Our study took place in the health district of the V commune of Bamako (Mali). We conducted a retrospective, cross-sectional, descriptive study.

Our study occurred from June 1^st, 2020 to June 30^th, 2023, i,e, a period of three (3) years.

All rape survivors admitted to the “One-Stop Center” unit at CS Ref CV in Bamako, who happened during the study period, were included in this study.

Except for men and boys, all survivors of other forms of gender-based violence such as: sexual assault without penetration including FGM/Excision, physical assault, forced/child marriage, denial of resource, opportunity or service, psychological/emotional violence and all other forms of violence are included in these types.

We have carried out an exhaustive sampling of all rape cases.

Data were entered and analyzed by using World, Excel and SPSS version 25.0 software.

In total, we recorded 855 cases of gender-based violence, including 167 cases of sexual assault, i.e. 19.53% of all gender-based violence (GBV) Cases ( Tables 1-10 ).

Other*: Antihypertensives, anxiolytics...

Limitations of the study:

During our study, we encountered a number of difficulties, particularly in our bibliographic research, due to the limited number of studies carried out in One-Stop Centres. These centres are new in Mali. Underestimation of the prevalence of GBV due to:

(1) Stigmatization;

(2) Fear of reprisals linked to the socio-cultural context;

(3) Social pressure;

(4) Impunity;

(5) Unavailability and inaccessibility of GBV services.

Difficulties in obtaining certain information about survivors: files locked in a cupboard, silence from the centre’s staff and from some survivors.

During the study period, rape accounted for 19.53% of all cases of gender-based violence (GBV). Our rate is comparable to that of Djelia L in Senegal [7] , which reported 10% of rape cases out of all GBV cases. However, it is lower than that of Haidara T [8] , who found a frequency of 0.53% of gender-based violence among all gynaecology admissions in the same facility. This difference could be explained by the fact that he reported rape cases as a proportion of all gynaecological consultations.

The average age of our survivors was 15, with extremes of 6 and 62. In our sample, 51.5% were pupils/students and 71.3% were single ( Figure 1 ). In some series reported in the literature, approximately one out of every two survivors was a student [5] [7] . We found 100% of admissions by requisition. Thiam O in Dakar [5] found 92.6% of admissions by requisition. These high rates could be explained by the fact that the One-Stop Center team includes police officers who are called by the health workers as soon as the patient is admitted, and the requisition is issued the same day.

Penetration into the vagina was encountered in 92.2% of cases and ejaculation in 8.4%. Several African authors have reported similar results [9] - [11] .

We found 85.6% hymenal tears and 1.3% vaginal tears. Thiam O [5] in Senegal found 74.7% hymenal lesions, 60% of which were old, and 25.3% intact hymens. In France, 60% of victims of sexual violence had recent lesions due to a short consultation time of less than 48 hours [12] .

In our study, the majority of survivors (54.5%) consulted within 72 hours after the act. In a Senegalese study, the authors reported 46.6% of consultation cases within 72 hours. In the same study, the authors reported that 70% of minors consulted within 96 hours [9] .

Urinary βHCG assays were systematically performed and enabled us to diagnose nine cases of pregnancy confirmed by ultrasound. Systematic HIV screening of survivors did not reveal any positive cases. Antiretroviral drugs were given to all survivors (100.0%) for preventive purposes. Thiam O and Cissé in Senegal [6] [13] reported respectively 14.7% and 20% HIV-positive antiretroviral prophylaxis. Spermatozoa were identified in vaginal swabs in 8.4% of cases in our study. Thiam O in Senegal [5] reported one case of positive sperm test out of a total percentage of 21% of cases. Authors such as Laudat A [12] and Boutin L [14] reported up to 30% of positive sperm tests. This difference could be explained by the long delay between the consultation and the risk of intimate cleansing before the consultation, and also, above all by the level of performance of the laboratories.

In this study, we recorded 3% psychological disorders and 45% agitation. All our survivors received psychosocial assistance. GANHI Eminka [15] reported no cases of psychological counselling.

Psychosocial support for rape survivors remains an essential part of the holistic management of GBV. Psychological support from a psychologist is essential for survivors undergoing such a tragedy. It is a necessary step in the process of reconstruction and rehabilitation. At this stage of the treatment, we assess the survivor’s needs and develop an action plan that we implement until she recovers.

Security/legal/judicial/economic assistance:

Security assistance is provided by the police, who are often present or called in as required. They ensure the safety of the survivors in their environment and at the One-Stop Centre if they are hospitalized. They take charge of requisitions and pass them on to the relevant authorities. All the survivors were involved in this study. Rape is considered as a crime in Mali, any case of rape must be reported to the relevant authorities, otherwise the provider’s silence could be considered as complicity, even if no complaint has been done.

After the preliminary investigation, cases may be referred to the public prosecutor’s office for action to be taken.

Economic support is often provided through training and the provision of income-generating activities (IGAs).