Therapeutic efficacy trial of artemisinin-based combination therapy for the treatment of uncomplicated malaria and investigation of mutations in k13 propeller domain in Togo, 2012-2013.

BACKGROUND: Since 2005, the Togo National Malaria Control Programme has recommended two different formulations of artemisinin-based combination therapy (ACT), artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL), for the treatment of uncomplicated malaria. Regular efficacy monitoring of these two combinations is conducted every 2 or 3 years. This paper reports the latest efficacy assessment results and the investigation of mutations in the k13 propeller domain. METHODS: The study was conducted in 2012-2013 on three sentinel sites of Togo (Lomé, Sokodé and Niamtougou). Children aged 6-59 months, who were symptomatically infected with Plasmodium falciparum, were treated with either AL (Coartem(®), Novartis Pharma, Switzerland) or ASAQ (Co-Arsucam(®), Sanofi Aventis, France). The WHO standard protocol for anti-malarial treatment evaluation was used. The primary end-point was 28-day adequate clinical and parasitological response (ACPR), corrected to exclude reinfection using polymerase-chain reaction (PCR) genotyping. RESULTS: A total of 523 children were included in the study. PCR-corrected ACPR was 96.3-100 % for ASAQ and 97-100 % for AL across the three study sites. Adverse events were negligible: 0-4.8 % across all sites, for both artemisinin-based combinations. Upon investigation of mutations in the k13 propeller domain, only 9 (1.8 %) mutations were reported, three in each site. All mutant parasites were cleared before day 3. All day 3 positive patients were infected with k13 wild type parasites. CONCLUSIONS: The efficacy of AL and ASAQ remains high in Togo, and both drugs are well tolerated. ASAQ and AL would be recommended for the treatment of uncomplicated malaria in Togo.

An analysis of global youth tobacco survey for developing a comprehensive national smoking policy in Timor-Leste.

BACKGROUND: Smoking is a global public health concern. Timor-Leste is facing a rapidly growing epidemic of tobacco use. The trend of smoking in Timor-Leste seems to be increasing and the magnitude of the problem affects people who smoke before reaching adulthood. One of the factors implicated in the continuously rising trend of smoking among young people in Timor-Leste is clearly due to unavailability of restrictive laws and regulations. Therefore, our study sought to analyze available dataset from the Global Youth Tobacco Survey (GYTS) for developing a comprehensive national smoking policy in order to lower smoking risks among young people in Timor-Leste. METHODS: We conducted a secondary analysis of the 2009 GYTS in Timor-Leste. The 2009 GYTS assessed 1657 in-school students aged 13-15 years for current smoking prevalence and determinants of tobacco use. We used IBM SPSS version 21 software to analyze the data. Frequency analyses were computed to identify demographic characteristics of study participants. Bivariate logistic regression analysis was performed to examine the association between each demographic characteristic as well as each independent variable and the outcome of being current smokers. RESULTS: Out of 1657 in-school students, 51 % were of ages less than 15; 53 % were girls; and 45 % were in grade 2. Prevalence of current cigarette smoking was found to be 51 %. The prevalence of current smoking among in-school students increased with ages (from 46 % in less than 15 to 57 % in 15 plus). Boys were more likely to be smokers than girls (59 % versus 28 %). Significant factors positively associated with current smoking included parental smoking; closed-peer smoking; number of days people smoked in the house; having family discussion about harmful effects of smoking; being smoking in areas such as school, public places and home; and having seen cigarette advertisements on billboard. CONCLUSION: Timor-Leste has higher prevalence of cigarette smoking among minors, especially among boys. Our analysis provides evidence-based information for developing comprehensive tobacco control programs - both education and policy interventions to reduce smoking rate among young people in Timor-Leste.

Unmet needs for modern contraceptive methods among sexually active adolescents and young women in Togo: a nationwide cross-sectional study.

Background: The unmet need for modern contraceptives among sexually active adolescent and young women (AYW) in Africa contributes to high morbidity and mortality. To investigate the prevalence of unmet need for modern contraceptives and its associated factors among AYW in Togo, we performed a secondary analysis of data from the MICS-62017 survey. Method: We extracted data from sexually active AYW aged 15-24 years for the analysis and used multi-level logistic regression models to identify factors associated with unmet need for modern contraceptives. Results: Among the AYW, the median age was 20 years. The prevalence of unmet need for modern contraceptives was 27.02%. Factors that increased the likelihood of having unmet need for contraceptives included being in the "Poor" or "Middle" quintile of household wealth, aged 20-24 years, and completing primary or secondary education. Living in a household headed by a woman and having a household head aged 19-38, 39-58, or greater than 78 years decreased the likelihood of unmet need for modern contraceptives. Conclusion: The study highlights the high-unmet need for modern contraceptives among sexually active AYW in Togo and emphasizes the importance of addressing individual and household/community factors to improve their sexual and reproductive health. Interventions such as increasing AYW awareness, providing social marketing campaigns in schools, and targeting men-headed households could help promote modern contraceptive use and improve the sexual and reproductive health of AYW in Togo.

Monitoring migrant groups as a post-validation surveillance approach to contain the potential reemergence of lymphatic filariasis in Togo.

BACKGROUND: In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo's case investigation algorithm to prevent resurgence of LF and sustain Togo's elimination success. METHOD: A cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia. RESULTS: Refugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case's surroundings. CONCLUSION: This study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.

Surveillance for lymphatic filariasis after stopping mass drug administration in endemic districts of Togo, 2010-2015.

BACKGROUND: Togo is a country previously endemic for lymphatic filariasis (LF). In 2010, following nine years of mass drug administration (MDA) for LF, the country established a post-treatment surveillance (PTS) system. We present here the results of these PTS activities, carried out from 2010 to 2015, as well as the findings of follow-up investigations in 2016 to confirm the absence of infection in previously infected individuals. METHODS: The routine surveillance established in 2010 consisted of a network of 47 laboratories, which searched for Wuchereria bancrofti microfilaria on nocturnal blood smears collected for malaria diagnosis and an additional network of 20 peripheral health facilities, which collected dried blood spots and tested them for Og4C3 antigen. Two transmission assessment surveys (TAS) were also undertaken, as recommended by WHO, in 2012 and 2015. Any positive case identified through any surveillance activity was immediately retested by nocturnal smear and confirmed cases were immediately investigated by screening family members and neighboring household members. In 2016, 32 of the 40 positive cases detected during TAS or laboratory and health facility network activities were traced and whether confirmed positive by nocturnal smear or not were tested again simultaneously by filariasis test strip (FTS), Og4C3 and a nocturnal blood smear to rule out any active infection. RESULTS: From 2010 to 2015, the laboratory network identified one microfilaria-positive individual (0.0% of 26,584 persons tested) and the peripheral health facility network detected 19 Og4C3-positive individuals (0.28% of 6788 persons tested). All 19 Og4C3 cases were negative for microfilaremia by nocturnal blood smear. In the 2012 and 2015 TAS, thirteen and six ICT/FTS positive cases, respectively, were identified, which were significantly below the critical cut-off (18-20 cases) across all evaluation units. Three of the six ICT/FTS-positive cases from the 2015 TAS were positive by nocturnal smear; immediate investigation identified one additional microfilaria-positive individual. Epidemiological investigation revealed that four of the five cases of microfilaremia were imported from another country in the region. In 2016, 32 of the 40 positive cases detected by at least one test during all surveillance activities were traced: four (12.5%) individuals were still positive by FTS but all 32 individuals were negative for microfilaremia and Og4C3 antigen. CONCLUSION: The results of post-treatment surveillance in Togo have demonstrated that W. bancrofti filariasis is no longer of public health concern in Togo, more than six years after stopping MDA. Every possible effort should be made to maintain surveillance in order to promptly detect any resurgence and preserve this achievement.

Molecular xenomonitoring for post-validation surveillance of lymphatic filariasis in Togo: no evidence for active transmission.

BACKGROUND: Lymphatic filariasis (LF) is a mosquito-borne filarial disease targeted for elimination by the year 2020. The Republic of Togo undertook mass treatment of entire endemic communities from 2000 to 2009 to eliminate the transmission of the disease and is currently the first sub-Saharan African country to be validated by WHO for the elimination of LF as a public health problem. However, post-validation surveillance activities are required to ensure the gains achieved are sustained. This survey assessed the mosquito vectors of the disease and determined the presence of infection in these vectors, testing the hypothesis that transmission has already been interrupted in Togo. METHOD: Mosquitoes were collected from 37 villages located in three districts in one of four evaluation units in the country. In each district, 30 villages were selected based on probability proportionate to size; eight villages (including one of the 30 villages already selected) where microfilaremia-positive cases had been identified during post-treatment surveillance activities were intentionally sampled. Mosquitoes were collected using pyrethrum spray collections (PSC) in households randomly selected in all villages for five months. In the purposefully selected communities, mosquitoes were also collected using human landing collections (HLC) and exit traps (ET). Collected mosquitoes were identified morphologically, and the identification of Wuchereria bancrofti DNA in the mosquitoes was based on the pool screening method, using the LAMP assay. RESULTS: A total of 15,539 mosquitoes were collected during the study. Anopheles gambiae (72.6%) was the predominant LF vector collected using PSC. Pool screen analysis of 9191 An. gambiae in 629 pools revealed no mosquitoes infected with W. bancrofti (0%; CI: 0-0.021). CONCLUSIONS: These results confirm the findings of epidemiological transmission assessment surveys conducted in 2012 and 2015, which demonstrated the absence of LF transmission in Togo. The challenges of implementing molecular xenomonitoring are further discussed.