African particularities of sudden adult death in Togo on autopsy cases

Background

The purpose of the study was to determine the circumstances of occurrence of these sudden deaths, risk factors, to identify the causes of sudden death in adults at autopsy, with a view to improving prevention.

Methods

This is a retrospective study of the cases of sudden death that were the subject of an autopsy in the pathology anatomy department of the University Hospital Sylvanus Olympio in Lomé from 2009 to 2018.

Results

A total of 318 sudden death cases were recorded. The sex ratio (M/F) was 1.8, and the mean age was 43 ± 0.36 years. Sudden deaths were the second most common reason for autopsies after traffic accidents. The place of death was home in 76.7% of cases and in hospitals in 23.3%. Obesity was noted in 59.4%, with an umbilical adipose panicle varying between 7 and 12 cm thick. Cardiovascular causes excluding cerebral involvement (n = 173 cases, 54.40%) followed by pulmonary causes (n = 100 cases, 31.44%) were the most common cause of sudden death. The predominant cardiac pathology was infarction accounting for 32.07% of all causes of sudden death, and pulmonary embolism with 19.49% was the leading cause at the pulmonary level.

Conclusion

The victims of sudden death in Togo are relatively young, predominantly male and predominantly obese. The main causes of sudden death were myocardial infarction followed by pulmonary embolism. The prevention of sudden death remains paramount, especially in the African context, where pre-hospital care is often inadequate.

Systemic T Cell Subsets and Cytokines in Patients With Homozygous Sickle Cell Disease and Asymptomatic Urinary Tract Infections in Togo

Background: In sickle cell disease (SCD), cytokine expression influences the pivotal pathways that contribute to disease pathogenesis. Additional infection could affect the immune profile of patients with SCD and increase disease mortality. The aim of this study was to investigate the cytokines and T helper cells profile in patients with asymptomatic urinary tract infection and homozygous SCD (HbSS).

Methods: From July to September 2018, 22 HbSS subjects were recruited at Centre Hospitalier Universitaire Campus in Lomé, Togo, 12 of whom had urinary tract bacterial infections and 10 of whom were uninfected. Cytokines from plasma were measured by the enzyme-linked immunosorbent assay (ELISA) sandwich method, and immune cell profiles were performed by flow cytometry. The immunogenicity of bacteria-derived antigens isolated from the urine of HbSS subjects with asymptomatic urinary tract infections was studied in a cell culture system, and the induction of the cytokines was measured.

Results: The mean age of HbSS subjects with urinary tract infections was 20.33 ± 3.58 years, and the male/female ratio was 0.09 (1:11). HbSS subjects with asymptomatic urinary tract infections had elevated plasma levels of interferon gamma (IFN-γ) and interleukin (IL)-10. CD4⁺Tbet⁺IFN-γ⁺ and CD4⁺FoxP3⁺IL-10⁺ T cell populations were decreased in HbSS subjects with asymptomatic urinary tract infections. Bacterial antigens from HbSS subjects induced the production of IL-10 but not IFN-γ in uninfected volunteer donors (HbAA).

Conclusion: Our study demonstrated that patients with SCD and asymptomatic urinary tract infections had elevated IFN-γ and IL-10 levels. This chronic inflammatory condition could be a risk for this group of patients in terms of vaso-occlusive crisis. Systematic cytobacteriologic examination of the urine of HbSS subjects would be of interest.

Reconfirming HIV serostatus in three West African Military ART clinics

BACKGROUND

HIV rapid diagnostic test (RDT) algorithms have been successfully employed worldwide to accelerate critically important HIV testing. Deviations from the algorithm and processing errors have been associated with inaccurate algorithm results. Positive RDT algorithm results should be confirmed prior to HIV clinic enrollment, but compliance varies. We sought to retest HIV status of patients in three West African military HIV clinics.

SETTING

Military HIV clinics in Lome, Togo; Freetown, Sierra Leone; and Monrovia, Liberia METHODS: Patients coming for routine HIV clinic visits were approached for enrollment. Consenting participants completed a 15-minute questionnaire and provided blood samples for both national and WHO-recommended HIV RDT algorithms, and HIV ELISA (plus HIV PCR if HIV ELISA negative).

RESULTS

In total, 817 participants provided data: 374 in Togo, 360 in Sierra Leone, and 83 in Liberia. One participant from Liberia was HIV-negative (although follow-up testing was positive). Two of 807 participants on antiretroviral treatment (ART) had inconclusive algorithms, while 2 of 10 participants not on ART had algorithms, for 4 total based on the WHO-approved algorithm. Using the national algorithms, only 3 were inconclusive. A substantial proportion of the cohort had taken ART for over 6 years (25-46%, depending on the site).

CONCLUSION

HIV RDT retesting in three military HIV clinics did not uncover significant numbers of misclassified HIV patients. There was no significant difference between national and WHO-recommended RDT algorithms, although the study was underpowered to detect a difference. Antiretroviral treatment was not associated with increased rates of inconclusive RDT algorithm results.

Breast Cancer in Togolese Women: Imaging and Clinicopathological Findings

Background:

Breast cancer is the most common cancer in women, and its incidence and mortality rates are expected to increase significantly over the next few years, particularly in developing countries. The aim of this study was to describe the epidemiological, clinical, radiological, histopathological, and prognostic aspects of breast cancer in Togo.

Materials and methods:

We retrospectively analyzed at our Department of Pathology of Lomé all cases of breast cancer in women confirmed by histology over a period of 20 years (2000-2019).

Results:

We collected 804 cases of breast cancer in women. The median age was 46.7 years (range, 12-86 years). Patients aged <40 years represented 48.38% of cases, and the left breast was more affected (51.24%). Most women were sexually active (71.52%) and resided in urban areas (66.29%). Carcinomas represented the predominant histological group (796 cases, 99.00%) with a predominance of invasive nonspecific type carcinoma (92.34%). These cancers were diagnosed at late stage III using Nottingham grading (55.10%). The TNM classification showed a predominance of grades T2NxMx (72.45%) and T4N1Mx (17.76%). The luminal B profile (40.85%) was found mostly, and the mutation of BRCA2 and BRCA1 genes was found in 2.61% of cases. Mastectomy was performed in 7.59%, radiotherapy in 3.61%, and chemotherapy in 18.66%.

Conclusion:

Breast cancer is a frequent pathology in Togolese women, predominant in young adults, often diagnosed at a late stage with limited possibilities of treatment. The establishment of early care programs is essential.

[Management of objective patellar instabilities at the University Hospital Center Sylvanus Olympio of Lome, Togo]

Introduction

patellar instability is a rare multifactorial condition whose treatment is complex. The purpose of this study was to describe cases of patellar instabilities and then to assess treatment outcomes in low-income countries.

Methods

the study was conducted from March 2013 to February 2018. Eight patients aged >15 years and who had undergone surgery for objective patellar instability were enrolled. Before and after surgery knee function was assessed using IKDC score.

Results

the average age at surgery was 28.5 years and female sex was predominant (6 cases). Trochlear dysplasia was the main etiological factor (7 patients). In four cases dysplasia was related to patellar height (mean Caton index: 1.4). In five cases, section of lateral patellar retinaculum associated with TTA transposition and Insall's plasty was performed. Functional outcome was satisfactory, with a mean IKDC score of 91.3%.

Conclusion

patellar instabilities are rare. Management is delayed in our developing countries, but outcomes are good when protocols are adapted.

[Place of theses and dissertations in the scientific publications of dermato-venereology teachers of the University of Lome (Togo)]

The aim of this study was to situate the place of theses and dissertations (senior healthcare technicians, D.E.S or master) in the scientific publications of dermato-venerology teachers at the University of Lomé (Togo). We listed the theses and dissertations on dermato-venerology between 1990 and 2016, in three institutions of the University of Lomé and consulted databases (Medline, Inist, registers of the service) to search for publications by teachers during this period. A total of 41 theses and 50 dissertations were completed, on infectious dermatoses and STI/HIV (46.1%), immunoallergic dermatoses (11.0%) and tumour dermatoses (8.8%). Of these 91 works, 56 (including 28 theses) were published in indexed (21 theses and 26 dissertations) or non-indexed (7 theses and 2 dissertations) journals. These 56 publications represented 27.7% of the 202 publications made by the dermato-venerology teachers at the University of Lomé during this period. Of the 28 published theses, the MD student was the first author in one case (3,6%) This work shows that theses and dissertations in dermato-venerology represent almost one third of the publications in this discipline in Togo.

Knowledge about Autism among Graduate Students in Togo

Graduate students in healthcare or education programs should have adequate knowledge about autism as they could become professionals in that field. However, we were unable to locate any published studies that examined knowledge about autism among graduate students in francophone sub-Saharan Africa. Thus, the goal of this study was to describe knowledge about autism among 254 graduate psychology, medical, and education students in Togo. Results suggested that only 5% of graduate students had good knowledge about autism. Although graduate psychology students achieved higher scores than others, all subgroups had inadequate knowledge about specific characteristics of autism. The findings highlight the necessity of passing public policies to promote autism research and training in local universities in Togo.

Molecular characterization of high-risk human papillomavirus (HR-HPV) in women in Lomé, Togo

BACKGROUND

The causative agent of cervical cancer referred to as Human papillomavirus (HPV) remains a real public health problem. Many countries in West Africa, such as Togo have no data on the high-risk HPV (HR-HPV) infection and genotypes distribution. In order to fill the knowledge gap in the field in Togo, the main objective of this study was to determine the prevalence of pre-cancerous lesions of the cervix and HR-HPV genotypes among Togolese women.

METHODS

Samples were collected from 240 women by introducing a swab in the cervix. Then, the screening of precancerous cervical lesions using the visual inspection with acetic acid and lugol (VIA / VIL) was conducted. The HR-HPV genotypes were characterised by real-time multiplex PCR.

RESULTS

Out of 240 women recruited, 128 (53.3%) were infected by HR-HPV. The most common genotypes were HPV 56 (22.7%), followed by HPV 51 (20.3%), HPV 31 (19.5%), HPV 52 (18.8%) and HPV 35 (17.2%). The least common genotypes were HPV 33 (2.3%) and HPV 16 (2.3%). Among the women, 1.3% (3/240) were positive to VIA/VIL.

CONCLUSION

This study allowed HR-HPV genotypes to be characterised for the first time in Lomé, Togo. This will help in mapping the HR-HPV genotypes in West Africa.

Monitoring migrant groups as a post-validation surveillance approach to contain the potential reemergence of lymphatic filariasis in Togo

BACKGROUND

In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo's case investigation algorithm to prevent resurgence of LF and sustain Togo's elimination success.

METHOD

A cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia.

RESULTS

Refugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case's surroundings.

CONCLUSION

This study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.

Dosimetry of pediatric chest X-Ray examinations in Togo

OBJECTIVE

To assess the entrance surface dose (ESD) of pediatric chest X-ray examinations in order to establish a diagnostic reference levels (DRLs) in Togo.

MATERIALS AND METHODS

The study was carried out in 13 radiology departments within the 6 health regions of the country. This is a descriptive cross-sectional study relating to the dosimetric assessment of the skin of children aged from 0 to 15 years during chest X-ray examinations. The assessment was made by the empirical formula calculation of the entrance surface dose (ESD = 0.15 × (U/100)² × Q × (1/FSD)²) and with the Internet Dose Calculation Module (MICADO) software online. Statistical assessment was performed using IBM SPSS 21 software.

RESULTS

Our sample numbered 390 with a sex ratio of 1.3 and predominantly male. Examinations performed with the analog radiography units were more irradiating (0.14 mGy) than ones performed with digital detectors (0.12 mGy). The mean dose calculated with MICADO was low (Avg. = 0.12 mGy) compared to that calculated with the theoretical method (Avg. = 0.16 mGy). No significant relationship was found between the professional experience of operators and the entrance surface dose (r  > -1 with p = 0.146 not significant). MICADO doses increased with age. The values of the diagnostic reference levels used for the antero-posterior or postero-anterior chest X-ray examinations for children aged 0-1 year; 1-5 years; 5-10 years and 10-15 years were respectively, 0.15 mGy; 0.14 mGy; 0.15 mGy and 0.17 mGy.

CONCLUSION

The entrance surface dose varied greatly from one health facility to another for this same examination. In most of the different age groups of children, the diagnostic reference level was higher than that found in literature. Thus, effective measures must be put in place to optimize the doses delivered to children during chest X-ray examinations.

State of the art of the management of medical and biological laboratory solid wastes in Togo

The biomedical analysis laboratory is a structure intended to carry out biological, immuno-serological, biochemical, hematological or other examinations of substances of human origin to provide information useful for the diagnosis, management, prevention or treatment of diseases. These laboratories produce solid and liquid biomedical waste (BMW) that constitutes a serious health problem for humans and their environment. Temain goal of this study is to assess the management of solid BMW produced by biomedical laboratories in Togo. It is a descriptive, exploratory and transverse study that took place from March 5 to July 5, 2018. Through a systematic random sampling 82 public and private biomedical analysis, laboratories were selected and submitted to a questionnaire. Direct observation and an interview were made with the managers of these laboratories to assess the state of BMW management. The assessment of BMW management of the prospected centers showed that among the 67.1% of public centers and 32.9% of private centers present in the study sample, only 26.3% present all laboratory units and together in 87.8% of cases. Males predominate in these facilities (85.3%) with an average age of 37.07 ± 7.34 years and work experience of 10.24 ± 5.81 years. While in 67.0% of the cases, the location of waste storage is available, only 18.3% of these locations meet international requirements. Incinerators were available in 72.0%. Plastic pedal/balance garbage cans were the most commonly used tools for collection in 32.9% of the facilities. Black bags are used 82.9% for collection. Waste generation is significant with 13.4% of the laboratories producing more than 8 kg/d. Gloves were available and taps in sufficient number in the laboratories. The most common health problems reported were respiratory disorders (32.9%) followed by gastrointestinal disorders (17.1%). BMW is in most cases (18.3%) disposed of in public dumps, while 72% of producers have received training on BMW management.

The problem of BMW management remains a concern in health facilities in Togo. Safe disposal of BMW is therefore necessary.

[Congenital ocular anomalies at the University Hospital Campus in Lomé, Togo]

Introduction

les anomalies congénitales oculaires sont des entités cliniques rares dans le monde. Le but de cette étude est de décrire les aspects épidémiologiques et cliniques des anomalies congénitales oculaires au Centre Hospitalier Universitaire-Campus de Lomé.

Méthodes

une étude rétrospective a été réalisée de janvier 2016 à décembre 2018 (3 ans) dans le service d´ophtalmologie du Centre Hospitalier Universitaire-Campus de Lomé. Elle a concerné les enfants porteurs d´anomalies congénitales oculaires. Les variables d´étude ont été: le sexe; l´âge au moment du diagnostic; le type d´anomalies congénitales oculaires; la latéralité.

Résultats

sur 2621 enfants examinés durant la période d´étude, 103 (3,9%) étaient porteurs d´anomalies congénitales oculaires. Des 103 patients, il y avait 60 (58,2%) garçons et 43 (41,8%) filles. L´âge moyen de diagnostic était de 16 ± 5,2 mois (extrêmes: 1 mois et 5 ans). L´anomalie congénitale oculaire la plus fréquente était la cataracte (53,4 %). Les atteintes unilatérales étaient prépondérantes (56,3%). Les anomalies congénitales oculaires étaient: isolées (82,5%) ; associées aux anomalies systémiques (11,7%); associées entre elles (5,8%).

Conclusion

ces résultats indiquent que les caractéristiques épidémiologiques et cliniques des anomalies congénitales oculaires se rapprochent de celles rapportées dans la littérature. Cependant, dans notre milieu, la fréquence des anomalies congénitales oculaires et l´âge de diagnostic sont élevés. Il est important de diagnostiquer tôt les anomalies congénitales oculaires dans le but d´assurer la prise en charge et de préserver la fonction visuelle.

The use of dried tube specimens of Plasmodium falciparum in an external quality assessment programme to evaluate health worker performance for malaria rapid diagnostic testing in healthcare centres in Togo

BACKGROUND

The use of rapid diagnostic tests (RDTs) to diagnose malaria is common in sub-Saharan African laboratories, remote primary health facilities and in the community. Currently, there is a lack of reliable methods to ascertain health worker competency to accurately use RDTs in the testing and diagnosis of malaria. Dried tube specimens (DTS) have been shown to be a consistent and useful method for quality control of malaria RDTs; however, its application in National Quality Management programmes has been limited.

METHODS

A Plasmodium falciparum strain was grown in culture and harvested to create DTS of varying parasite density (0, 100, 200, 500 and 1000 parasites/µL). Using the dried tube specimens as quality control material, a proficiency testing (PT) programme was carried out in 80 representative health centres in Togo. Health worker competency for performing malaria RDTs was assessed using five blinded DTS samples, and the DTS were tested in the same manner as a patient sample would be tested by multiple testers per health centre.

RESULTS

All the DTS with 100 parasites/µl and 50% of DTS with 200 parasites/µl were classified as non-reactive during the pre-PT quality control step. Therefore, data from these parasite densities were not analysed as part of the PT dataset. PT scores across all 80 facilities and 235 testers was 100% for 0 parasites/µl, 63% for 500 parasites/µl and 93% for 1000 parasites/µl. Overall, 59% of the 80 healthcare centres that participated in the PT programme received a score of 80% or higher on a set of 0, 500 and 1000 parasites/ µl DTS samples. Sixty percent of health workers at these centres recorded correct test results for all three samples.

CONCLUSIONS

The use of DTS for a malaria PT programme was the first of its kind ever conducted in Togo. The ease of use and stability of the DTS illustrates that this type of samples can be considered for the assessment of staff competency. The implementation of quality management systems, refresher training and expanded PT at remote testing facilities are essential elements to improve the quality of malaria diagnosis.

Assessment of the usefulness of anti-Wb123 antibody for post-elimination surveillance of lymphatic filariasis

Background

The World Health Organization has targeted lymphatic filariasis (LF) for elimination as a public health problem and recommends, among other measures, post-elimination surveillance of LF. The identification of sensitive and specific surveillance tools is therefore a research priority. The Wuchereria bancrofti-specific antigen Wb123-based enzyme-linked immunosorbent assay (Wb123 ELISA) detects antibodies to the recombinant Wb123 antigen of W. bancrofti and may be useful as a surveillance tool for LF. Six years after stopping mass drug administration to eliminate LF and recording successful results on two post-treatment transmission assessment surveys, a study was conducted in Togo aimed at helping to identify the role of the Wb123 ELISA in post-validation surveillance of LF.

Methods

This was a cross-sectional study in eight previously LF-endemic districts and one non-endemic district in Togo. In each sub-district of these nine districts, two schools were selected and 15 children aged 6 to 9 years old at each school provided finger-stick blood for testing for antibodies to Wb123 using the Filaria Detect™ IgG4 ELISA kit® (InBios, International, Inc., Seattle, WA, USA).

Results

A total of 2654 children aged 6 to 9 years old were tested in 134 schools in the nine districts. Overall, 4.7% (126/2654) children tested positive for antibodies to the Wb123 antigen of W. bancrofti. The prevalence of Wb123 antibodies varied across the eight previously endemic LF districts, from 1.56 to 6.62%. The highest prevalence, 6.99%, was found in the non-endemic district, but this was not significantly different from the average of all the LF districts (4.49%, P = 0.062).

Conclusions

The Wb123 ELISA was positive in 4.7% of Togolese school-age children who were almost certainly unexposed to LF. This apparent lack of specificity in the Togo context makes it difficult to establish a seroprevalence threshold that could serve to signal LF resurgence in the country, precluding the use of this test for post-validation surveillance in Togo. There remains a need to develop a useful and reliable test for post-elimination surveillance for LF in humans.

Skin cancers in people with albinism in Togo in 2019: results of two rounds of national mobile skin care clinics

Background

In people with albinism (PWA), the deficiency of melanin increase the risk of skin cancers. The aim of this study was to determine the prevalence of skin cancers and characteristics of these detected skin cancers (histological types, localization) in PWA in 10 cities in Togo in 2019.

Methods

This is a cross-sectional study of medical records of PWA systematically examined during two mobile skin care clinics in 2019, as part of a programme for the prevention and management of skin cancers in these subjects.

Results

During the study period, 280 (95.2%) of the 294 PWA consulted, had developed skin lesions. Of the 280 PWA, the pathological reports from the medical records of 33 patients (11.8%; (95%CI = [8.2–16.2]) had concluded to non-melanoma skin cancers. The mean age of these 33 patients was 38.6 ± 15.2 years and the sex-ratio was 1. Their occupations were mainly resellers (21.2%), traders (15.2%) and farmers (12.2%). In the 33 patients, 54 cases of non-melanoma skin cancers were identified, with some patients having more than one tumor, and some of them having more than one (histologically confirmed) diagnosis. These 54 non-melanoma skin cancers were divided into 21 cases of invasive squamous cell carcinomas, 2 cases of Bowen’s disease and 31 cases of basal cell carcinomas. These non-melanoma skin cancers mainly occurred in the head and neck (33 cases; 61.1%), the upper limbs (15 cases; 27, 8%) and the trunk (4 cases; 7.4%).

Conclusion

The results of this study show a high prevalence of skin cancers among PWAs in Togo in 2019, only non-melanoma skin cancers. In addition, they illustrate the role of ultraviolet rays with regard to the localization of skin cancers and the occupations of patients. Popularization and compliance with photo protection measures, systematic and regular examination of the skin of these PWAs will allow early detection and treatment of these skin cancers.

A mixed-methods study to explore opportunities and challenges with using a mHealth approach to engage men who have sex with men in HIV prevention, treatment and care in Lomé, Togo

BACKGROUND

In Togo, men who have sex with men (MSM) experience disproportionately high rates of human immuno-deficiency virus (HIV), with prevalence at 13% compared to the countrywide general HIV prevalence of 2.5%. Mobile phone adoption has grown rapidly in West Africa in recent years and mobile health (mHealth) provides an opportunity to engage high-risk populations in HIV prevention, treatment and care (PTC). This study focuses on the text messaging component of a mHealth program and resulting linkages to PTC in Lomé, Togo.

METHODS

We used a mixed-methods approach to collect information directly from a purposive sample of MSM to estimate the potential impact of the mHealth intervention on specific outcomes. A structured survey captured 503 MSM experiences with program activities to increase access to PTC through short message system (SMS), including data on socio-demographics, HIV knowledge and testing history, program awareness, use of services and referrals, use of mHealth, and experiences with and preferences for receiving HIV SMS messages. Twelve in-depth interviews captured qualitative data on MSM experiences and opinions related to the mHealth intervention, as well as barriers and facilitators to linkages between mHealth and clinic services.

RESULTS

Predicted probabilities of MSM being reached by the program and linked to PTC is higher for those exposed to the program and significantly different (P<0.001). The probability of being linked to HIV prevention emerges as the highest among MSM exposed to SMS messages with 92% probability. MSM exposed to SMS had a 63% probability to be linked to treatment compared to only 40% among those not exposed to SMS. Program barriers and facilitators were identified through the thematic analysis of the qualitative data. Several facilitators to PTC were reported including: increased knowledge and awareness; convenient location of HIV testing coupled with distribution of products; ensuring individual confidentiality; and perceived care of providers. The main barriers to the program were lack of program awareness, program functionality and affordability for referral services, and peer educator training.

CONCLUSIONS

The probability of being reached, and adhering to PTC is significantly higher among MSM exposed to HIV related SMS messages; however, the usefulness of SMS in HIV programs targeting MSM needs to be better understood.

[Drug use for abortifacient purposes among teenage hairdressers and seamstresses in one suburb of Lome]

The use of drugs is not solely determined by its therapeutic properties but refers to diversions of these properties.

OBJECTIVE

To assess the level of knowledge of the diversion of drugs for abortifacient purposes among hairdressers and seamstresses of the suburb of Togblékopé.

MATERIAL AND METHOD

We conducted a cross-sectional study among hairdressers and seamstresses living in Togblékopé, a suburb on the outskirts of the city of Lomé.

RESULTS

Of the 114 respondents, 74.6% knew that drugs were diverted for abortion, mostly among older young people, singles and apprentices. In addition, 70.6% reported having at least once attended a drug abortion by someone. Thus, drugs such as paracetamol, chloroquine and acetylsalicylic acid have been reported for abortifacient purposes' diversion, most often purchased on the street and responsible for serious side effects.

CONCLUSION

This study has highlighted the knowledge of drugs' use for abortifacient purposes among hairdressers and seamstresses. It is necessary to carry out actions that will aim at teaching the risks of drug intoxication and reduce the risk of pregnancy through family planning.

[Association between consanguinity with the ocular congenital abnormalities in Togo]

OBJECTIVES

To investigate the possibility of an association between parental consanguinity and the occurrence of congenital ocular abnormalities.

MATERIALS AND METHODS

A retrospective cross-sectional study was carried out over 3 years, from January 2016 to December 2018, in the pediatric ophthalmology unit of the University Hospital Campus of Lomé (Togo). It included children with congenital ocular abnormalities. Age, gender, geographic origin (city or urban area, village or rural area), degree of consanguinity of parents and types of congenital ocular abnomalities were the variables of study. Odds Ratio (OR) and logistic regression were used to investigate the correlation between parental consanguinity and the occurrence of congenital ocular abnormalities. A P-value of<0.05 was considered statistically significant.

RESULTS

Among the 103 patients with congenital ocular abnormalities, there were 60 (58.2%) males and 43 (41.8%) females. The mean age of the patients was 16 months, range 1 month-5 years. Patients born to consanguineous parents were 26.2% (27) of the total population. Of these 27 patients, 25 (92.6%) were born to second-cousin marriages and 24 (88.89%) came from a rural area. Parental consanguinity was correlated with developmental abnormalities of the globe (OR=37.50; 95% CI_: [4.46-314.80]; r=3.62; P=0.00), sclerocornea (OR=13.04; 95% CI: [1.39-122.54]; r=2.57; P=0.02) and corneal dystrophy (OR=9.37; 95% CI: [0.93-94.36]; r=2.24; P=0.02).

CONCLUSION

Our study suggests the existence of a correlation between parental consanguinity and the occurrence of congenital ocular abnormalities.

Predictors of three-month mortality among hospitalized older adults in Togo

Background

Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo.

Methods

We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality.

Results

The median age of the 650 older adults included in the study period was 61 years, IQR: [55–70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4–20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5 and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases.

Conclusion

Togolese health system needs to adjust its response to an aging population in order to provide the most effective care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01907-y.

Breast cancer in togolese women: immunohistochemistry subtypes

Background

Molecular classification of breast cancer is an important factor for prognostic and clinical outcomes. There are no data regarding molecular breast cancer subtypes among Togolese women. The objective of this study was to evaluate the expression of ER, PR, HER2, and molecular subtypes of breast cancer receptors in Togolese patients and to establish the correlation between clinical and histological data and molecular types.

Methods

Clinicopathologic data of patients were collected from clinical records. Immunohistochemistry biomarkers (ER, PR, and HER2) were assessed in patients who have been diagnosed with invasive breast cancer from March 2016 to March 2020 in the department of oncology. The analysis of variance and the Chi-square Test was used to analyze the data.

Results

A total of 117 cases were collected. The mean age of patients was 52.05 ± 12.38 with an age range of 30 to 85 years. Half of the patients were over 50 years old and the majority (70.9%) was postmenopausal. More than half of patients (52.1%) presented with T3-T4tumors.The most common histologic subtype of breast cancer was invasive ductal carcinoma of no special type (95.7%). Tumors grade 2 were predominant (51.3%) followed by grade 3 (42.7%). Advanced carcinomas were found in 69 patients (59%). The percentage of ER+, PR+, and HER2 positive tumors was 54.7%, 41%, and 15.4% respectively. The predominant molecular subtype was Triple negative (37.6%), followed by Luminal A (30.8.7%), Luminal B subtype (23.9%), and HER2 enriched (7.7%). There was a significant association between stage and breast cancer subtypes (p 0.025), histologic grade, and subtype (p < 0.0001) but no correlation was found with age, menopausal status, and tumor size.

Conclusion

Breast carcinoma in our patients are high grade tumors and are diagnosed at an advanced stage. Triple negative and Luminal A are the two predominant breast cancer subtypes in Togolese women. Consequently, Receptor testing availability should be a priority to offer the best breast cancer treatment.

A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy

BACKGROUND

Since the novel coronavirus emerged in late 2019, the scientific and public health community around the world have sought to better understand, surveil, treat, and prevent the disease, COVID-19. In sub-Saharan Africa (SSA), many countries responded aggressively and decisively with lockdown measures and border closures. Such actions may have helped prevent large outbreaks throughout much of the region, though there is substantial variation in caseloads and mortality between nations. Additionally, the health system infrastructure remains a concern throughout much of SSA, and the lockdown measures threaten to increase poverty and food insecurity for the subcontinent's poorest residents. The lack of sufficient testing, asymptomatic infections, and poor reporting practices in many countries limit our understanding of the virus's impact, creating a need for better and more accurate surveillance metrics that account for underreporting and data contamination.

OBJECTIVE

The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with new and decomposable surveillance metrics of COVID-19 that overcome data limitations and contamination inherent in public health surveillance systems. In addition to prevalence of observed daily and cumulative testing, testing positivity rates, morbidity, and mortality, we derived COVID-19 transmission in terms of speed, acceleration or deceleration, change in acceleration or deceleration (jerk), and 7-day transmission rate persistence, which explains where and how rapidly COVID-19 is transmitting and quantifies shifts in the rate of acceleration or deceleration to inform policies to mitigate and prevent COVID-19 and food insecurity in SSA.

METHODS

We extracted 60 days of COVID-19 data from public health registries and employed an empirical difference equation to measure daily case numbers in 47 sub-Saharan countries as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R.

RESULTS

Kenya, Ghana, Nigeria, Ethiopia, and South Africa have the most observed cases of COVID-19, and the Seychelles, Eritrea, Mauritius, Comoros, and Burundi have the fewest. In contrast, the speed, acceleration, jerk, and 7-day persistence indicate rates of COVID-19 transmissions differ from observed cases. In September 2020, Cape Verde, Namibia, Eswatini, and South Africa had the highest speed of COVID-19 transmissions at 13.1, 7.1, 3.6, and 3 infections per 100,0000, respectively; Zimbabwe had an acceleration rate of transmission, while Zambia had the largest rate of deceleration this week compared to last week, referred to as a jerk. Finally, the 7-day persistence rate indicates the number of cases on September 15, 2020, which are a function of new infections from September 8, 2020, decreased in South Africa from 216.7 to 173.2 and Ethiopia from 136.7 to 106.3 per 100,000. The statistical approach was validated based on the regression results; they determined recent changes in the pattern of infection, and during the weeks of September 1-8 and September 9-15, there were substantial country differences in the evolution of the SSA pandemic. This change represents a decrease in the transmission model R value for that week and is consistent with a de-escalation in the pandemic for the sub-Saharan African continent in general.

CONCLUSIONS

Standard surveillance metrics such as daily observed new COVID-19 cases or deaths are necessary but insufficient to mitigate and prevent COVID-19 transmission. Public health leaders also need to know where COVID-19 transmission rates are accelerating or decelerating, whether those rates increase or decrease over short time frames because the pandemic can quickly escalate, and how many cases today are a function of new infections 7 days ago. Even though SSA is home to some of the poorest countries in the world, development and population size are not necessarily predictive of COVID-19 transmission, meaning higher income countries like the United States can learn from African countries on how best to implement mitigation and prevention efforts.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/21955.

Prevalence of hepatitis B among childbearing women and infant born to HBV-positive mothers in Togo

Background

Hepatitis B virus (HBV) infection is a public health problem in Togo and transmission to the child occurs mainly during childbirth. The objective of this study was to estimate the prevalence of HBV among childbearing women and infants born to HBV positive mothers in Togo.

Methods

A national cross-sectional study was carried out in six cities in Togo in the six health regions in Togo. Mother-child pairs were recruited from immunization centers or pediatric wards in Lomé, Tsévié, Atakpamé, Sokodé, Kara and Dapaong in 2017. Women aged 18 and over with one child of at least 6 months old were included. A standardized questionnaire was used for data collection and HBV screening was performed using Determine® rapid tests. The prevalence of HBV, defined by a positive HBV surface antigen (HBsAg), was estimated in mothers and then in infants of mothers who were positive for HBsAg. Logistic regression model was performed to identify risk factors for HBsAg positivity in mothers.

Results

A total of 2105 mothers-pairs child were recruited. The median age of mothers and infants was 29 years, interquartile range (IQR) [25–33] and 2.1 years, IQR [1–3] respectively. About 35% of women were screened for HBV during antenatal care and 85% of infants received three doses of HBV immunization. Among mothers, the prevalence of HBV was 10.6, 95% confidence interval (95% CI) [9.4–12.0%], and 177 had detectable HBV viral load (> 10 IU/mL). Among mothers with positive HBsAg, three infants also had positive HBsAg, a prevalence of 1.3, 95% CI [0.2–3.8%]. In multivariable analysis, HIV-infection (aOR = 2.19; p = 0.018), having at least three pregnancies (aOR = 1.46; p = 0.025) and living in Tsévié (aOR = 0.31; p < 0.001) compared to those living in Lomé, were associated to HBV infection in mothers.

Conclusion

In this study, one out of 10 childbearing women were infected with HBV, but less than 2% of infant born to HBV positive mothers under 5 years’ old who received immunization under the Expanded Program on Immunization were infected. Improving antenatal screening and providing targeted interventions in babies could help eliminate HBV in Togo.

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

BACKGROUND

Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protection of households in Togo.

METHODS

Data were obtained from a cross-sectional, representative household survey involving 1180 insured households that had reported either illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. A nested logit model was used to account for the utilization of health services and provider choice, and methods of assessing catastrophic health care expenditures were used to analyze the level of household financial protection.

RESULTS

Policyholders of private health insurance use private health care facilities more than policyholders of public health insurance. The main reasons for not using health centers among households with public insurance were out-of-pocket payments (49.19%), waiting time (36.80%), and distance to the nearest health center (36.76%). Furthermore, on average, households with public insurance spent a higher proportion of their total monthly nonfood expenditures on health care than those with private insurance. We find that the type of insurance, share of expenditures allocated to food, distance to the nearest health center, and waiting time significantly impact the choice of provider. Regardless of the type of health insurance, elderly individuals avoid using private health centers and referral hospitals due to the high cost.

CONCLUSION

We found that a multiple health insurance system results in a multilevel health system that is not equitable for everyone. The capacity of the health insurance system to provide equitable health care services and protect its members from catastrophic health care expenditures should be at the core of health care reform. This study recommends raising awareness of the criteria for the reimbursement of medical procedures within the framework of public insurance and promoting specific health insurance mechanisms for elderly individuals. Careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care.

Genome-Wide Analysis of the Malaria Parasite Plasmodium falciparum Isolates From Togo Reveals Selective Signals in Immune Selection-Related Antigen Genes

Malaria is a public health concern worldwide, and Togo has proven to be no exception. Effective approaches to provide information on biological insights for disease elimination are therefore a research priority. Local selection on malaria pathogens is due to multiple factors including host immunity. We undertook genome-wide analysis of sequence variation on a sample of 10 Plasmodium falciparum (Pf) clinical isolates from Togo to identify local-specific signals of selection. Paired-end short-read sequences were mapped and aligned onto > 95% of the 3D7 Pf reference genome sequence in high fold coverage. Data on 266 963 single nucleotide polymorphisms were obtained, with average nucleotide diversity π = 1.79 × 10⁻³. Both principal component and neighbor-joining tree analyses showed that the Togo parasites clustered according to their geographic (Africa) origin. In addition, the average genome-wide diversity of Pf from Togo was much higher than that from other African samples. Tajima’s D value of the Togo isolates was −0.56, suggesting evidence of directional selection and/or recent population expansion. Against this background, within-population analyses identifying loci of balancing and recent positive selections evidenced that host immunity has been the major selective agent. Importantly, 87 and 296 parasite antigen genes with Tajima’s D values > 1 and in the top 1% haplotype scores, respectively, include a significant representation of membrane proteins at the merozoite stage that invaded red blood cells (RBCs) and parasitized RBCs surface proteins that play roles in immunoevasion, adhesion, or rosetting. This is consistent with expectations that elevated signals of selection due to allele-specific acquired immunity are likely to operate on antigenic targets. Collectively, our data suggest a recent expansion of Pf population in Togo and evidence strong host immune selection on membrane/surface antigens reflected in signals of balancing/positive selection of important gene loci. Findings from this study provide a fundamental basis to engage studies for effective malaria control in Togo.