Are Women In Lomé Getting Their Desired Methods Of Contraception? Understanding Provider Bias From Restrictions To Choice

Background

Despite improvements in contraception availability, women face persistent barriers that compromise reproductive autonomy and informed choice. Provider bias is one way in which access to contraception can be restricted within clinical encounters and has been established as common in sub-Saharan Africa. This analysis assessed the prevalence of provider restrictions and the potential impact on women's method uptake in Lomé, Togo.

Methods

This sub-analysis used survey data from provider and client interviews collected to assess the impacts of the Agir pour la Planification Familiale (AgirPF) program in Togo. The relationships between provider restrictiveness and women's receipt of their desired method of contraception were modelled using mixed effects logistic regressions looking at all women and among subgroups hypothesized to be at potentially higher risk of bias.

Results

Around 84% of providers reported a restriction in contraceptive provision for the five contraceptive methods explored (pill, male condom, injectable, IUD, and implant). Around 53% of providers reported restricting at least four of the five methods based on age, parity, partner consent, or marital status. Among all women, there were no significant associations between provider restrictiveness and women's receipt of desired method, including among those who desired long-acting methods. In adjusted modeling, marital status was a covariate significantly associated with desired method, with married women more likely to receive their desired method than unmarried women (aOR 2.73, 95% CI 1.45-5.13).

Conclusion

Provider reports of high levels of restrictions in this population are concerning and should be further explored, especially its effects on unmarried women. However, restrictions reported by providers in this study did not appear to statistically significantly influence contraceptive method received.

[Atypical Localization of a Case of Leprosy in Lomé (Togo)]

This was a 50-year-old woman with a selling activity living in Lomé who came for a consultation in March 2016 for a facial flushing that had been going on for 2 months without pain or pruritus. On examination, there was a single, erythemato-squamous closet of the right hemiface. There was no infiltration of the right ear. There was moderate cutaneous heat compared to the left hemiface which was without any lesion. Examination of nails, hair, palms and plants was normal. There was no hypertrophy of the peripheral nerves (superficial cervical plexus, ulnar, median). The face was not fixed. Complementary examinations noted a normal blood count and negative HIV status. Histology performed on a biopsy fragment concluded tuberculoid leprosy. The patient was first put on WHO multidrug therapy during 6 months. But one month after stopping this treatment, the lesions resumed. She was referred to a multibacillary leprosy protocol during one year. She had been seen 4 months after stopping treatment, without recurrence. It is important not to ignore leprosy in case of atypical erythema of the face even in the absence of other evocative signs and to perform a biopsy to the slightest doubt.

Married women's experiences of intimate partner violence and utilization of antenatal health care in Togo

OBJECTIVES

The aim of this study is to explore the relationship between intimate partner violence (IPV) and antenatal care use (ANC) in the Togolese context. We explore the associations between three indicators of ANC utilization (i.e., timing and number of ANC visits, and place of delivery) and three types of IPV (i.e., physical, emotional, and sexual violence) among married women.

METHODS

Drawing data from the 2013-14 Togo Demographic and Health Survey, we employ a series of logistic regression analyses to explore the association between women's ANC use and experience of IPV.

RESULTS

At the bivariate level, women who have experienced any form of IPV were less likely to meet the requirement for all the indicators of ANC utilization, except that the relationship between the timing of the first ANC visit and sexual violence was not statistically significant. Some of these associations were attenuated when we controlled for socioeconomic variables such as education and household wealth.

CONCLUSION

Based on these findings, we have several policy recommendations. For example, there is a need for interventions targeted towards poorer and less educated women. There is also a need to address patriarchal gender norms with community-level education that targets both wives and husbands.

Neisseria meningitidis Serogroup W Meningitis Epidemic in Togo, 2016

BACKGROUND

During 2014, 4 regions in Togo within the African meningitis belt implemented vaccination campaigns with meningococcal serogroup A conjugate vaccine (MACV). From January to July 2016, Togo experienced its first major Neisseria meningitidis serogroup W (NmW) outbreak. We describe the epidemiology, response, and management of the outbreak.

METHODS

Suspected, probable, and confirmed cases were identified using World Health Organization case definitions. Through case-based surveillance, epidemiologic and laboratory data were collected for each case. Cerebrospinal fluid specimens were analyzed by polymerase chain reaction, culture, or latex agglutination. Vaccination campaigns were conducted in affected districts.

RESULTS

From January 11 to July 5, 2016, 1995 suspected meningitis cases were reported, with 128 deaths. Among them, 479 (24.0%) were confirmed by laboratory testing, and 94 (4.7%) and 1422 (71.3%) remained as probable and suspected cases, respectively. Seven epidemic districts had cumulative attack rates greater than 100 per 100 000 population. Of the confirmed cases, 91.5% were NmW; 39 of 40 available NmW isolates were sequence type-11/clonal complex-11.

CONCLUSIONS

This outbreak demonstrates that, although high coverage with MACV has reduced serogroup A outbreaks, large meningococcal meningitis outbreaks due to other serogroups may continue to occur; effective multivalent meningococcal conjugate vaccines could improve meningococcal disease prevention within meningitis belt populations.

Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol

BACKGROUND

Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities.

METHODS

The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster.

DISCUSSION

Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT03694366 , registered 3 October 2018.

[Characteristics of chronic lymphocytic leukemia in Togo]

The epidemiological, clinical and biological characteristics of chronic lymphocytic leukemia (CLL) are little studied in Togo. The purpose of this study was to describe these characteristics at the time of diagnosis. We conducted a retrospective and descriptive study of patients diagnosed at the University Hospital Campus from January 1999 to December 2018. Over the past two decades, 87 patients were seen for CLL (20% of patients with hematological malignancies) with an annual prevalence of 4.35 new cases. The average age of patients was 61 +/- 12,48 years (ranging from 17-85 years); 55 women and 32 men (sex ratio M/F 0.58) were enrolled. Clinically, 16 patients (18%) had no tumor syndrome, 33 patients (38%) had lymphadenopathy, 62 patients (71%) splenomegaly and 23 patients (26%) hepatomegaly. Biologically, the mean blood and medullary lymphocyte count was 87188/mm3 (ranging from 7000-481780/mm3) and 75.75% +/- 12,88 (ranging from 44,5-96,5%) respectively; 65 patients (75%) had haemoglobin less than 10g/dl and 20 patients (23%) had platelet count below 100000/mm3. At the time of diagnosis, 67 patients (77%) had Binet stage C, 7 patients (8%) stage B and 13 patients (15%) stage A. The study of biological prognostics factors showed that 66% of cases had β2-microglobulin level higher than normal and 95% of cases had LDH higher than normal. CLL is a reality in Togo with a predominance of women and an average age of 61 years. Most patients are seen at Binet stage C and their assessment has revealed huge tumor mass with increased LDH and β2-microglobulin. The current follow-up of these patients will enable us to assess their overall survival.

Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo

Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6-23 months and investigates their relationships with length-for-age z-score (LAZ) and stunting, using cross-sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6-11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18- to 23-month-old children, only the consumption of iron-rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12-17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9-23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.

Resistance profile of children and adolescents infected with HIV-1 in urban areas in Togo

INTRODUCTION

Children and adolescents are more vulnerable than adults to virologic failure and the emergence of resistance. The objective of our study was to determine the resistance patterns in adolescents on antiretroviral therapy at Sylvanus Olympio University Hospital in Lome, Togo.

METHODS

From June 1 to September 30, 2014, we included patients who had been on HAART for more than 12 months in the pediatric ward of Sylvanus Olympio University Hospital. Patients with an HIV viral load ≥ 1000 copies underwent resistance genotyping.

RESULTS

Virologic failure was found in 36 of the 198 children and adolescents in the study (18.2%). Half were in WHO stage 3,72.2% were treated with a combination of two NRTIs (nucleoside reverse transcriptase inhibitors) and one NNRTI (non-nucleoside reverse transcriptase inhibitor). The mutations were mostly found in the NNRTI class with 100% mutations for EFV and NVP. The mutations associated with the most frequent NRTIs were M184V, Y181C, and T215Y.

CONCLUSION

Our study shows the need to use PIs (boosted protease inhibitors) in most children treated with NNRTI. It is necessary to strengthen the virological monitoring of children on HAART.

Preliminary Screening of Mosquito Spatial Distribution in Togo: With Special Focus on the Aedes (Diptera: Culicidae) Species

The Togolese Republic has a tropical and humid climate which constitutes an ideal environment for mosquitoes to breed and transmit diseases. The Aedes mosquito is known to transmit yellow fever (YF), dengue, chikungunya, and Zika viruses in West Africa. Togo has been suffering from YF virus transmission, despite vaccination efforts. Unfortunately, there is scarcity in the data that reflect mosquito spatial distribution in Togo, specifically possible YF vectors. In the current study, mosquito surveillance efforts targeted areas with confirmed YF cases between July and August 2012. Indoor mosquitoes were collected using knockdown insecticide spraying, whereas Biogents (BG) traps were used to collect outdoor mosquito adults. Mosquito larval surveillance was conducted as well. In total, 17 species were identified. This investigation revealed the presence of medically important vectors in Togo, especially the Aedes aegypti (Linnaeus) (Diptera: Culicidae) which was collected in the four regions. Screening of all pools of female Aedes mosquitoes for YF, by real-time PCR, showed negative results. This is the first record for Coquillettidia flavocincta (Edwards) (Diptera: Culicidae) species in West Africa. This preliminary work serves as a baseline for further mosquito distribution studies in Togo.

High Levels of Knockdown Resistance in Anopheles coluzzii and Anopheles gambiae (Diptera: Culicidae), Major Malaria Vectors in Togo, West Africa: A 2011 Monitoring Report

A survey of susceptibility to DDT, deltamethrin, bendiocarb, and chlorpyrifos-methyl was conducted in five localities in 2011 in Togo, West Africa, to assess the insecticide resistance status of Anopheles gambiae s.l. (Diptera: Culicidae). Female populations of An. gambaie s.l. emerged from collected larvae (F0) were exposed to insecticide-impregnated papers using World Health Organization test kits for adult mosquitoes; the susceptible reference strain Kisumu was used as a control. Resistance to DDT and deltamethrin was observed within the mosquito populations tested. Anopheles gambiae s.s. and Anopheles coluzzii represented the only species recorded in the study sites. The frequency of knockdown resistance (kdr L1014F) mutation determined using polymerase chain reaction diagnostic tests was lower in An. gambiae than in An. coluzzii in all of the localities except Kolokopé. Further investigations of An. gambiae s.l. resistance are needed in Togo to help the National Malaria Control Programme in vector control decision making and implementation of resistance management strategy.

Distribution of quinolone resistance gene (qnr) in ESBL-producing Escherichia coli and Klebsiella spp. in Lomé, Togo

Background

Qnr genes are known to confer a low-level resistance to fluoroquinolone in Enterobacteriaceae. They are often found on the same resistance plasmids as extended spectrum β-lactamase (ESBL) and constitute the most common antibiotic resistance mechanism. This study aimed to detect the presence of qnr genes in ESBL-producing E. coli and Klebsiella spp.

Methods

From May 2013 to July 2015, 91 E. coli and 64 Klebsiella spp. strains with phenotypic resistance to quinolone were collected from several specimens and analyzed for the detection of qnrA, qnrB, qnrS genes and the β-lactamase resistance genes (blaCTX-M, blaTEM, blaSHV) using simplex and multiplex PCR.

Results

In the present study, 107 (69%; 61 E. coli and 46 Klebsiella spp.) of 155 bacterial strains tested were found harboring at least one qnr gene consisting of 74 (47.74%) qnrB, 73 (47.10%) qnrS and 4 (2.58%) qnrA. Of the 107 strains encoding qnr genes, 102, 96 and 52 carried CTX-M1, TEM and SHV type ESBL respectively.

Conclusion

This study identified quinolone resistance (qnr) gene in ESBL-producing E. coli and Klebsiella spp. in Togo. These finding which suggest a possible resistance to quinolone are of high interest for better management of patients and control of antimicrobial resistance in Togo.

Electronic supplementary material

The online version of this article (10.1186/s13756-019-0552-0) contains supplementary material, which is available to authorized users.

Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo

To disseminate lessons learned from the implementation experience of a public-private sector partnership, we describe a comprehensive HIV/AIDS program including 5-year survival outcomes for individuals who initiated antiretroviral therapy (ART) treatment in Togo from 2010 to 2015. A retrospective case study analysis was conducted from a cohort of patients receiving ART at an HIV/AIDS care clinic in Kara Region, Togo. Kaplan-Meier curves with Log rank tests were used to compare estimated survival curves by demographic and clinical characteristics. Associations were described between survival probability and age, gender, World Health Organization (WHO) disease stage, and timing of ART initiation. Cox proportional hazard model was used to determine predictors of mortality. After approximately five-years since ART initiation (1780 days), there were 114 deaths, with a survival probability of 75.3% (95% CI: 70.3-80.6%). Participants with advanced WHO disease stage were more likely at risk of death relative to patients categorized as WHO Stage 1, with Stage 4 approximately 9 times more likely (aHR 9.22, 95% CI 4.29-19.84). Our study suggests that delivering comprehensive HIV care through a private-public partnership may serve as a model to expand and improve HIV/AIDS care as well as high quality primary care.

Consistent Condom Use Among Men Who Have Sex With Men in Lomé and Kara, Togo

High transmission probability of HIV during condomless anal sex puts men who have sex with men (MSM), transgender, and nonbinary individuals at increased risk of infection. This analysis aims to examine the socioeconomic, biological, and behavioral factors that are associated with consistent condom use (CCU) during insertive/receptive anal sex among MSM in the last month in the cities of Lomé and Kara, Togo. A total of 683 MSM ≥18 years of age were surveyed using respondent-driven sampling (RDS) for a cross-sectional survey in Lomé (n = 354; 51.8%) and Kara (n = 329; 48.2%). Participants completed a structured questionnaire and were tested for HIV and syphilis. Statistical analyses included RDS-weighted proportions, bootstrapped confidence intervals (CIs), and logistic regression models. When compared with Lomé, MSM in Kara had lower odds of CCU [adjusted odds ratio (aOR) = 0.29, 95% CI = 0.19-0.44]. Other factors associated with lower CCU were having an income of 2,000 Communaute Financiere Africaine (CFA)-12,000 CFA (aOR = 0.53, 95% CI = 0.36-0.77) or above 12,000 CFA (aOR = 0.34, 95% CI = 0.20-0.57), transgender women (aOR = 0.47, 95% CI = 0.25-0.92), and intersex gender (aOR = 0.42, 95% CI = 0.24-0.73), and ever being forced to have sex (aOR = 0.42, 95% CI = 0.21-0.82). Factors associated with CCU were identified in this study including older age (aOR = 1.49, 95% CI = 1.04-2.14) and having easy access to condoms (aOR = 2.70, 95% CI = 1.23-5.94) and very easy access to condoms (aOR = 2.73, 95% CI = 1.20-6.16). Reported condom use in this study was low, and several factors associated with CCU were identified including older age and access to condoms. This study highlights multiple barriers to preventive services experienced by MSM in Togo and therefore leveraging strategies to address these barriers may improve prevention of HIV and syphilis.

Insecticide resistance profiles of Anopheles gambiae s.l. in Togo and genetic mechanisms involved, during 3-year survey: is there any need for resistance management?

Background

Malaria, one of the world’s greatest public health challenges, is an endemic disease with stable transmission in Togo. Combating malaria requires an effective vector control. This study provides temporal data on insecticide resistance status in the major malaria vector Anopheles gambiae sensu lato (s.l.) from Togo.

Methods

Two to 5 days old females of An. gambiae s.l., originating from three localities (Baguida, Kovié, Kolokopé) were subjected to insecticide-impregnated papers during 3 years (2012, 2013, 2016) as follows: organochlorides (4% DDT), pyrethroids (0.05% deltamethrin, 0.75% permethrin, 0.05% lambdacyhalothrin), carbamates (0.4% bendiocarb and 0.1% propoxur), and organophosphates (5% malathion, 0.4% chlorpyrifos methyl, 1% fenitrothion) following the WHO standard protocol. Dead and surviving mosquitoes were stored separately in Eppendorf tubes containing silica gel for DNA extraction, species identification, and kdr and ace-1 genotyping.

Results

Knockdown times (KDT₅₀ and KDT₉₅) were high in An. gambiae s.l. The lowest KDTs were recorded at Baguida in 2013 for deltamethrin (KDT₅₀ = 24.7, CI [22.4–27.12] and KDT₉₅ = 90.78, CI [76.35–113.49]). No KDTs were recorded for DDT and in some instances for permethrin. In general, An. gambiae s.l. was resistant to most of the four classes of insecticides during the survey periods regardless of locality and year, except to chlorpyrifos methyl. In some instances, mosquitoes were fully susceptible to fenitrothion (Kolokopé: 100% and Kovié: 98.05%, CI [95.82–100.26]) and malathion (100% at both Kolokopé and Kovié) in 2013, and malathion only (Kolokopé; 100%) in 2016. Anopheles coluzzii, An. gambiae and Anopheles arabiensis were the three sibling species identified at the three localities with some hybrids at Baguida (2013), and Kovié (2012 and 2016), respectively. Anopheles gambiae was relatively dominant (61.6%). The kdr 1014F allele frequency was > 0.9 in most of the cases, except at Kolokopé (f (1014F) = 0.63, CI [0.55–0.71]) in 2013. The kdr 1014S allele frequency was below 0.02. The highest ace-1 frequencies were identified in An. gambiae at Baguida (2012: 0.52, CI [0.34–0.69] and 2013: 0.66, CI [0.46–0.86]).

Conclusion

The resistance status is worrying in Togo and should be considered in future malaria vector resistance management programmes by decision-makers.

Electronic supplementary material

The online version of this article (10.1186/s12936-019-2813-z) contains supplementary material, which is available to authorized users.

Prevalence and factors associated to disclosure of same-sex practices to family members and health care workers among men who have sex with men in Togo

Disclosure of same-sex practices is associated with improved access to health services and better health outcomes. Our aim was to estimate the prevalence of same-sex practice disclosure to family members and health care workers (HCW) in two cities in Togo. 683 MSM ≥18 years of age were surveyed using respondent driven sampling (RDS) for a cross-sectional survey using a structured questionnaire in Lomé (354 (51.8%)) and Kara (n = 329 (48.2%)). Median age was lower in Lomé than in Kara. A significantly higher proportion of MSM in Lomé (RDSa: 37.0%; 95% CI: 29.7, 44.3) than in Kara (RDSa: 8.0%; 95% CI: 4.7, 11.3) told a HCW that they have sex with men. Disclosure to a family member was associated with female gender, living with HIV, difficulties accessing health services, and blackmail. Disclosure to a HCW was associated with living with HIV, and physical abuse. MSM had decreased odds of disclosure to a HCW if they were living in Kara, reported female gender or intersex, or if had difficulties accessing health services. These data highlight the positive health outcomes associated with disclosure contextualized by the complex environments in which disclosure of same-sex practices takes place.

' It is a question of determination': a case study of monitoring and evaluation of integrated family planning services in urban areas of Togo

Background: Integrating family planning into postabortion and postpartum services can increase contraceptive use and decrease maternal and child death; however, little information exists on the monitoring and evaluation of such programs. This article draws on research completed by the EngenderHealth’s AgirPF project in three urban areas of Togo on the extent to which monitoring and evaluation systems of health services, which operated within the AgirPF project area in Togo, captured integrated family planning services.

Methods: This mixed methods case study used 25 health facility assessments with health service record review in hospitals, large community clinics, a dispensary, and private clinics and 41 key informant interviews with health faculty, individuals working at reproductive health organizations, individuals involved in reproductive health policy and politics, health care workers, and health facility directors.

Results: The study found the reporting system for health care was labor intensive and involved multiple steps for health care workers. The system lacked a standardized method to record family planning services as part of other health care at the patient level, yet the Ministry of Health required integrated family planning services to be reported on district and partner organization reporting forms. Key informants suggested improving the system by using computer-based monitoring, streamlining the reporting process to include all necessary information at the patient level, and standardizing what information is needed for the Ministry of Health and partner organizations.

Conclusion: Future research should focus on assessing the best methods for recording integrated health services and task shifting of reporting. Recommendations for future policy and programming include consolidating data for reproductive health indicators, ensuring type of information needed is captured at all levels, and reducing provider workload for reporting.

Prevalence of human papillomavirus, human immunodeficiency virus and other sexually transmitted infections among female sex workers in Togo: a national cross-sectional survey

OBJECTIVES

Sub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW).

METHODS

A multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests.

RESULTS

In all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10^-5). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively.

CONCLUSIONS

This first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.

Case report: an area postrema syndrome revealing a neuromyelitis optica spectrum disorder associated with central nervous system tuberculosis in a young Togolese (black African) woman

Background

Area postrema syndrome (APS) is considered to be one of the most specific clinical presentations of neuromyelitis optica spectrum disorders (NMOSDs). In sub-Saharan Africa, NMOSDs and even more so those revealed by an APS, are rarely reported. However, studies among mixed populations have shown that NMOSDs disproportionately affect black people with relatively more frequent encephalic involvement. We report a case of APS revealing an NMOSD associated with central nervous system (CNS) tuberculosis in a young Togolese woman residing in Togo (West Africa).

Case presentation

A 28-year-old Togolese woman was admitted for left hemibody sensory problems with ataxia. These problems were observed while the patient was hospitalized for a few days in the hepato-gastroenterology department for persistent vomiting, abdominal pain and hiccups lasting for about a month. The examination confirmed left hemibody ataxia with nystagmus when looking to the left, pronounced left osteotendinous reflexes, and left hemibody hypoesthesia up to the base of the neck. Encephalic magnetic resonance imaging (MRI) showed a hypersignal lesion in the bulbar more lateralized on the left in the fluid-attenuated inversion recovery sequence, not enhanced after a gadolinium injection. Biological assessment showed the presence of Mycobacterium tuberculosis deoxyribonucleic acid in the cerebrospinal fluid and a sedimentation rate of 120 mm in the 1st hour. The result of the anti-AQP4 antibody test was positive. Two months from the onset of digestive problems with Lhermitte’s sign and hand and foot contracture access without vesico-sphincter problems were established. Cervical medullary MRI showed an additional intramedullary hypersignal lesion in the T2 sequence at the C2 level, not enhanced after a gadolinium injection. A second course of intravenous corticosteroids was administered, and anti-tuberculosis treatment was continued. The outcome was favorable. After 8 months of anti-tuberculosis treatment, the patient started immunosuppressive therapy (azathioprine 50 mg twice daily) to limit the risk of recurrence of NMOSD.

Conclusion

The recognition of an APS is an additional challenge for the diagnosis of NMOSDs, especially in countries with limited resources. CNS tuberculosis must be tested when faced with an NMOSD because it seems to be a major cause.

Natural occurrence of mycotoxins in maize and sorghum in Togo

Mycotoxins are fungal secondary metabolites frequently affecting agronomical crops and consequently imposing a major challenge for food safety and public health. In this study, a total of 67 raw cereals (55 maize and 12 sorghum) were collected from the market of Togo. The samples were investigated on the occurrence of 21 mycotoxins using state-of-the-art high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS). The most frequent occurring mycotoxins were fumonisins (88 and 67% for maize and sorghum respectively) with concentrations ranging from 101 to 1838 μg/kg for maize and 81.5 to 361 μg/kg for sorghum, respectively. Aflatoxin B1 was detected in 38% of the maize samples with maximum contamination levels of 256 μg/kg, and 25% of the sorghum samples (range 6-16 μg/kg). The concentrations of aflatoxins were high in maize, with some cases exceeding the maximum legislative limits (EU) for unprocessed maize placed on the market. In addition to these high contamination levels, the co-occurrence of three classes of mycotoxins (i.e., aflatoxins, fumonisins, and trichothecenes) was observed in this study. For the first time, the multi-mycotoxins occurrence in agronomical crops in Togo was reported.

Causes of deaths in the intensives care unit of Sylvanus Olympio Teaching Hospital, Lomé, Togo

To analyze the causes of deaths in the intensive care unit (ICU) at the CHU Sylvanus Olympio (CHU SO) teaching hospital of Lomé. This retrospective study examined the files of patients who died in the ICU of CHU SO, during the 12-month period from November 2012 to October 2013. Of 732 patients admitted to the ICU, 237 died, for a mortality rate of 32.38%. Men accounted for 163 (68.8%) of the deaths, and women 74 (31.2%), for a M/F ratio of 2.2. The average age of patients who died was 41.7 years; the age group 21-30 years comprised 16% of the deaths, that 31-40 years 19.8%, and 41-50 years 17.7%. Trauma (50.64%) dominated the causes of death, including especially severe traumatic brain injury (34.18%), followed by postoperative intensive care (25.32%), including peritonitis (8%). Medical diseases accounted for 18.14% of ICU admissions. More than half the deaths (55.7%) took place in the 72 hours after ICU entry. Mortality in the ICU at CHU SO of Lomé remains very high. It affects young patients, mainly with traumatic and surgery-related pathologies.

Factors associated with the death of patients infected with the human immunodeficiency virus hospitalized in the gastroenterology department of the Campus Teaching Hospital of Lomé, Togo

AIM

To determine the factors associated with the death of patients infected with human immunodeficiency virus (HIV) while hospitalized in the hepato-gastroenterology department of the Lomé University Hospital, Togo.

PATIENTS AND METHOD

A retrospective cross-sectional study reviewed records covering a 10-year period from this department. It included all patients aged 15 years and older who were positive for HIV infection.

RESULTS

The study included 432 HIV⁺ patients, including 201 men and 231 women (sex ratio: 0.87). Their median age was 41 years (interquartile range: 35 to 48.2 years). The death rate was 15.3 %, and differed significantly between men (19.4%) and women (11.7%) (P = 0.0262). The probability of death increased significantly with age assessed in quartiles (P = 0.0472). Impaired general status, jaundice, and abdominal distension were associated with a high risk of death (P = 0.0017). Conditions unrelated to HIV that were associated with a high risk of death were hepatocellular carcinoma, cirrhosis, and toxic hepatitis (P < 0.0001). Anemia and CD4 count were not associated with death.

CONCLUSION

Death was associated with social and demographic (male sex and age) and clinical (altered general status, jaundice, cirrhosis, hepatocellular carcinoma and toxic hepatitis) factors.

Panorama of inflammatory arthropathies in rheumatologic consultations in Northern Togo

To determine the frequency and epidemiological profile of inflammatory arthropathies seen during rheumatologic consultations in Togo. This retrospective study examined the records of patients with inflammatory arthropathy seen at a rheumatologic consultation at Kara Teaching Hospital (Northern Togo) over a four-year period. Among the 2361 patients with rheumatic disorders, 152 (6.43%) had an inflammatory arthropathy: 57.24% were men and 42.76% women. The main causes observed were: chronic inflammatory rheumatism (CIR) and connective tissue disease (49.34%), infectious arthritis (26.32%), and gout (24.34%). The mean age of the 75 patients with CIR at the onset of the disease was 40 years and the average duration of evolution was 3.11 years. The main clinical forms of CIR were rheumatoid arthritis (11 cases), spondylarthropathies (20 cases within 11 cases of reactive arthritis), connective tissue diseases (4 cases), and unclassified CIR (31 cases). Nine patients with reactive arthritis were HIV positive. The infectious arthritis was caused by a banal germ in 31 cases and by Koch bacillus in nine other cases. Gout patients (35 men and 2 women) had a mean age of 43 years at the onset of the disease, and the mean duration of the disease was 4.1 years. Gout was monoarticular in 8 cases, oligoarticular in 19 cases and polyarticular in the other 10 cases. This study demonstrates the high incidence of chronic inflammatory rheumatism in Northern Togo.

Health-related quality of life among people living with HIV/AIDS in Togo: individuals and contextual effects

OBJECTIVE

The objective of this study is to assess the quality of life and to identify factors associated with good global quality of life among people living with HIV/AIDS (PLWHA) in Togo.

RESULTS

In total, 880 PLWHA with mean age (standard deviation) of 39.6 (10.1) years, were interviewed. Most of them (78.4%) were female. The global score of quality of life was ranged from 42.6 to 112, with a mean (standard deviation) estimated at 86.3 ± (13.3). More than the three-quarters (76.2%) of the participants had a good global quality of life. In multivariate analysis, secondary education level or higher (adjusted odds ratio = 1.78, 95% confident interval (CI) [1.10-2.85]), living in Kara health region (adjusted odds ratio = 4.39, 95% CI [2.94-6.57]), being on antiretroviral therapy (adjusted odds ratio = 6.99, 95% CI [4.11-11.9]) and HIV sero-status disclosure (adjusted odds ratio = 1.83, 95% CI [1.28-2.61]) were associated with a better overall quality of life (score ≥ 77.3).

Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso

Background

Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa.

Methods

This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures’ convergent validity, their correlations with expected variables were examined through bivariate logistic regression models.

Results

One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach’s alpha ranged from 0.71–0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW.

Conclusions

Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.

Prevalence and risk factors of anemia in children aged from 6 to 59 months in Togo: analysis from Togo demographic and health survey data, 2013-2014

BACKGROUND

Anemia in children continues to be a major public health challenge in developing countries and particularly in Sub-Saharan Africa. Anemia has serious consequences on the growth and development of the children in the early stages of life. This study aimed to determine the prevalence and associated factors of anemia among children from 6 to 59 months in Togo.

METHODS

Data from the Togo Demographic and Health Survey 2013-2014 were used for this study. This nationally representative survey provided data on a wide range of indicators such as mother and child health, nutrition and other characteristics. Anemia status was determined using hemoglobin level (Hb < 11.0 g/dl), and the weighted prevalence of childhood anemia along with 95% confidence intervals were provided. Data were analyzed using logistic regression models to estimate odds ratios (OR) and their 95% confidence intervals (95% CI) for associated factors.

RESULTS

Two thousand eight hundred ninety children aged 6-59 months were included in this analysis. The weighted prevalence of anemia was 70.9% [95% CI = 68.8-73.1] with 2.6% [95% CI = 2.0-3.3] of severe anemia among these children. In the multivariate analysis, the adjusted odds ratio (aOR) for anemia was 0.33 [95% CI = 0.26-0.42] in children aged from 24 to 42 months and 0.22 [95% CI = 0.17-0.29] in children aged from 43 to 59 months. Children's malaria status was strongly associated to childhood anemia with an aOR of 3.03 [95% CI = 2.49-3.68]. The secondary level of education and more for the mother was associated to childhood anemia with an aOR of 0.67 [95% CI = 0.52-0.86]. The aOR for children whose mother had anemia was 1.62 [95% CI = 1.30-2.02].

CONCLUSION

This study has highlighted the high prevalence of childhood anemia in Togo and revealed that younger children and maternal anemia were positively associated to childhood anemia whereas age of children and high level of maternal education were negatively associated to childhood anemia.