuberculeuses du parenchyme pulmonaire acquises au sein de la communauté. Elles ont une présentation clinique atypique et un mauvais pronostic chez le sujet âgé. Matériels et Méthodes : Il s'agissait d'une étude transversale prospective menée au service de pneumologie du centre hospitalier universitaire (CHU) du Point-G, du 30 Octobre 2018 au 30 Septembre 2019. L'objectif était de déterminer les particularités cliniques, étiologiques, thérapeutiques et évolutives de la PAB chez le sujet âgé. Ont été inclus tout âge ≥ 65 ans, présentant des signes cliniques et radiologiques d'une PAB Résultats : Durant la période d'étude 85 patients répondaient aux critères d'inclusion sur 178 hospitalisés. Le sex-ratio était de 3/1. Environ 2/3 étaient tabagiques et 11% était positif au VIH. La fièvre n'était pas constante enregistrée dans 51,76% des cas. Les signes respiratoires étaient dominés par la toux (96, 47%), la dyspnée (94, 11%) et extra respiratoires par le trouble de la conscience. Le Klebsiellapneumoniae était le germe le plus retrouvé. L'antibiotique le plus utilisé était l'amoxicilline-acide clavulanique. La durée moyenne d'hospitalisation était de 9 jours. La mortalité était de 19%. Conclusion: La PAB chez le sujet âgé est d'une symptomatologie clinique frustre. Elle est grave avec une surmortalité

Introduction: Community-acquired acute bacterial pneumonia (ABP) is an acute, non-suppurative, non-tuberculosis lower respiratory infection of the lung parenchyma acquired within the community. They have an atypical clinical presentation and a poor prognosis in the elderly. Materials and Methods: This was a prospective cross-sectional study conducted in the Pneumology department of the University Hospital Center (CHU) of Point-G, from October 30, 2018, to September 30, 2019. The objective was to determine the clinical, etiological, therapeutic and progression of BAP in the elderly. Were included any age ≥ 65 years, presenting clinical and radiological signs of a PAB. Results During the study period, 85 patients met the inclusion criteria out of 178 hospitalized. The sex ratio was 3/1. About 2/3 were smokers and 11% were HIV positive. Fever was not constant recorded in 51.76% of cases. Respiratory signs were dominated by cough (96.47%), dyspnea (94.11%) and extra respiratory by impaired consciousness. Klebsiella pneumoniae was the most found germ. The most commonly used antibiotic was amoxicillin-clavulanic acid. The average length of hospitalization was 9 days. Mortality was 19%. Conclusion: The PAB in the elderly is of a frustrating clinical symptomatology. It is serious with excess mortality

[Community acute bacterial pneumonitis of the subject age in pulmonology at the Point-g hospital and university center, Bamako-Mali]. / La pneumopathie aigue bacterienne communautaire du sujet age en pneumologie au centre hospitalier et universitaire du Point-g, Bamako-Mali.

INTRODUCTION: Community-acquired acute bacterial pneumonia (ABP) is an acute, non-suppurative, non-tuberculosis lower respiratory infection of the lung parenchyma acquired within the community. They have an atypical clinical presentation and a poor prognosis in the elderly. MATERIALS AND METHODS: This was a prospective cross-sectional study conducted in the Pneumology department of the University Hospital Center (CHU) of Point-G, from October 30, 2018 to September 30, 2019. The objective was to determine the clinical, etiological, therapeutic and progression of BAP in the elderly. Were included any age ≥ 65 years, presenting clinical and radiological signs of a PAB. RESULTS: During the study period, 85 patients met the inclusion criteria out of 178 hospitalized. The sex ratio was 3/1. About 2/3 were smokers and 11% were HIV positive. Fever was not constant recorded in 51.76% of cases. Respiratory signs were dominated by cough (96.47%), dyspnea (94.11%) and extra respiratory by impaired consciousness. Klebsiella pneumoniae was the most found germ. The most commonly used antibiotic was amoxicillin-clavulanic acid. The average length of hospitalization was 9 days. Mortality was 19%. CONCLUSION: The PAB in the elderly is of a frustrating clinical symptomatology. It is serious with excess mortality.

INTRODUCTION: Les pneumopathies aiguës bactériennes (PAB) communautaires sont des infections respiratoires basses aiguës, non suppurées, non tuberculeuses du parenchyme pulmonaire acquises au sein de la communauté. Elles ont une présentation clinique atypique et un mauvais pronostic chez le sujet âgé. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale prospective menée au service de pneumologie du centre hospitalier universitaire (CHU) du Point-G, du 30 Octobre 2018 au 30 Septembre 2019. L'objectif était de déterminer les particularités cliniques, étiologiques, thérapeutiques et évolutives de la PAB chez le sujet âgé. Ont été inclus tout âge ≥ 65 ans, présentant des signes cliniques et radiologiques d'une PAB. RÉSULTATS: Durant la période d'étude 85 patients répondaient aux critères d'inclusion sur 178 hospitalisés. Le sex-ratio était de 3/1. Environ 2/3 étaient tabagiques et 11% était positif au VIH. La fièvre n'était pas constante enregistrée dans 51,76% des cas. Les signes respiratoires étaient dominés par la toux (96, 47%), la dyspnée (94, 11%) et extra respiratoires par le trouble de la conscience. Le Klebsiellapneumoniae était le germe le plus retrouvé. L'antibiotique le plus utilisé était l'amoxicilline-acide clavulanique. La durée moyenne d'hospitalisation était de 9 jours. La mortalité était de 19%. CONCLUSION: La PAB chez le sujet âgé est d'une symptomatologie clinique frustre. Elle est grave avec une surmortalité.

[Management Of Pelvic Ureter Lithiasis At The Gabriel Touré UHC Urology Department]. / Prise En Charge Des Lithiases De L'Uretere Pelvien Au Service D'Urologie Du CHU Gabriel Toure.

PURPOSE: To study the cases of pelvic ureteral stones in our daily practice and to discuss the epidemiological, clinical and therapeutic aspects. PATIENTS AND METHODS: We performed a descriptive retrospective study of 37 cases of patients with pelvic ureteriasis. These files were collected in the Urology Department of Gabriel Touré Hospital in Mali from 30/01/2014 to 31st December 2017. For each patient we studied: age, sex, clinical, para-clinical and therapeutic aspects. RESULTS: We had 37 cases. The average age of patients was 41.86 ± 12.58 years with extremes of 22 and 72 years. The average consultation time was 2 years +/- 1year1 / 2 with extremes ranging from 4 days to 9 years. Urinary schistosomiasis was the most common medical history (6 cases). The clinical symptomatology was dominated by nephric colic. The ASP / Ultrasound pair allowed diagnosis in the majority of cases. The treatment was surgical in all cases. CONCLUSION: Extracorporeal lithotripsy and ureteroscopy are currently the gold standard in the treatment of these lithiases. Open surgery remains relevant in our epidemiological and socioeconomic context. Although it is the most traumatic surgical technique, it has the advantage of being able to extract the lithiasis in one single step and correct any associated urological abnormalities.

BUTS: évaluer la prise en charge des cas de lithiase de l'uretère pelvien dans notre pratique quotidienne et discuter les aspects épidémiologiques, cliniques et thérapeutiques. PATIENTS ET MÉTHODES: Nous avions réalisé une étude rétrospective descriptive portant sur 37 dossiers de patients porteurs de lithiase de l'uretère pelvien. Ces dossiers ont été colligés dans le Service d'urologie de l'hôpital Gabriel Touré au Mali du 30 /01/2014 au 3l décembre 2017. Pour chaque patient nous avons étudié l'âge, le sexe les aspects cliniques, paracliniques et thérapeutiques. RÉSULTATS: Nous avions recensé 37 patients porteurs de lithiase de l'uretère pelvien. L'âge moyen des patients était de 41,86±12,58 ans avec des extrêmes de 22 ans et 72 ans. Le délai moyen de consultation était de 2ans avec des extrêmes allant de 4 jours à 9 ans. La bilharziose urinaire était l'antécédent médical le plus fréquent (6 cas). La symptomatologie clinique était dominée par la colique nephretique. Le couple ASP/ Echographie permettait le diagnostic dans la majorité des cas. Le traitement a été chirurgical dans tous les cas. CONCLUSION: La lithotripsie extracorporelle, l'urétéroscopie sont actuellement le gold standard du traitement de ces lithiases. La chirurgie ouverte reste d'actualité dans notre contexte épidémiologique et socio-économique c'est la technique opératoire la plus traumatisante, elle présente l'avantage de pouvoir en un seul temps extraire la lithiase et corriger d'éventuelles anomalies urologiques associées.

[Clinical, paraclinical and epidemiological profile of erectile dysfunction in consultation at the urology department of the Point G University Hospital]. / Profil epidemiologique clinique et paraclinique de la dysfonction erectile en consultation dans le service d'urologie du CHU du Point G.

OBJECTIVE: To study the epidemiological, clinical and paraclinical profile of erectile dysfunction in outpatient urology. MATERIAL AND METHODS: It was a prospective longitudinal study from January to August 2012 (8 months) in the urology department of the Point G University Hospital. 72 patients were involved, and were consulting for erectile dysfunction. These patients underwent clinical and laboratory examinations. Erectile dysfunction was evaluated by the Massachusetts Male Aging Study self-assessment (Single question of Self report of Erectile Dysfunction Massachusetts Male Aging Scale). RESULTS: Frequency of erectile dysfunction was estimated at 9.6%, average age was 45 years, 71% of patients were polygamous, and 18% were monogamous. Most patients (82%) resided in Bamako; traders were most represented (34%). The deficit was moderate in 48.61% of patients. The average time of consultation was 2.5 years. Co-morbidity factors were found in 54.16% of patients, the most frequent risk factors were physical inactivity (34.72%). Blood glucose was elevated in 27.78% patients, cholesterol and triglycerides were elevated in 13.15% of patients, testosterone was low in three patients, prolactin was high in six patients. A Doppler ultrasound of the penis revealed a low perfusion of corpus cavernosum in six cases, and three cases of Peyronie's disease. CONCLUSION: At the end of the study the epidemiological, clinical and paraclinical profile is identical to that found in other countries. But a more serious study with specific evaluation scores will help to identify this profile.

OBJECTIF: Etudier le profil épidémiologique, clinique et paraclinique des patients présentant une dysfonction érectile reçus en consultation externe dans le service d'urologie. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude longitudinale prospective réalisée de Janvier 2012 à Aout 2012 (8 mois) dans le service d'urologie du Centre Hospitalier Universitaire du Point G. Elle a porté sur tous les patients qui ont consulté pour dysfonction érectile. Ces patients ont bénéficié d'examens cliniques et paracliniques. La dysfonction érectile a été évaluée par l'échelle de l'unique question d'auto-évaluation de la dysfonction érectile du Massachusetts Male Aging Study. (Single question of Self report of erectile dysfonction Massachusetts Aging Study). RÉSULTATS: La fréquence de la dysfonction érectile a été estimée à 9,6 %, l'âge moyen était de 45 ans; 71% des patients étaient polygames, 18% étaient monogames.La plupart des patients (82%) résidait à Bamako, les commerçants étaient les plus représentés (34%). Le déficit était modéré chez 48,61% des patients. Le délai moyen de consultation était de 2,5 ans. Des facteurs de Co-morbidités ont été retrouvés chez 54,16% des patients, le facteur de risque le plus fréquent a été la sédentarité (34,72%). La glycémie était élevée chez 27,78% patients, les cholestérols et les triglycérides étaient élevés chez 13,15% des patients, la testostérone était basse chez trois patients, la prolactine était élevée chez six patients. L'écho-doppler de la verge a révélé une faible perfusion des corps caverneux dans six cas, trois cas de Maladie de Lapeyronie. CONCLUSION: Au terme de notre étude le profil épidémio-clinique et paraclinique retrouvé reste identique à celui d'autres pays. D'autres études plus détaillées avec des scores d'évaluation précis permettront de mieux cerner ce profil.

Toilet compost and human urine used in agriculture: fertilizer value assessment and effect on cultivated soil properties.

Toilet compost (TC) and human urine are among natural fertilizers, which raise interest due to their double advantages to combine sanitation and nutrient recovery. However, combination of urine and TC is not so spread probably because the best ratio (urine/TC) is still an issue and urine effect on soil chemical properties remains poorly documented. This study aims to determine the best ratio of urine and TC in okra cultivation, by targeting higher fertilization effect combined with lower impact on soil chemical properties. Based on Nitrogen requirement of okra, seven treatments were compared: (T0) no fertilizer, (T1) chemical fertilizer (NPK: 14-23-14), (T2) 100% urine, (T3) 100% TC, (T4) ratio of 75% urine+25% TC, (T5) 50% urine+50% TC and (T6) 25% urine+75% TC. Results indicated that T4 (75% urine+25% TC) gave the highest plant height and yield. In contrast, T2 (100% urine) gave the lowest results among all treatments, indicating toxicity effects on plant growth and associated final yield. Such toxicity is confirmed by soil chemical properties at T2 with soil acidification and significant increase in soil salinity. In contrast, application of urine together with TC mitigates soil acidification and salinity, highlighting the efficiency of urine and TC combination on soil chemical properties. However, further investigation is necessary to refine better urine/TC ratio for okra production.

[Utilisation of community health centres in Koulikoro region, Mali]. / Frequentation des centres de sante communautaires dans la region de Koulikoro, Mali.

In Mali since the adoption of community health center (CSCOM) politics, their number knew a progression remarkable: 370 in 1998 and 660 in the end of 2003. Concerning the health staff, the ratio always remained per capita weak in relation to the international norms. In 2001 for the first level of health center, the quantum was: 1 physician for 14,612 inhabitants (norm being of 1/10,000); 1 nurse for 13,989 inhabitants (WHO norm being of 1/10,000). In spite of the well stocked efforts, the foreseen objectives are far from being reached. For example, the used rate of curative consultation was of 0.19 new contact/year/inhabitant. The foreseen objective is of 0.50. Our survey had as objectives to study the reasons of CSCOM's under frequenting, to identify the reasons and to propose some recommendations to improve the situation. We conducted a cross-sectional study that had taken place in Banamba and Dioïla in the Koulikoro's region in April 19 to May 8, 2004. Interview have been performed with the head of CSCOM, the CSCOM's staff, the persons responsible of community health association (ASACO), the mothers residing in the areas at least six months and having a child less than 5 years and the community leaders. We found that women in Banamba (89%) frequented the CSCOM more that those of Dioïla (60%). The reasons of the CSCOM's under frequenting are especially bound to the staff's instability, the geographical accessibility, to poverty and to the insufficiency of information. We recommend to the different actors to inform and to sensitize the population on the importance of the CSCOM's activities, to the state to take the staff's part in charge to improve their stability, in the ASACO to establish the contracts of work with the staff.

Analyse biochimique et nutritionnelle de quelques mets traditionnels de Cote d'Ivoire

"Les mets traditionnels a base de cereales; racines; tubercules et banane a cuire sont analyses en vue d'une meilleure exploitation. Les resultats d'analyse revelent que les teneurs en eau de la plupart de ces mets traditionnels; a l'exception du "" gwonmi "" et du "" bachi "" prepares a partir des grains de cereales; excedent les 50pour cent. Le "" bachi "" se caracterise par une forte teneur en glucides (80;93pour cent). Les beignets a base de farine de mil sont plus riches en lipides (20;32pour cent). D'une maniere generale; ces mets traditionnels se revelent pauvres en proteines (8;12pour cent a 8;31pour cent). Les taux de cendres se situent entre 0;83pour cent et 4;62pour cent. Le "" bachi "" avec 371;34 kcal semble plus energetique contre 56;01 kcal pour la bouillie des grains de mil. Les valeurs de pH de ces mets traditionnels varient de 3;80 a 6;75."

Etude sur la sous frequentation des CSCOM dans la region de Koulikoro (Mali)

Il s'agit d'une etude transversale qui s'est deroulee a Banamba et a Dioila dans la region de Koulikoro du 19 avril au 8 mai 2004. Les resultats relatifs a la sous frequentation ont ete obtenus aupres des chefs de postes medicaux; du personnel des CSCOM; des responsables des ASACO; des meres ayant un enfant de moins de 5 ans et des leaders communautaires. L'analyse des resultats a montre que les femmes a Banamba (89) frequentent plus les CSCOM que celles de Dioila (60). Les causes de la sous frequentation des CSCOM sont surtout liees a l'accessibilite geographique; a la pauvrete; l'insuffisance d'information; selon le cercle

[The effect of nutritional management on the mortality of malnourished children, uninfected and infected with the human immunodeficiency virus]. / Impact d'une prise en charge nutritionnelle sur la mortalité d'enfants malnutris infectés ou non par le virus de l'immunodéficience humaine.

Weight loss is a major complication in children infected with HIV. Very few studies have focused on the nutritional management of malnourished HIV-positive children, particularly in developing countries, although there have been some studies in adults. Therefore, the aim of this retrospective study was to evaluate, as a function of HIV status, the effect of a nutritional rehabilitation program on the mortality of malnourished children in an Ivory Coast nursery. We studied 193 malnourished children over the age of 15 months from January 1 1994 to December 31 1996; 41 % of these children (80 of 193) were HIV-positive. The nutritional rehabilitation program was introduced in 1995. It had a beneficial effect in HIV-negative children because the setback rate (the number of deaths and transfers x 1,000/the number of child-months at risk) decreased significantly over the three years of the study (1994: 130; 1995: 113; 1996: 26; p < 0.05). The rate in HIV-positive children did fall slightly, but this decrease was not statistically significant. These results demonstrate the difficulties involved in the nutritional management of malnourished HIV-positive children. However, recent studies have suggested that nutritional rehabilitation (by mouth) combined with total vitamin and mineral supplementation may be more effective. Given the frequency of malnutrition in HIV-positive children, clinical studies aimed at improving the nutritional management of these children should be a priority in developing countries.

HIV-related gender biases among malnourished children in Abidjan, Côte D'Ivoire.

This study, conducted in a health centre in Abidjan for malnourished children, shows that there were more girls than boys among children admitted who were HIV seropositive whereas there were more boys than girls among seronegative children. Reasons for this gender bias are investigated.

[Anthropometric characteristics of HIV infected malnourished children in Ivory Coast]. / Caractéristiques anthropométriques d'enfants malnutris infectés par le VIH en Côte d'Ivoire.

Stunting and weight-loss are common complications of HIV infection in children. The aim of this study was to assess whether stunting, assessed using a height-for-age index, is a discriminating factor for HIV in malnourished children. This is a retrospective study of 66 children, all older than 15 months, with marasmus-type malnutrition. They were studied at a nursery in the Côte d'Ivoire from 1994 to 1995. Forty-five percent of the children were HIV-positive. The anthropometric indices (weight-for-age, weight-for-height, height-for-age and body mass index) were lower in seropositive than in seronegative children, but the difference was not significant. The rate of stunting was similar in the two groups, with 66% of seropositive and 58% of seronegative children stunted. Thus, stunting was not a discriminating factor for HIV infection. Studies aimed at increasing our understanding of nutritional disorders associated with HIV are necessary to improve the nutritional management of these children, especially in Africa where malnutrition is endemic.

[Dehydration: an important factor of mortality in human immunodeficiency virus (HIV) seropositive malnourished children]. / Déshydratation: un facteur important de mortalité chez l'enfant malnutri séropositif vis-à-vis du virus de l'immunodéficience humaine (VIH).

A combination of diarrhoea and malnutrition frequently occurs in HIV seropositive children and constitutes a bad prognosis factor. The impact of dehydration induced by diarrhoea in these children has not as yet been assessed and constitutes the aim of this study. This retrospective analysis was conducted on 121 malnourished children monitored in 1994 at an infant home in Cöte d'lvoire. 46.2% of the children were HIV seropositive and their mortality rate was significantly higher than that observed among seronegative children (42.8% vs. 15.3%; p < 0.01). Among the various pathologies observed in these children, diarrhoea and oral candidosis were discriminating factors in seropositive children. Besides, the findings confirmed the effect of dehydration on the mortality of malnourished children as a whole. Studies allowing a better understanding of factors involved in diarrhoea or dehydration among HIV seropositive malnourished children appears to be essential to improve the management of these children.

Effect of tsetse control on trypanosome prevalence in livestock: problems of experimental design and statistical interpretation--a case study in northern Côte d'Ivoire.

As part of a study on livestock productivity under trypanosomosis risk in the region of Boundiali, northern Côte d'Ivoire, 21 herds of cattle (N'Dama, Baoulé and Zebu crosses) and 20 flocks of Djallonké and Djallonké x Sahel sheep were monitored monthly for body weight, packed red cell volume and trypanosomal parasitaemia over various periods between January 1984 and December 1992. A tsetse control campaign using biconical traps impregnated with alpha-cypermethrin started in December 1987. Tsetse control reduced the relative tsetse density by over 95% between 1988 and 1992, and this was associated with reductions in the prevalence of Trypanosoma congolense over the same period of over 90% both in sheep and cattle. Average reductions in the prevalence of T. vivax were lower, on average 68% in adults and 85% in young animals. Attempts were made in the design of the study to allow comparisons between controlled and uncontrolled areas; however, there were too many confounding and uncontrollable factors to allow such comparisons to be made. It was necessary, therefore, to compare data collected from all herds and flocks before and after the intervention, with the consequential difficulties in accounting for uncontrollable year-to-year variations in factors affecting trypanosome prevalence in livestock.

[Parasitological and clinical response to amodiaquine versus chloroquine in the treatment of Plasmodium falciparum malaria in children in an endemic area]. / Réponses parasitologique et clinique de l'amodiaquine versus chloroquine dans le traitement de l'accès palustre simple à Plasmodium falciparum chez l'enfant en zone d'endémie.

The therapeutic management of malaria in endemic regions is now hampered not only by the limited number of antimalarial agents, but also by the appearance of chemoresistant plasmodial strains and by the sometimes severe adverse effects related to the use of some of these drugs. Between January and July 1993, 100 patients presenting with symptomatic Plasmodium falciparum malaria were randomised to receive amodiaquine or chloroquine at the dose of 30 mg/kg for 3 days. The objective of this study was to compare the efficacy and safety of these two 4-aminoquinolines in the treatment of uncomplicated malaria. The parasite clearance was 4.87 (+/- 0.33) days in the amodiaquine group and 5.55 (+/- 0.31) days in the chloroquine group. All subjects in both groups were afebrile by D7. Cutaneous adverse effects, such as pruritus, were reported with both amodiaquine (3.2%) and chloroquine (6.8%). Amodiaquine was found to be significantly more effective than chloroquine in terms of parasite clearance on D7. The therapeutic failure rate was 0% for amodiaquine versus 16.3% for chloroquine. At a time when chemoresistance of Plasmodium falciparum, especially chloroquine-resistance, has spread to malarial endemic zones, amodiaquine should be very widely indicated in the treatment of simple malaria due to its excellent efficacy and good safety.

[Decrease in chloroquine resistant Plasmodium falciparum in the Abidjan region (Ivory Coast)]. / Baisse du niveau de la chloroquino-résistance de Plasmodium falciparum dans la région d'Abidjan (Cote d'Ivoire).

The authors reviewed the evolution of Plasmodium falciparum chloroquine resistance in greater Abidjan for the year 1990. They used the classical course of treatment consisting of 25 mg per kg of bodyweight distributed on three days. Parasitaemia and body temperature controls were carried out on day O, day 2 and day 7. The study, which involved 547 children averaging 38.3 months of age disclosed an early in vivo resistance in the range of 18.20% as against 29.6% in 1988.

Frequentation des centres de sante communautaires dans la region de Koulikoro; Mali

Au Mali depuis l'adoption de la politique de creation des centres de sante communautaires (CSCOM) a nos jours; leur nombre a connu une progression remarquable : 370 en 1998 et 660 en fin 2003. Concernant le personnel sanitaire; le ratio par habitant reste toujours faible par rapport aux normes internationales. En 2001 pour le premier niveau de contact; les ratio etaient de : 1 medecin pour 14612 habitants (norme etant de 1/10 000) ; 1 infirmier pour 13989 habitants (norme OMS etant de 1/10 000). Malgre les efforts fournis; les objectifs prevus sont loin d'etre atteints. Par exemple; le taux d'utilisation de la consultation curative etait de 0;19 nouveau contact (Nc)/an/habitant 0;19 en 2003. L'objectif prevu est de 0;50 Nc/an/Habitant. Notre etude avait comme objectif d'identifier les determinants qui pourraient expliquer cette sous frequentation afin de proposer des strategies pour amener les populations a mieux frequenter les centres. Il s'agissait d'une etude transversale qui s'est deroulee a Banamba et a Dioila dans la region de Koulikoro du 19 avril au 8 mai 2004. Les resultats obtenus ont ete collectes aupres des chefs de postes medicaux; du personnel des CSCOM; des responsables des associations de sante communautaires (ASACO); des meres residant dans les aires de sante depuis au moins six mois et ayant un enfant de moins de 5 ans et des leaders communautaires. L'analyse des resultats a montre que les femmes a Banamba (89) frequentaient plus les CSCOM que celles de Dioila (60). Les causes de la sous frequentation des CSCOM sont surtout liees a l'instabilite du personnel; l'accessibilite geographique; a la pauvrete et a l'insuffisance d'information. Nous recommandons aux differents acteurs d'informer et de sensibiliser la population sur l'importance des activites des CSCOM; a l'Etat de prendre en charge une partie du personnel pour ameliorer leur stabilite; au ASACO d'etablir les contrats de travail avec le personnel