Study population and sampling

Midwifery and obstetrics nursing students who were enrolled in degree program in health sciences training schools constituted the study population of this study. Schools were selected using a maximum variation sampling strategy based on their attendance rate and their location, so as to include midwifery and obstetric nursing students from different regions and different sectors.

The study included six private schools, one (the only) public training school in Mali, and three of its annexes. The public training school, the National Institute for Training in Health Sciences (INFSS), has a central structure in Bamako and four regional schools. It is in charge of research and training of allied health workers in Mali. It provides training at Bachelor (license) and Master levels. Public schools in the regions are annexes of the INFSS and have no autonomy of management and operation. They provide training up to the bachelor level. Three of them have been included in the study. The private schools train midwives and obstetrics nurses. Of the 10 schools involved in the studies, only one was situated in a rural area; two were situated in Bamako and seven in other urban areas. There were no midwife training school located in rural areas. Table 1 gives the overview of training schools involved in the study.

For the quantitative component, all midwifery and obstetric nursing students in their last training year at the selected schools were invited to participate. They were contacted in the classroom by researchers at the end of a lecture with request to participate. Those who agreed to participate were included. We conducted a convenience sampling among final year students. Potential participants were asked if they were willing to participate and were interviewed after they had provided consent. School managers were included as key informants. All school managers from selected schools were asked to participate and all of them agreed to. In addition, school managers from a private school, Gao nursing school, in the northern region in Mali (Gao) were included because it is the first and was for many years the only school located in the northern region in Mali. The managers were telephoned with request for interview. After agreeing and giving consent they were interviewed.