Quality Mindset: The Missing Ingredient in Tuberculosis Care and Control in Togo

Quality has been mentioned as the missing ingredient in TB care and control. In Togo, TB is a priority public health problem. We hypothesize that "quality mindset" is the missing ingredient for excellence in TB care and control in Togo. We used statistical process control (SPC) tools to analyze cohort data from the National Tuberculosis Control Program. There was an unstable quarterly variation in smear-positive pulmonary TB (TBP+) treatment success rate from 2017 to 2022. The general trend since the first instability was a quarterly variation around a success rate of 86%. Results showed stability in the quarterly variation of TBP+ case fatality rate at 7% since 2017. The root cause analysis of the low performance of the program revealed that TB management and DOTS strategy standards were not well adhered to. Based on the Pareto chart prioritizing the most affected health systems building blocks, health services delivery and health workforce building blocks accounted for 70% of all the dysfunctions. This study revealed that quality mindset is the missing ingredient for TB control program to be a center of excellence in Togo. It is therefore timely for a national project to verify the real contribution of total quality care to TB program performance in Togo

ETIOLOGIES DES PLEURESIES DU SUJET AGE AU TOGO

Objective: The aim of this study was to review the current aetiologic profile of pleurisies in the elderly people. Materials and method: We carried out a retrospective study based on the data of 126 patients, old of at least 55 years, hospitalised from January 2007 to December 2011 for pleurisy in the pneumology department of Sylvanus Olympio teaching hospital of Lome. Results: Pleurisies represent 23,11 % of elderly people’s hospitalisation motives. The Sex-ratio was 1 and the average age of the patients 65 ± 09 years old. The clinical aspect was dominated by thoracic pain (88,88 %) and cough (69,84 %). The chest X-ray revealed pleural effusion at the left side in 48,41 %, at right side in 46,83% and of medium abundance in 57,93 %. The liquid was citrine in 53,97 %, haematic in 30,95% and purulent in 15,08% . Pleurisies were of cancerous origin in 32,54 %, tubercular in 17,46 % and bacterial not tubercular in 14,58%. No aetiology had been found in 33,33 %. The mortality was 27,78 % and due to cancers and idiopathic pleurisies in 86 % during three months’ follow up. Conclusion: Cancers are the first aetiology of pleurisies followed by tuberculosis in elderly people. The acquisition of the new means of pleural exploration is important to reduce the proportion of idiopathic pleurisies

ETIOLOGIES DES PLEURESIES DU SUJET AGE AU TOGO

Objective: The aim of this study was to review the current aetiologic profile of pleurisies in the elderly people. Materials and method: We carried out a retrospective study based on the data of 126 patients, old of at least 55 years, hospitalised from January 2007 to December 2011 for pleurisy in the pneumology department of Sylvanus Olympio teaching hospital of Lome. Results: Pleurisies represent 23,11 % of elderly people’s hospitalisation motives. The Sex-ratio was 1 and the average age of the patients 65 ± 09 years old. The clinical aspect was dominated by thoracic pain (88,88 %) and cough (69,84 %). The chest X-ray revealed pleural effusion at the left side in 48,41 %, at right side in 46,83% and of medium abundance in 57,93 %. The liquid was citrine in 53,97 %, haematic in 30,95% and purulent in 15,08% . Pleurisies were of cancerous origin in 32,54 %, tubercular in 17,46 % and bacterial not tubercular in 14,58%. No aetiology had been found in 33,33 %. The mortality was 27,78 % and due to cancers and idiopathic pleurisies in 86 % during three months’ follow up. Conclusion: Cancers are the first aetiology of pleurisies followed by tuberculosis in elderly people. The acquisition of the new means of pleural exploration is important to reduce the proportion of idiopathic pleurisies

Facteurs etiologiques des pneumopathies communautaires bacteriennes chez les sujets ages au Centre Hospitalier Universitaire Tokoin (Togo)

Objectif: Décrire les facteurs étiologiques des pneumopathies communautaires bactériennes non tuberculeuses chez les sujets âgés de 60 ans et plus au CHU-Tokoin au Togo.Patients et méthode: Il s’agissait d’une étude rétrospective réalisée dans le service de Maladies Infectieuses et de Pneumologie du CHU-Tokoin (Lomé) du 1er janvier 2003 au 31 décembre 2008. Les patients étaient retenus sur la base des arguments cliniques, radiographiques, bactériologiques et évolutifs. Ainsi tout dossier de patient âgé de 60 ans et plus pris en charge dans le service pour une infection pulmonaire à l’exception de la tuberculose a été considéré comme sujet d’étude. Les résultats bactériologiques étaient issus des examens cytobactériologiques (ECB) de la ponction pleurale, de l’expectoration et de l’hémoculture. Le test VIH pour la recherche de l’infection avait été réalisé chez les patients qui avaient donné leur accord.Résultats: Quatre vingt neuf (89) cas soit 11,1 % de pneumopathies bactériennes du sujet âgé ont été enregistrés. Quarante huit (54 %) avaient une mauvaise hygiène buccodentaire. Le sexe ratio homme/femme a été de 1,23. Vingt six soit 29,21 % ont été tabagiques .Vingt deux patients (25 %) ont bénéficié d’une antibiothérapie trois mois avant leur hospitalisation. Seize (35 %) des 46 patients qui ont accepté le test VIH avaient une infection par le VIH associée. Six patients étaient sous chimio prophylaxie au cotrimoxazole dans le cadre de la prise en charge de l’infection par le VIH. Le tableau clinique a été dominé par la toux (85,39 %), dyspnée 59,55 %, la douleur thoracique 57,30 %, fièvre 51,68 %, douleurs thoraciques 57,30 % et parfois l’altération de l’état général 28,09 %. Streptococcus pneumoniae, Klebsiella pneumoniae étaient les plus rencontrés. Toutes les souches de pneumocoque et Klebsiella étaient sensibles au ceftriaxone, amoxicilline-acide clavulanique, ciprofloxacine et à l’amoxicilline dans 50 % des cas pour le pneumocoque, Cinq souches de pneumocoque et trois de klebsiella étaient résistantes au cotrimoxazole. En première intention la bi antibiothérapie (Amoxicilline plus gentamicine) a été choisie dans 72 % des cas.Mots clés: Pneumopathies, sujet âgé, facteurs étiologiques, TogoEnglish AbstractObjective: Describe etiologic factors of bacterial community pneumonia among person old than 60 years and more in Infectious Diseases and Pneumology Service (CHU-Tokoin) of Togo.Material and methods: We retrospectively reviewed the records of hospitalized for community-acquired pneumonia among elderly persons in the service of Infectious Diseases and Pneumology (CHU-Tokoin, Togo). The patients were retained on the basis of clinical, radiographic, bacteriological and prognostic argument. Between January 1st 2002 and December 31st 2005 inpatient dossiers were identified. So all file of patient aged of 60 years and older admitted in the service for a pulmonary infection has been considered like topic of survey. The tuberculosis cases were excluded. The bacteriological results were descended of the exams cytobacteriological (ECB) of the pleural puncture, the expectoration and the haemoculture The HIV test had been achieved among the patients who had given their agreement.Results: Eighty nine (89) cases (11.1%) of elderly person with bacterial pneumopathies have been recorded in the service. Forty eight (54%) had bad mouth hygiene. The sex ratio (man / woman) was of 1.23. Twenty six, either 29.21% have smoked. Twenty two patients (25%) had used antibiotherapy three months before their hospitalization. Sixteen (35%) of 46 patients who accepted HIV test had an HIV infection. Six patients were under cotrimoxazole’s prophylaxis. The clinical picture has been dominated by the cough (85.39%), dyspnea 59.55%, the thoracic pain 57.30%, fever 51.68%, thoracic pains 57.30% and the general status alteration 28.09%. Streptococcus pneumoniae, Klebsiellas pneumoniae were the more accounted for pneumopathies. All pneumococcus and Klebsiella were sensitive to the ceftriaxone, amoxicillin-clavulanate, ciprofloxacine. Fifty percent (50%) of pneumococcus’s cases were also sensitive to amoxicillin.Five stumps of pneumococcus and three of klebsiella were resistant to the cotrimoxazole. In first intention the bi antibiothérapie (Amoxicilline plus gentamicine) has been chosen in 72% of the cases.Keywords: Pneumopathy, elderly persons, Tog

Sarcoïdose médiastino-pulmonaire :analyse de la concordance entre la classification selon la radiographie du thorax et le scanner du thorax

info:eu-repo/semantics/publishe

Prevalence of SARS-CoV-2 among high-risk populations in Lomé (Togo) in 2020.

BackgroundIn December 2019, the COVID-19 outbreak began in China and quickly spread throughout the world and was reclassified as a pandemic in March 2020. The first case of COVID-19 was declared in Togo on March 5. Two months later, few data were available to describe the circulation of the new coronavirus in the country.ObjectiveThis survey aimed to estimate the prevalence of SARS-CoV-2 in high-risk populations in Lomé.Materials and methodsFrom April 23, 2020, to May 8, 2020, we recruited a sample of participants from five sectors: health care, air transport, police, road transport and informal. We collected oropharyngeal swabs for direct detection through real-time reverse transcription polymerase chain reaction (rRT-PCR) and blood for antibody detection by serological tests. The overall prevalence (current and past) of infection was defined by positivity for both tests.ResultsA total of 955 participants with a median age of 36 (IQR 32-43) were included, and 71.6% (n = 684) were men. Approximately 22.1% (n = 212) were from the air transport sector, 20.5% (n = 196) were from the police sector, and 38.7% (n = 370) were from the health sector. Seven participants (0.7%, 95% CI: 0.3-1.6%) had a positive rRT-PCR test result at the time of recruitment, and nine (0.9%, 95% CI: 0.4-1.8%) were seropositive for IgM or IgG against SARS-CoV-2. We found an overall prevalence of 1.6% (n = 15), 95% CI: 0.9-2.6%.ConclusionThe prevalence of SARS-CoV-2 infection among high-risk populations in Lomé was relatively low and could be explained by the various measures taken by the Togolese government. Therefore, we recommend targeted screening