Analysis of abortion cases data at the referral hospital of Haho health district, Notsè – Togo, 2012 – 2017

Introduction: More than 95 percent of unsafe abortions occur in developing countries and contribute to 4.70 percent to 13.20 percent of maternal deaths. Abortions’ magnitude and characteristics are unknown at Notsè hospital yet these parameters are critical for effective planning of interventions and to mobilize resources for abortion management. We aimed to describe data quality, socio-demographic and clinical features of abortions cases. Methods: We conducted a descriptive study based on secondary data analysis of abortion cases admitted at Notsè hospital from January 2012 to December 2017. Data Completeness (DC) was used to classify data quality as Good: DC≥80%, Fair: 50%≤DC<80% or Poor: DC<50%. Medical files were reviewed to collect sociodemographic and clinical data. We performed descriptive analysis using Epi-info-7 software. Results: Over the study period, 760 abortions cases were admitted. Among the 34 study variables 26.47% (9/34) were of poor quality and 63.16% (12/19) of required data were of good quality. Overall women mean age ranged from 23.97 ±6 years in 2012 to 26.8 ±7.60 years in 2017 (p=0.026) and those aged from 18 to 30 represented 69.8% (505/724). Seventy percent of women were from rural area. Housewives represented 53.8% (388/721) and 10.5% (76/721) were pupils. Per 1,000 women aged 15-49, abortion ratio varied from 23 in 2012 to 45 in 2017. In medical history 94.56% (644/681) of cases had experienced at least one abortion in the past and 70.53% (474/672) of abortions occurred before 17 weeks of gestation. Among women admitted with metrorrhagia, 9.59% (52/542) had received blood transfusion. Malaria was diagnosed and treated in 30.93% of the 333 tested women. No death was recorded. Conclusion: Abortions are frequent, mainly in women with malaria and hemorrhagic complications. The quality of some required data was poor. Caregivers’ training and strategies to improve access to malaria care for pregnant women and increase access to contraceptive methods should be strengthened

Epidemiological profile, treatment outcomes and factors associated with unfavorable treatment outcomes among patients co-infected with Tuberculosis and Human Immunodeficiency Virus in the Centrale Health Region in Togo, 2008 – 2017

Introduction: Co-infection with Tuberculosis and Human Immunodeficiency Virus (TB/HIV) is highly lethal and Africa hosts 74% of cases. In Togo, the prevalence of TB/HIV co-infection was 22% in 2016 with a 42% mortality among the TB/HIV co-infected cases. There is limited data on TB/HIV co-infection in Centrale health region to inform control and commitment efforts towards end TB by 2030. We aimed to describe epidemiological characteristics, treatment outcomes and identify factors associated with unfavorable outcomes among TB/HIV co-infected cases. Methods: We conducted a descriptive analysis of secondary data on TB cases recorded in the four Centers of Diagnosis and Treatment (CDTs) of the Togolese Centrale health region from 2008 to 2017. Socio-demographical, clinical and treatment data were collected on a designed questionnaire by reviewing all TB management tools of the four CDTs. We subsequently entered data in Epi-Info-7 and calculated means, ratio and proportions for descriptive analysis. In multivariate analysis, logistic regression was performed to obtain Adjusted Odd Ratio (AOR), 95% Confidence Interval (CI) and p-value to identify factors associated with unfavorable outcomes. Results: Over the period, 1,448 patients were screened for HIV among 1,825 TB patients recorded. Overall, TB/HIV prevalence was 30.87% (447/1448) range 43.8% in 2008 to 27.6% in 2017 (p=0.01). The mean age of TB/HIV patients varied from 28.80±7.70 years in 2008 to 33.48±8.11 years in 2017. Female to Male sex ratio varied from 9.7 in 2008 to 2.5 in 2017. Pulmonary TB form cases accounted for 94.41% (422/447) of which 74.41% (314/422) were smear positive (SPT+) and 25.59% (108/422) were smear negative, while extra-pulmonary form cases represented 5.59% (25/447). The proportion of TB/HIV patients on Antiretroviral Treatment (ART) varied from 5.25% (2/32) in 2008 to 94.29% (33/35) in 2017. Lost to follow up patients represented 1.57% (7/447) while treatment success rate varied from 62.29% in 2008 to 82.00% in 2017. Case fatality rate decreased from 34.48% in 2008 to 23.53% in 2017. Smear-positive TB (AOR=2.11, 95% CI (1.21-3.60)), TB treatment initiation in the second quarters of the year (AOR=1.71, 95% CI (1.03-2.85)) and having been taken care of between 2015 and 2017 (AOR=1.90, 95% CI (1.14 – 3.12)) were independently associated with unfavorable outcome. When stratified by type of outcome, the absence of ART (AOR=2.62, 95% CI (1.46 – 4.69) were associated with deaths. Conclusion: TB/HIV co-infection affected young people particularly women with high mortality. The TB form, period of treatment initiation and lack of HIV care influenced treatment outcomes. Systematic HIV screening and ART earlier initiation, practice of DOTS whether based on family or based on caregivers for each patient and caregivers training on TB/HIV co-infection management are necessary to improve patients' survival

Evaluation du système de surveillance épidémiologique de la méningite bactérienne dans la région des Savanes au Togo, 2016 – 2019: Evaluation of the epidemiological surveillance system for bacterial meningitis in the Savanes region of Togo, 2016 – 2019

Introduction: La surveillance cas par cas de la Méningite Bactérienne Aiguë (MBA) a démarré depuis 2014 dans la ré-gion des Savanes mais le niveau de sa performance est méconnu. L’objectif de cette étude était d’évaluer ce système de surveillance de 2016 à 2019. Méthodes: Il s’est agi d’une étude transversale qui a inclus tous les cas de MBA notifiés dans la région des Savanes entre la semaine 1 (S1) 2016 et S19 2019, 34 Formations Sanitaires (FS) périphériques, sept hôpitaux de districts (HD) et l’hôpital régional (CHR). Les données ont été collectées par interview, observation et examen de registres. Les directives éditées dans le guide « CDC-Atlanta 2001 », ont été utilisées pour dé-crire l’organisation, le fonctionnement et les attributs : utilité, simplicité, acceptabilité, flexibilité, représen-tativité, réactivité, qualité des données et Valeur Prédictive Positive (VPP). Résultats: Le système opérait avec trois mécanismes de transmission des données suivant le circuit : FS-Direction préfectorale-Direction régionale-Niveau central. Trois épidémies causées par Nm W en 2016 et 2017 et Nm C en 2019 ont été détectées. Le délai moyen de vaccination réactive était de cinq semaines. La promp-titude des rapports hebdomadaires, initialement à 100%, a régressé à moins de 60% après introduction de « Argus » et « District Health Information System, deuxième version (DHIS-2) ». Les prestataires avaient prélevé le LCR et rempli la fiche d’investigation dans 92,2% (141/153), IC 95% (86,7% - 95,9%) des cas. Dans la base de données, respectivement 24,6% (252/1024), IC 95% (22,2% - 27,3%) et 20,7% (212/1024), IC 95% (18,3% - 23,3%] des données manquaient pour les variables « Résultat final » et « Classification finale ». Les cas provenaient de tous les districts et représentaient toutes les tranches d’âge. La Valeur Pré-dictive Positive globale a varié de 42,1% (122/290), IC 95% (36,3% - 48,0%) en 2016 à 64,0% (48/75), IC 95% (52,1% - 74,8%) en 2019. Conclusion: Le système de surveillance de la MBA dans la région des Savanes était utile, acceptable et représentatif malgré certaines données manquantes. Il était complexe, non flexible et peu prompt pour la riposte vacci-nale. Il faudrait un mécanisme unique de transmission des données, pouvoir confirmer les cas dans les HD et auditer les données. Introduction: Case-by-case surveillance of Acute Bacterial Meningitis (ABM) started since 2014 in the Savannah region but the level of its performance is unknown. The objective of this study was to evaluate this surveillance system from 2016 to 2019. Methods: This was a cross-sectional study that included all cases of (ABM) notified in the Savanes region between week 1 (W1) 2016 and week19 2019, 34 peri-urban Health Formations (SFs), seven district hospitals (DHs) and the regional hospital (RHC). Data were collected by interview, observation and review of records. The guidelines published in the CDC-Atlanta 2001 guide were used to describe the organisation, functioning and attributes: utility, simplicity, acceptability, flexibility, representativeness, responsiveness, data quality and Positive Predictive Value (PPV). Results: The system operated with three data transmission mechanisms following the circuit: FS-Prefectural Directorate-Regional Directorate-Central level. Three epidemics caused by Nm W in 2016 and 2017 and Nm C in 2019 were detected. The average time for reactive vaccination was five weeks. The promptness of weekly reporting, initially 100%, decreased to less than 60% after the introduction of Argus and District Health Information System, version 2 (DHIS-2). Providers had collected CSF and completed the investigation form in 92.2% (141/153), 95% CI (86.7% - 95.9%) of cases. In the database, 24.6% (252/1024), 95% CI (22.2% - 27.3%) and 20.7% (212/1024), 95% CI (18.3% - 23.3%) of the data were missing for the variables "Final outcome" and "Final classification" respectively. The cases came from all districts and represented all age groups. The overall Positive Predictive Value ranged from 42.1% (122/290), 95% CI (36.3% - 48.0%) in 2016 to 64.0% (48/75), 95% CI (52.1% - 74.8%) in 2019. Conclusion: The surveillance system for MVA in the Savanes region was useful, acceptable and representative despite some missing data. It was complex, inflexible and not very prompt for the vaccine response. A single data transmission mechanism is needed, as well as the ability to confirm cases in HDs and audit data

Représentativité et réactivité du système de surveillance de la Fièvre Jaune au Togo, 2004-2014: Representativeness and responsiveness of the Yellow Fever surveillance system in Togo, 2004-2014

Introduction: Peu d’informations sont disponibles sur le système de surveillance de la fièvre jaune au Togo. L’objectif est d’évaluer la simplicité, la représentativité et la réactivité de ce système. Méthodes: Une étude transversale descriptive a été menée de 2015 à 2016 à l’Institut Na-tional d’Hygiène (INH) qui est le Laboratoire National de Référence (LNR) pour les maladies à po-tentiel épidémique du Togo. La base de données de 2004-2014 de la fièvre jaune- rougeole -rubéole du LNR et le guide de surveillance intégrée des maladies et riposte, le guide d’évaluation des systèmes de surveillance de Centers for Disease Control and Prevention (CDC) ont été utilisés. Les médianes, intervalles interquartiles et les proportions ont été calculés avec Epi Info 7 et Excel 2003. Résultats: Un cas suspect de fièvre jaune nécessite une confirmation biologique qui se fait à plusieurs niveaux. Le système est représentatif de tous les districts, toutes les années et de toutes les populations du Togo. Un total de 3054 de cas suspects a été notifié dont 32 cas probables et 12 cas confirmés, par-mi lesquels, 8 étaient des hommes. Environs 93,01 % (2833) des cas suspects ont été prélevés dans les 14 jours suivants le début des symp-tômes, 28,39% (866) des échantillons ont été acheminés dans les 72 heures et 77,95% des résultats rendus dans les 7 jours rendant le système peu réactif. Conclusion: Le système de surveillance de la fièvre jaune au Togo est représentatif, complexe et peu réactif. Il s’avère nécessaire de mettre en place un système de convoyage rapide des échantillons. Introduction: Little information is available on yellow fever surveillance system in Togo. The simplicity, representativeness and responsiveness of this system were assessed. Material and Methods: It was a descriptive cross-sectional study conducted from October 2015 to February 2016 at the Institut National d’Hygiène, the National Reference Laboratory (NRL) for epidemic prone diseases of Togo. We used the yellow fever-measles-rubella database, the integrated dis-ease surveillance and response guideline and the Centers for Disease Control and Prevention (CDC) guidelines for surveillance system evaluation. Medians, interquartile intervals and proportions were calculated and presented in tables and figures with Excel 2003 and Epi Info 7. Results: A yellow fever case must be confirmed at several reference levels making yellow fever surveillance complex. This surveillance system is representative of all districts, all years and all populations of Togo. A total of 3054 suspected cases were reported, including 32 probable cases and 12 confirmed cases. Of the confirmed cases, 08 were men. About 93.01% (2833) of the suspected cases samples were taken within 14 days after the symptoms onset, 28,39% (866) of samples were transported within 72 hours and 77, 95% of the results were available within 7 days, making the system unresponsive. Conclusion: The yellow fever surveillance system in Togo is representative, complex, and unresponsive due to the long delay in transporting samples to the NRL. A rapid sample conveying system is recommende

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Case study of Argus in Togo: An SMS and web-based application to support public health surveillance, results from 2016 to 2019.

IntroductionArgus is an open source electronic solution to facilitate the reporting and management of public health surveillance data. Its components include an Android-phone application, used by healthcare facilities to report results via SMS; and a central server located at the Ministry of Health, displaying aggregated results on a web platform for intermediate and central levels. This study describes the results of the use of Argus in two regions of Togo.MethodsArgus was used in 148 healthcare facilities from May 2016 to July 2018, expanding to 185 healthcare facilities from July 2018. Data from week 21 of 2016 to week 12 of 2019 was extracted from the Argus database and analysed. An assessment mission took place in August 2016 to collect users' satisfaction, to estimate the concordance of the received data with the collected data, and to estimate the time required to report data with Argus.ResultsOverall completeness of data reporting was 76%, with 80% of reports from a given week being received before Tuesday 9PM. Concordance of data received from Argus and standard paper forms was 99.7%. Median time needed to send a report using Argus was 4 minutes. Overall completeness of data review at district, regional, and central levels were 89%, 68%, and 35% respectively. Implementation cost of Argus was 23 760 USD for 148 facilities.ConclusionsThe use of Argus in Togo enabled healthcare facilities to send weekly reports and alerts through SMS in a user-friendly, reliable and timely manner. Reengagement of surveillance officers at all levels, especially at the central level, enabled a dramatic increase in completeness and timeliness of data report and data review

Emergence of Lassa Fever Disease in Northern Togo: Report of Two Cases in Oti District in 2016

International audienceBackground: Lassa fever belongs to the group of potentially fatal hemorrhagic fevers, never reported in Togo. The aim of this paper is to report the first two cases of Lassa fever infection in Togo.Case presentation: The two first Lassa fever cases occurred in two expatriate's health professionals working in Togo for more than two years. The symptoms appeared among two health professionals of a clinic located in Oti district in the north of the country. The absence of clinical improvement after antimalarial treatment and the worsening of clinical symptoms led to the medical evacuation. The delayed diagnosis of the first case led to a fatal outcome. The second case recovered under ribavirin treatment.Conclusion: The emergence of this hemorrhagic fever confirms the existence of Lassa fever virus in Togo. After a period of intensive Ebola virus transmission from 2013 to 2015, this is an additional call for the establishment and enhancement of infection prevention and control measures in the health care setting in West Africa

Risk factors of hepatitis B virus surface antigen carriage and serological profile of HBsAg carriers in Lomé Togo, 2016

International audienceIn Togo, the prevalence of Hepatitis B Virus Surface Antigen (HBsAg) among young people aged 15-24 years was estimated at 16.4% in 2010; however, risk factors for HBsAg carriage are poorly documented. We sought to identify risk factors for HBsAg carriage and the serological profile of HBsAg carriers in Lomé (capital city of Togo)

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