The most common form of sickle cell disease is characterized by frequently recurring pain crises. Success in managing these crises can be considered a measure of the quality of life in patients with sickle cell disease. There is a paucity of data on the level of care and quality of management of pain crises in sickle cell patients in Africa. The purpose of this study was to assess these two parameters in Mali. Data were collected by interview using a validated individual survey form. Analysis of data demonstrated that sickle cell crises were being managed at all levels of the health care system by practitioners with differing competency levels. Management did not follow a single algorithm. Vasodilators were the most commonly prescribed medications. Major analgesics were prescribed by fewer than 10% of the practitioners surveyed. Blood transfusion appeared to be overused. Based on these findings we conclude that strategies to improve management of sickle cell pain crises must recognize the urgent need for training health care providers to use standardized algorithms of proven efficacy.