Managerial Policy Share in the Poor Performance of Municipal Health Facilities in Zio District in Togo from 2012 to 2015

Countries develop national health policies, strategies, and plans to overturn the global burden of disease. Managerial policy practice questions the policy share in the poor performance of public health facilities. We designed a descriptive observational study to analyze the root causes of low coverage of health services in municipal health facilities in Zio District. The study, a managerial policy analysis, covered the period of implementation of the 2012-2015 national strategic plan (NSP). Our findings showed that apart from vaccination, in which Tsévié and Agbélouvé performed well, municipal health facilities did not reach the targets of the 2012-2015 NSP. Health information system and health services delivery accounted for 51% of the dysfunctions causing the poor performance. Compliance with standards was the leading root cause (72%) of poor performance of municipal health facilities. More than two-thirds (68%) of the corrective policies were operational. The corrective policies must be enacted in 31% by the central level. The municipal health facilities also share a proportion of 31%. This study showed the important share of managerial policies, especially that of operational policies. The study adds to the previous ones to highlight the quality mindset needed in Togo health system. The next steps before the creation of a training program for quality specialists will have to resolve the questions of their number and assignment positions

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

Knowledge, attitudes, and practices of health care professionals regarding dengue fever: need for training and provision of diagnostic equipment in Togo in 2022, a cross-sectional study

BackgroundHealth statistics on dengue are virtually non-existent, despite the fact that the virus is circulating in Togo. This study aimed to assess the knowledge, attitudes, and practices (KAP) of health professionals in the Kara health region.MethodsA cross-sectional study was conducted from March to June 2022 among healthcare professionals who had worked in the Kara region of northern Togo were selected using an exhaustive recruitment method. Data were collected by trained resident doctors with a face-to-face interview using a standardized, pretested questionnaire based on the WHO 2009 dengue guide. Three multivariate regression models were utilized to investigate factors associated with knowledge, attitudes and, and practices.ResultsA total of 464 respondents (37.1% female), median age 35 years, interquartile range (29–43 years) were included. Only (3.0%) of the participants had received training on dengue fever diagnosis, treatment and prevention in the last 3 years, and 10.3% had dengue rapid diagnostic tests available at their hospital. Half of the respondents (49.1%) had good knowledge of dengue fever, compared with 30.0% who had positive attitudes. Of a total of 256 professionals who had encountered a case of dengue fever in their practice, only 24 (9.4%) had appropriate practices for diagnosing and treating dengue fever. In multivariate analysis, the healthcare professionals who had taken part in ongoing training on dengue fever were more likely to have adequate dengue diagnosis and treatment practice aOR = 8.1; CI 95% = [1.7–36.0].ConclusionStrengthening healthcare professionals' dengue-related skills through ongoing training and the provision of dengue diagnostic tests could help improve early detection practices and management of dengue fever in Togo

HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa

We assessed the effect of HIV status disclosure on retention in care from initiation of antiretroviral therapy (ART) among HIV-infected children aged 10 years or more in Cote d'Ivoire, Mali and Sénégal.Multi-centre cohort study within five paediatric clinics participating in the IeDEA West Africa collaboration. HIV-infected patients were included in this study if they met the following inclusion criteria: aged 10-21 years while on ART; having initiated ART ≥ 200 days before the closure date of the clinic database; followed ≥ 15 days from ART initiation in clinics with ≥ 10 adolescents enrolled. Routine follow-up data were merged with those collected through a standardized ad hoc questionnaire on awareness of HIV status. Probability of retention (no death or loss-to-follow-up) was estimated with Kaplan-Meier method. Cox proportional hazard model with date of ART initiation as origin and a delayed entry at date of 10th birthday was used to identify factors associated with death or loss-to-follow-up.650 adolescents were available for this analysis. Characteristics at ART initiation were: median age of 10.4 years; median CD4 count of 224 cells/mm³ (47% with severe immunosuppression), 48% CDC stage C/WHO stage 3/4. The median follow-up on ART after the age of 10 was 23.3 months; 187 adolescents (28.8%) knew their HIV status. The overall probability of retention at 36 months after ART initiation was 74.6% (95% confidence interval [CI]: 70.5-79.0) and was higher for those disclosed compared to those not: adjusted hazard ratio for the risk of being death or loss-to-follow-up = 0.23 (95% CI: 0.13-0.39).About 2/3 of HIV-infected adolescents on ART were not aware of their HIV status in these ART clinics in West Africa but disclosed HIV status improved retention in care. The disclosure process should be thus systematically encouraged and organized in adolescent populations

Sexuality, sexually transmitted infections and contraception among health sciences students in university of Lomé, Togo

Abstract Objectives Evaluate the practice of sexuality, contraception and the risk of sexually transmitted infections among students in the Faculty of Health Sciences, University of Lomé, Togo. Results Three hundred and sixteen (316) students were interviewed, with a response rate of 43.3%. The average age of students completing the form was 21.4 ± 2.7 years and their sex ratio was 2.2. Of this number of students who completed the form, 51.8% have already had sex. The mean age of first intercourse was 17.9 ± 3.2 years; 70.3% were heterosexual. Regarding the number of sexual partners, 48.5% of students had more than one partner, of whom 15.9% had at least 5 sexual partners. 21.5% of these students had only one sexual intercourse per month. Regarding contraception among students with the card, 67.5% of students used a method of contraception. Among those using contraceptives, it was a 55.3% condom, followed by the Ogino method at 14.1%. Some of our respondents used more than one method of contraception and 28.5% of respondents indicated that their partners used a method of contraception. For STIs, 10.8% of students completing the form were already infected. Gonorrhea was reported in 30.4% of cases, candidiasis in 26.1% of cases

Suicidal ideation and suicide attempts in subjects aged 15–19 in Lomé (Togo)

Abstract Objectives The purpose of this study was to study the epidemiological and clinical profile of adolescents with suicidal thoughts, with or without suicide attempts, and to identify associated factors. Results A total of 155 (16.5%) of the 941 adolescents interviewed had suicidal thoughts. The average age of the respondents was 18 ± 2.1 years. The sex ratio (m/f) was 1.4. With regard to marital status, 70.2% were single and 29.8% were in a relationship with a cohabiting partner. Family history of suicide was reported in 40%. In their personal history, eight were infected with HIV, three were chronic ethylic and two were diabetics. Forty-six (29.7%) of the 155 adolescents who had suicidal ideation had ever had a suicide attempt. Teens affected by suicide lived in a boarding school in 25.8%, with one parent in 23.9% and 50.3% with both parents. Factors associated with suicide attempts were female sex (p = 0.0107), age over 18 years (p = 0.0177), living in a couple (p = 0.0316), underlying immunodepression (HIV infection, p = 0.0059, sickle cell disease, p = 0.0043) and having a family history of suicides (p = 0.0461)

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

Abstract 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)

Oral lesions among HIV‐infected children on antiretroviral treatment in West Africa

ObjectiveTo estimate the prevalence of oral mucosal diseases and dental caries among HIV-infected children receiving antiretroviral treatment (ART) in West Africa and to identify the factors associated with the prevalence of oral mucosal lesions.MethodsMulticentre cross-sectional survey in five paediatric HIV clinics in Côte d'Ivoire, Mali and Sénégal. A standardised examination was performed by trained dentists on a random sample of HIV-infected children aged 5-15 years receiving ART. The prevalence of oral and dental lesions and mean number of decayed, missing/extracted and filled teeth (DMFdefT) in temporary and permanent dentition were estimated with their 95% confidence interval (95% CI). We used logistic regression to explore the association between children's characteristics and the prevalence of oral mucosal lesions, expressed as prevalence odds ratio (POR).ResultsThe median age of the 420 children (47% females) enrolled was 10.4 years [interquartile range (IQR) = 8.3-12.6]. The median duration on ART was 4.6 years (IQR = 2.6-6.2); 84 (20.0%) had CD4 count<350 cells/mm(3). A total of 35 children (8.3%; 95% CI: 6.1-11.1) exhibited 42 oral mucosal lesions (24 were candidiasis); 86.0% (95% CI = 82.6-89.3) of children had DMFdefT ≥ 1. The presence of oral mucosal lesions was independently associated with CD4 count < 350 cells/mm(3) (POR = 2.96, 95% CI = 1.06-4.36) and poor oral hygiene (POR = 2.69, 95% CI = 1.07-6.76).ConclusionsOral mucosal lesions still occur in HIV-infected African children despite ART, but rarely. However, dental caries were common and severe in this population, reflecting the need to include oral health in the comprehensive care of HIV

Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) of risk of death or loss-to-follow-up of adolescents after ART initiation (n = 650).

<p>Pediatric IeDEA West Africa Collaboration.</p><p>All analyses used the center as a cluster variable, taking into account the correlation of the observations within a same center.</p><p>HR: Hazard ratio.</p><p>aHR: adjusted hazard ratio.</p><p>MD: missing data.</p><p>ART: Antiretroviral therapy.</p><p>NNRTI: non nucleoside reverse transcriptase inhibitor.</p><p>Severe anemia: haemoglobin≤6.9 g/dL.</p><p>Severe immunosuppression : CD4<200 cells/mm³.</p