Contraception: School Knowledge and Practical Attitudes in the Urban Commune of Segou, Mali

The aim was to describe aspects of students’ knowledge of sexuality and contraception and their sexual behaviour in schools in Ségou, Mali. Materials and Methods: This was a one-pass cross-sectional survey with reasoned choice at the first level and random choice at the second level over a 3-month period from January 2013 to March 2013. Results: The majority of the students involved in our study reside in the commune of Ségou, 90.4%. The average age of our students was 18. The female sex was the most represented in our study with 59.7%. The majority of students had casual sex at 60.3% and 70.9% irregularly. The change of sexual partner affected 47.9% of schoolchildren. Of our sexually active students, 72.6% had sexual partners and 37.4% had more than 2 partners. The main sources of information are respectively the media with 72.1% followed by teachers with 12.9% and friends with 09.7%. Among the most well-known contraceptive methods, condoms rank first with 72.6%, followed by injectable with 72.0%. 70.6% of the population had not yet used a contraceptive method at first sexual intercourse and in 72.9% of cases was condoms. The most cited source of contraceptive supply is pharmacy with 49.5% followed by family planning centres and maternity wards at 16.2% and shops at 16.2%. Conclusion: The referral of young people to approved health facilities for contraception could prevent them from risky sexual behaviours.


Introduction
The concept of reproductive health as defined by the International Conference on Population and Development in 1994 was adopted by Mali. This concept is defined as reproductive health or reproductive health, we mean the general well-being, both physical, mental and social of the human person for everything related to the genital tract, its functions and functioning and not just the absence of disease or infirmity [1]. According to the United Nations Population Fund (UNFPA), reproductive health means that people are able to have a satisfying and unsafe sex life and that they have both the means to procreate and the freedom to decide whether, when and how often they do so [2]. According to the WHO, adolescence and youth range from 10 to 24 years of age [3]. During this phase of life, many changes occur in adolescents who are transitioning to adulthood. In 1994, at the International Conference on Population and Development, it was reported that 1.3 billion women worldwide and of childbearing age had more than 1.2 billion pregnancies which in more than 25% of cases were unwanted. These unwanted pregnancies resulted in the deaths of nearly 700,000 women, the majority of whom were complicated by complications of unsafe abortions [4].
Mali, for its part, has doubled its population by less than 40 years, from 4,100,000 in 1960 to 9,800,000 in 1998 [5]. Women are characterized by very high fertility at a young age (188 to 15 -19 years) and which increases rapidly to reach its maximum at 25 -29 years (292 euros), before declining steadily with age. The total fertility rate thus amounts to 6.6 children per woman [6]. However, Mali is one of the countries with one of the lowest contraceptive prevalence, despite efforts in reproductive health. The purpose of this work is to assess students' knowledge, attitudes and practices about contraception; and, above all, to identify barriers to the use of contraception in schools in Ségou.

Objectives
To describe aspects of students, knowledge of sexuality and contraception and their sexual behaviour in schools in Ségou, Mali.

Materials and Methods
This was a one-pass cross-sectional survey with reasoned choice at the first level and random choice at the second level over a 3-month period from January 2013 to March 2013. The study population was students from high schools and vocational schools in the city of Ségou. The sample size was calculated using the following formula: N-4.P.Q/I2 P-represents the prevalence of use of contraceptive methods by students in previous studies (5%). Q-1-P-0.95 I-the desired accu-

Socio-Demographic Characteristics
The majority of the students involved in our study reside in the commune of Ségou, 90.4%. The average age of our students was 18. The female sex was the most represented in our study with 59.7%. High school students were represented by 75.9% of the population surveyed compared to 24.1% students from vocational schools. In our study, among 10.9% of the married 57.8% were female. Table 1 and Table 2 show us the epidemiological characteristics of schoolchildren.

Sexual Behaviour
The majority of girls had their first period at an age between 13 -15 years of age or 68.3%. 60.3% of students had had casual sex and in 70.9% had an irregular sexual relationship. In our study, 47.9% of schoolchildren had changed sexual partners. In our series, the time between menarche and first sexual intercourse was on average 3 -4 years for 33.9% of girls. It was less than 1 year for 6.9% of girls. Of the 69.2% of schoolchildren who were aware of the fertility period only 10.8% knew the possibility of pregnancy from the first sexual encounter. Table 3 and Table 4 show the sexual behaviour of schoolchildren.

Risky Sexual Behaviour
More than half of our sexually active students, 72.6%, had a sexual partner and 37.4% had more than 2 sexual partners. Table 5 represents data on school-risk sexual behaviour.

Sources of Information
The main sources of information are the media (72.1%) respectively followed by teachers (12.9%) and friends (09.7%). Table 6 shows the source of information for schoolchildren.

Practical Knowledge and Attitudes
The majority of respondents, 93% say they have heard of family planning (PF).
Among the most well-known contraceptive methods, condoms rank first with 72.6% of students, followed by injectables with 72.0% regardless of gender and age. The majority of students (70.6%) in our study had not yet used a contraceptive method at first sexual intercourse. Of those surveyed who used a contraceptive method, 72.9% had used condoms. Contraception is known in schools and practical attitudes are most often problematic in its use. Table 7 and Table 8 present schoolchildren's knowledge of the existence of contraceptive methods and the use of methods at first sexual intercourse. Table 9 shows us the reasons for school use and non-use of contraceptives.

Sources of Supply
The main source of supply of contraceptive methods was the pharmacy represented by 49.5% of the workforce followed by the 16.2% FP centers, maternity wards and shops. Table 10 shows us the source of contraceptive supplies for schoolchildren.
T. Sylla et al.

Socio-Demographic Characteristics
In the literature, the average ages found by the authors are superimposed. In Mali, in Sikasso MAIGA O. L. [7] reports an average age of 17.25 years, SANGARE A. K. [8] in Bamako also reports an average age of 17.5 years. The average age of our students was 18 in our series. The majority of the students involved in our study resided in the city of Ségou, 90.4%. The female sex was the most represented in our study with 59.7% despite the low overall enrolment rate of girls. High school students were represented with 75.9% of the population surveyed compared to 24.1% students from vocational schools. The organization of African societies with its cultures and customs makes us observe that early marriage is still relevant through our rate of married girls of 10.9%, generally hindering the academic career of its daughters.

Risky Sexual Behaviour
According to the literature, several authors give different ages compared to first sexual intercourse. In the UNAZIGO et al. [9] study 40% were sexually active.
Among sexually active students in the sample (38%) had had their first sexual intercourse between the age of 14 and 17. In network 2000 [10], the authors indicate that in Chile studies have found that 1/3 of adolescents had their first sexual intercourse before the age of 15. KAMTCHOUING et al. [11] found that 56% of their sample had their first sexual intercourse before the age of 15. It was between 15 and 17 years old for SIDIBE et al. [12]. In Zimbabwe, the age at first sexual intercourse was 9 years [13], in Burkina Faso it is around the age of 15 [14]. In Niger, it was 12 years old [14]. In Senegal, 27% of adolescents reported having had their first sexual intercourse before the age of 15 in 1992, according to a study by the United Nations Development Fund (UNFPA) [14]. In our series, he was between 14 and 17 years old. Of the sample, 95.2% of students had had their first sexual intercourse and 40.5% before 17 years.
According to the WHO, anyone who has had a single sexual partner would be considered a low risk of being infected by sexually transmitted infections and the behaviour is only at high risk if the person has had more than two sexual part-

Sources of Information
The main source of information was the media, with a rate of 72.1% followed by teachers or 12.9% and friends or 09.7%. As with other studies including SIDIBE et al. [12], SANGARE A. K. [8], and BERTHE B. [17]), the media have been the main source of information for adolescents. SIDIBE et al. [12] found 96.3% for the media, 72.4% for friends and 19.6% for parents. FayE [18] had instead found the following order: the media, the school, the counselling centre for teenagers.
We think like BERTHE B. [17] that contraception, which is a subject related to sexuality, is considered taboo in our society. They concluded that the family is a rare source of family planning information.

Practical Knowledge and Attitudes
The majority of respondents, 93% say they have heard of family planning (PF).
This result is confirmed by other studies such as: BOMIA M. A. D. [19], conducted in the district of Bamako in school that found 93.8%. And a school-based study conducted in Bamako by CAMARA M. [20] found that 73.10% of schoolchildren had heard of PF. Among the most well-known contraceptive methods, condoms rank first with 72.6% of students, followed by injectables with 72.0% regardless of gender and age. SIDIBE et al. [12] found 96.9% and 91.6% for condoms and pills respectively. Other authors found comparable results, as well as SACKO-D [15]; and MAIGA-K [21] in their studies found in Mali, the same results with the most well-known methods: pills and condoms. In its study, SANGARE A. K. [8] had 31% of its respondents who claimed to have used a contraceptive method, while 42.6% of students said they had used condoms. The majority of students (70.6%) in our study had not yet used a contraceptive method at first sexual intercourse. Of those surveyed who had used a contraceptive method, 72.9% had used condoms.
Elsewhere BOMIA-M [19] found that 21% of his sample had used a condom at the first report. A study carried out in 6 schools (secondary level) in Côte d'Ivoire [22] found that condoms were the most used by adolescents with 38.06%. Regarding the reasons for the use of a contraceptive method at first sexual intercourse respectively 77.1% and 10.7% of respondents thought it was to T. Sylla et al.