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