[Stigmatization of people living with HIV in health care services in Togo]. / Stigmatisation des personnes vivant avec le VIH dans les services de soins au Togo.

Introduction: The elimination of AIDS as a threat to public health implies comprehensive care for those tested in all health facilities and without discrimination/stigmatization. The aim of this study is to evaluate the problems of stigmatization and discrimination of people living with HIV (PLHIV) in health care facilities and their implications for access to care for PLHIV. Methodology: This is a descriptive cross-sectional study in the 6 health regions of Togo targeting people aged 18 years and over, living with HIV. A hybrid sampling method combining a limited chain referral and a sampling based on the mapping of meeting places/activities was used. Data were collected using the digitized version 2.0 of the PLHIV Stigma Index questionnaire. Results: A total of 1 119 PLHIV with a mean age of 39 years were included. The sex-ratio was 0.5, and 43.4% had known their HIV status for 1 to 4 years. In the last 12 months, the experiences of stigmatization reported by the PLHIV from health personnel were: gossip (13%), disclosure of status without consent (10%) or avoidance of physical contact (2.6%). In terms of reproductive health, 2.1% of respondents had been advised not to become fathers/mothers and 1.4% had their access to antiretroviral drugs (ARV) conditioned by the use of a contraceptive method. 28.4% of those on ARV had missed one dose of treatment in the last 12 months for fear that someone would find out they were HIV positive. Also, 39.5% of the respondents who were not on ARV justified this by the fear that health workers would treat them badly or reveal their HIV status without their consent. Conclusion: In health care settings, this phenomenon of HIV-related stigma is multifaceted and deserves to be documented so that it can be taken into account in order to improve the quality of services offered to beneficiary populations.

Ethnopharmacological evaluation of antioxidant, anti-angiogenic, and anti-inflammatory activity of some traditional medicinal plants used for treatment of cancer in Togo/Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: Cancer is a multistep disease and its management is exceedingly expensive. Nowadays medicinal plants are gaining more attention in drug discovery and approximately 70% of anticancer drugs were developed from natural products or plants. A strong candidate from medicinal plant with anticancer potential should have four major properties: antioxidant, anti-inflammatory, anti-angiogenic, and cytotoxic activities. AIM OF THE STUDY: In order to assess Togolese traditional healer's claims about the anticancer potential of medicinal plants and obtain candidate plants for anticancer drug discovery, some species were selected from surveys and evaluated for their antioxidant, anti-inflammatory, anti-angiogenic and cytotoxic activities. METHODS: Four species, Cochlospermum planchonii (CP), Piliostigma thonningii (PT), Paullinia pinnata (PP), and Securidaca longipedunculata (SL) were selected and analyzed to detect the phytochemical components. The mentioned bioactivities were evaluated using in vitro, ex vivo and in vivo assays. RESULTS: Relative to SL extract, CP and PT have shown significantly high polyphenols and flavonoids content. The DPPH, FRAP, and TAC of the extracts revealed that CP, PT, and PP have a potent antioxidant effect compared to SL. MDA analysis revealed the same antioxidant activity as CP, PT and PP showed a minor MDA level. The egg albumin denaturation assay showed that IC50 of CP and PP was significantly higher than control (P < 0.05). In contrast, the Bovine Serum Albumin (BSA) results showed a nonsignificant effect (P > 0.05). Notably, SL extract was nonsignificant to control in both Egg Albumin and BSA. Furthermore, angiogenesis assay showed that SL at 50 µg/ml and PP at 100 µg/ml effectively reduced the number of blood vessels than control and showed a potent anti-angiogenic effect (2.7-fold and 2.5-fold, respectively, P < 0.05). No cytotoxicity on PBMC was reported for CP, PP, and PT up to 1000 µg/ml, whereas SL at 1000 µg/ml exhibit benign cytotoxicity (P < 0.0001). CONCLUSION: This study provided in vitro evidence supporting further evaluation on cancer cell lines and tumors in vivo.

Assessment of self-medication practices in the context of the COVID-19 outbreak in Togo.

BACKGROUND: To date, there is no effective treatment for COVID-19, which is a pandemic disease, caused by a novel coronavirus called SARS-CoV-2. In Togo, where four in five people practice self-medication, the absence of a cure for COVID-19 and the constant progression of the disease requires an assessment of self-medication patterns in the context of the pandemic. This study aimed to estimate the prevalence of self-medication to prevent COVID-19 and its associated factors in Lomé, Togo. METHODS: A cross-sectional study was conducted in Lomé, the capital city of Togo, from April 23rd to May 8th, 2020, with a sample of participants from five sectors: the healthcare, air transport, police, road transport and informal sectors. The participants were invited to provide information about their self-medication practices to prevent COVID-19 in the 2 weeks preceding the survey. RESULTS: A total of 955 participants (71.6% men) with a median age of 36 (IQR 32-43) were included. Approximately 22.1% were in the air transport sector, 20.5% were in the police sector, and 38.7% were in the health sector. The overall prevalence of self-medication to prevent COVID-19 was 34.2% (95% CI: 31.2-37.3%). The most commonly used products were vitamin C (27.6%) and traditional medicine (10.2%). Only 2.0% of participants reported using chloroquine/hydroxychloroquine. Female sex (aOR=1.90; p< 0.001), work in the health sector (aOR=1.89; p= 0.001), secondary education level (aOR= 2.28; p= 0.043) and university education level (aOR= 5.11; p< 0.001) were associated with self-medication. CONCLUSION: One-third of the individuals in high-risk populations in Lomé practiced self-medication. Intensifying awareness campaigns is crucial to fight misinformation about alleged COVID-19 prevention products on social media.

Ethnobotanical survey, anthelmintic effects and cytotoxicity of plants used for treatment of helminthiasis in the Central and Kara regions of Togo.

BACKGROUND: Traditional medicines are the main source of treatment of helminthiasis in endemic areas of Togo. The present study aimed to investigate the plants used by Traditional healers (THs) to treat helminth infections in endemic communities within the Central and Kara regions of Togo and to evaluate the anthelmintic activity of the three most cited plants. METHODS: An ethnobotanical survey was conducted from 19 to 24 June 2017 among traditional healers in the Central and Kara regions of Togo. The anthelmintic activity of the most cited plants namely Aframomum melegueta K. Schum, Khaya senegalensis A. Juss and Xylopia aethiopica A. Rich, was evaluated using microfilariae (Mf) of Litomosoides sigmodontis. The plants were evaluated for cytotoxicity according to the recommendation of NF EN ISO 10993-5 standard using the propidium iodide (PI) dye by flow cytometry on human peripheral blood mononuclear cells. RESULTS: A total of 197 THs were interviewed and 41 plant species were recorded. Leguminosae (14.6%) and Annonaceae (9.7%) families constitute the highest number of species cited for treatment of helminth infections. Afromomum melegueta was the most cited by the THs for the treatment of onchocerciasis (UV = 0.036) while X. aethiopica was associated with the treatment of schistosomiasis (UV = 0.061) and lymphatic filariasis (UV = 0.061). There was a great agreement among the THs regarding ethnomedicinal uses of plants to treat helminthiasis with ICF values ranging from 0.57 to 0.67. The anthelmintic assay yielded lethal doses values of 233 µg/mL, 265 µg/mL and 550 µg/mL, respectively for X. aethiopica, A. melegueta and K. senegalensis. Afromomum melegueta and X. aethiopica presented no cytotoxicity, less than 20% death, whereas K. senegalensis induced moderate toxicity, 24 ± 8% death. CONCLUSION: This study demonstrated the scientific rationale for the use of plants to treat helminthiasis in the Togolese traditional medicine. However, the use of K. senegalensis requires more caution since the plant is fairly toxic. TRIAL REGISTRATION: NA.

' It is a question of determination': a case study of monitoring and evaluation of integrated family planning services in urban areas of Togo.

Background: Integrating family planning into postabortion and postpartum services can increase contraceptive use and decrease maternal and child death; however, little information exists on the monitoring and evaluation of such programs. This article draws on research completed by the EngenderHealth's AgirPF project in three urban areas of Togo on the extent to which monitoring and evaluation systems of health services, which operated within the AgirPF project area in Togo, captured integrated family planning services. Methods: This mixed methods case study used 25 health facility assessments with health service record review in hospitals, large community clinics, a dispensary, and private clinics and 41 key informant interviews with health faculty, individuals working at reproductive health organizations, individuals involved in reproductive health policy and politics, health care workers, and health facility directors. Results: The study found the reporting system for health care was labor intensive and involved multiple steps for health care workers. The system lacked a standardized method to record family planning services as part of other health care at the patient level, yet the Ministry of Health required integrated family planning services to be reported on district and partner organization reporting forms. Key informants suggested improving the system by using computer-based monitoring, streamlining the reporting process to include all necessary information at the patient level, and standardizing what information is needed for the Ministry of Health and partner organizations. Conclusion: Future research should focus on assessing the best methods for recording integrated health services and task shifting of reporting. Recommendations for future policy and programming include consolidating data for reproductive health indicators, ensuring type of information needed is captured at all levels, and reducing provider workload for reporting.

Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol.

BACKGROUND: Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities. METHODS: The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster. DISCUSSION: Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03694366 , registered 3 October 2018.

Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo.

Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6-23 months and investigates their relationships with length-for-age z-score (LAZ) and stunting, using cross-sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6-11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18- to 23-month-old children, only the consumption of iron-rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12-17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9-23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.

Pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo : retrospective study from 1997 to 2017.

OBJECTIVE: The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcome and to document the causes of pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo. METHODS: This retrospective study examined the records of patients seen for outpatient consultation and/or hospitalization in the three public dermatology departments of Lomé from January 1997 to September 2017. RESULTS: During the study period, 178 (0.4%) of 47,219 patients seen in these dermatology departments consulted for pellagra or pellagra-like erythema; 159 (89.3%) had pellagra-like erythema. The patients' mean age was 45.8±16 years, and the sex ratio (M/F) 1.8. All patients had at least one site of cutaneous involvement, nearly always erythematous or pigmented lesions in the photo-exposed areas (99.4% of cases). Gastrointestinal and neurological signs were dominated respectively by diarrhea (12.4 % of cases), peripheral neuropathies (8.4% of cases) and insomnia (8.4% of cases). The main causes identified were alcoholism (42.1% of cases) and nutritional deficiency (6.7% of cases). Five of 178 patients were infected with HIV. All patients were treated with nicotinamide and multivitamin supplementation. No deaths were recorded during follow-up. CONCLUSION: Our results document the extreme rarity of pellagra-like erythema/pellagra. Its two main causes remain alcoholism and nutritional deficiency. Moreover, its prognosis is good when treated quickly and adequately.

[Corrigendum: Ethnobotanical study of plants used in the treatment of diabetes in the traditional medicine of Maritime Region, Togo]. / Corrigendum: Étude ethnobotanique des plantes utilisées dans le traitement du diabète dans la médecine traditionnelle de la région Maritime du Togo.

[This corrects the article DOI: 10.11604/pamj.2015.20.437.5660.][This corrects the article DOI: 10.11604/pamj.2015.20.437.5660.].

Antibacterial activity and cytotoxicity of Pterocarpus erinaceus Poir extracts, fractions and isolated compounds.

ETHNOPHARMACOLOGICAL RELEVANCE: Pterocarpus erinaceus has been chosen based on ethnobotanical surveys carried out in the Tchamba district of the Republic of Togo. AIM OF THE STUDY: Investigation of the antibacterial as well as cytotoxic activities of whole extracts, fractions and compounds isolated from the leaves, trunk bark and roots of Pterocarpus erinaceus. MATERIALS AND METHODS: Bio-guided fractionation of the raw extracts of plant parts and subsequent isolation of compounds from active fractions using normal phase open column chromatography. The broth microdilution method was used to evaluate the antibacterial activity, based on the determination of Minimal Inhibitory Concentrations (MICs) against several bacterial species representative of the most commonly encountered infectious diseases worldwide. The cytotoxicity of the raw extract and the most active fractions on a human non-cancerous cell (namely MRC-5) was estimated with a MTT assay. The chemical structure of the compounds isolated was elucidated using a combination of advanced Nuclear Magnetic Resonance (NMR) and Mass Spectrometry (MS). RESULTS: All extracts and fractions tested have shown good activities against Gram-positive bacteria (including Methicillin-Resistant Staphylococcus aureus, MRSA) and against Pseudomonas aeruginosa with MIC values ranging from 32µg/mL to 256µg/mL. In contrast, extracts were not toxic to MRC-5 cells. Four compounds have been isolated: Compound 1 (friedeline); Compound 2 (2,3 dihydroxypropyloctacosanoate); Compound 3 (a mixture of ß-sitosterol, stigmasterol and campesterol); Compound 4 (ß-sitosteryl-ß-D-glucopyranoside) and shown to be active against some of the bacteria tested. They were active with MIC equal to 4µg/mL against strains of S. aureus (including MRSA). To the best of our knowledge, all of them except friedeline have never been reported in this plant species. CONCLUSION: P. erinaceus is confirmed as a plant harboring promising antibacterial activity with activities against serious human pathogens at very low concentrations. Some of the compounds isolated are also active at concentrations as low as 4µg/mL and therefore, may provide new leads for the development of antibacterial agents.

ETHNOBOTANICAL STUDY OF PLANTS USED TO TREAT ASTHMA IN THE MARITIME REGION IN TOGO.

BACKGROUND: Asthma is one of the most common chronic diseases in modern society and it is evident that its incidence and severity are increasing, however very little is known about the plants used in the management of the disease. This study therefore aimed to document the plants usage in the Togolese traditional medicine to treat asthma. METHODOLOGY: From January to June 2015, an ethnobotanical survey was conducted using a semi-structured questionnaire with traditional healers (THs) in the southern region of Togo. The importance of the plants species was assessed by the calculated use values. RESULTS: In Total, 121 THs (92 males and 29 females) were interviewed and 98 plants species belonging to 54 families were identified as curing asthma. The most represented families were: Leguminosae with 7 species followed by Euphorbiaceae and Rutaceae contributing with 6 and 5 species respectively. Based on the calculated use values the most important species were Carcica papaya L., Cataranthus roseus L., Eucalyptus camaldulensis Dehnh., Piper guineense Thonn., Eucalyptus citriodora Hook., Eucalyptus globules Labill. and Euphorbia hirta L. The leaves and the root were the parts predominantly used to prepare the formulations, mainly decoctions, administrated by oral route. Clinical manifestations such as wheezing (91.74%), difficulty as speaking or coughing (73.55%), dyspnea (66.94%), dry cough (52.89%), sweating and increased heart rate (52.07%) were used by TH to diagnose the disease. CONCLUSION: This study showed initial evidence of the use of plant materials by Togolese TH to heal asthma. These results could be a starting point for laboratory screenings.

Ethnobotanical Study of Latex Plants in the Maritime Region of Togo.

BACKGROUND: In Togo, a little is known about latex plants of the flora used for medicinal purposes. OBJECTIVE: The aim of this study was to identify the latex plant species and their medicinal uses in the Maritime Region of Togo. MATERIALS AND METHODS: The methodology was based on ethnobotanical semi-structural individual interviews of 220 informants. Quantitative ethnobotanical index was used to analyze the data. RESULTS: A total of 33 latex plants species were recorded, from 12 botanical families and 24 genera. The most represented families were Euphorbiaceae and Moraceae with eight species each. The relative importance (RI) value of each species and the informant consensus factor (ICF) of the ailments categories showed that Pergularia daemia (Forssk.) Chiov. (RI = 2.00) and Euphorbia hirta L. (RI = 1.91) were the most versatile in relation to their uses, and infectious diseases (ICF = 0.922) were the category with the greatest consensus among 17 categories. CONCLUSION: These latex plants of Togolese flora are variously used in traditional medicine and it would be important to undertake further investigations in phytochemistry, pharmacology, and toxicology to validate their uses. Abbreviations Used: UV: use value ICF: informant consensus factor RI: relative importance PP: pharmacological properties attributed to a species for a specific ailments AC: ailment categories treated by a given species.

Ethnopharmacological survey of plant species used in folk medicine against central nervous system disorders in Togo.

ETHNOPHARMACOLOGICAL RELEVANCE: Neurological diseases are rising all around the world. In a developing country such as Togo, although plant-based medicines are the only means, still very little is known regarding the nature and efficiency of medicinal plants used by indigenous people to manage central nervous system (CNS) disorders. AIM OF THE STUDY: This study, an ethnobotanical survey, aimed to report plant species used in traditional medicine (TM) for the management of various CNS disorders in Togo. MATERIALS AND METHODS: 52 traditional actors (TA) including 33 traditional healers (TH) and 19 medicinal plant sellers (MPS) were interviewed, using a questionnaire mentioning informants' general data and uses of medicinal plants. RESULTS: The present study reports 44 medicinal plant species distributed into 26 families, mentioning scientific and common local names, plant organs used, preparation method, root of administration and putative applications. CONCLUSION: It appears that there is a real knowledge on medicinal plants used for traditional treatment of CNS disorders in Togo and that the local flora abounds of potentially neuroactive plants which could be useful for the discovery of antipsychotic or neuroprotective molecules.

An ethnobotanical study of plants used to treat liver diseases in the Maritime region of Togo.

ETHNOPHARMACOLOGICAL RELEVANCE: In Togo, many persons still rely on plants for healing, however very little is known about the medicinal practices of the indigenous people. The present study aimed to document the medicinal plant utilization for the management of liver diseases in the Maritime region of the country. METHODOLOGY: This was an ethnobotanical survey conducted in the Maritime region of Togo from June to August 2015. The data were gathered from 104 traditional healers (TH) by direct interviews using a semi-structured questionnaire. The calculated use values (UV) were used to analyze the importance of the cited plants. RESULTS: A total of 99 plant species belonging to 88 genera and 49 families were cited by the TH as curing the hepatic diseases. The most represented families were Caesalpiniaceae with 8 species, followed by Euphorbiaceae with 7 species, Apocynaceae and Asteraceae with 6 species each. The highest UV were recorded with Gomphrena celosioides (0.13), Xylopia ethiopica (0.12), Senna occidentalis (0.12), Bridelia ferruginea (0.12), Cymbopogon citratus (0.12), Kigellia Africana (0.09), Cassia sieberiana (0.08) and Sanseviera liberica (0.08), showing their importance in the management of liver dysfunction in the surveyed region. The main used parts were the leaves, followed by the roots, the whole plant, the rhizome and the bark, accounting for more than 10% each. The herbal medicines were mostly prepared in the form of decoction and administrated by oral route. CONCLUSION: This study showed that Maritime region of Togo has an important plant biodiversity that is exploited by the indigenous TH. However, some plants cited by the TH have not been studied for their possible hepatoprotective effects. These plants are therefore a starting point for biological screenings.

Effects of hydroethanolic extracts of Balanites aegyptiaca (L.) Delile (Balanitaceae) on some resistant pathogens bacteria isolated from wounds.

BACKGROUND: The bark of Balanites aegyptiaca (L.) Delile (Balanitaceae) is widely used in the Togolese folk medicine for the treatment of wounds, malaria and skin diseases. This study aimed to evaluate the antioxidant properties and the activity of the bark extract of this plant against some resistant bacteria isolated from wounds. MATERIALS AND METHODS: The antimicrobial activity was assayed using the NCCLS microdilution while the DPPH free radical scavenging and ferric reducing antioxidant power (FRAP) were used for the antioxidant activity. The susceptibility to conventional antibiotics of bacteria was assessed by an agar disk diffusion method using commercial disk. Phenolics were quantified using spectrophotometric methods. RESULTS: The hydroethanolic extracts of the bark inhibited in vitro the growth of Pseudomonas aeruginosa and Staphylococcus aureus in a dose-dependent manner. Bacteriostatic effects were observed on 15 (33%) and 21 (47%) strains of Staphylococcus aureus and Pseudomonas aeruginosa respectively. The MICs and MBCs against Staphylococcus aureus strains ranged respectively from 2.5 to 12.5 µg/mL and 2.5 to 50 µg/mL. Concerning Pseudomonas aeruginosa, these values were equal (12.5 µg/mL). Multidrug resistance was 95% against six antibiotics for Pseudomonas aeruginosa and 91% against five antibiotics for Staphylococcus aureus. The DPPH radical scavenging and the FRAP assays yielded weak antioxidant activity, closely linked with the total phenolic contents. CONCLUSION: This study indicated that the bark extract of Balanites aegyptiaca possess bioactive compounds implicated in the free radical scavenging and antibacterial activities, justifying the use of the plant in the traditional medicines.

Herbal remedies and their adverse effects in Tem tribe traditional medicine in Togo.

In Africa, up to 80% of the population relies on herbal concoctions for their primarily health care. In Togo, western Africa, Tem tribe is a population with old knowledge of medicinal plants, however, still very little is known about their medical practices. The present study was conducted to access for the apprehension of adverse effects of traditional remedies by Tem traditional healers (TH). Enquiry was performed by interviews with healers from August to October 2007 in Tchaoudjo prefecture (Togo). The study allowed us to interview 54 TH including 41(75.93%) males and 13(24.07%) females, who cited 102 recipes assumed to have adverse effects. The recipes were used alone to cure several diseases including haemorrhoids (22.55%), female sexual disorders and infertility (21.57%), gastrointestinal disorders (18.63%), and malaria (6.86%). A total of 34 plants belonging to 21 families were cited to be components of the recipes. Euphorbiaceae and Mimosaceae families were the most represented, however, Nauclea latifolia, Khaya senegalensis, Pseudocedrela kotschyi and Xeroderris stuhlmannii were the main components of recipes linked to adverse effects. A total of 20 adverse effects were linked to the administration of theses drugs, and among them; diarrhoea, abdominal pains, polyuria, general weakness and vomiting were the most frequently encountered. These findings were in accordance with several reports of the literature concerning medicinal plants, although they were based on empirical observations. Laboratory screenings are needed to access for the effectiveness as well as the possible toxic effects of the recipes.

Women's socioeconomic position and contraceptive behavior in Togo.

Few studies have examined empirically the influence of women's position on contraceptive behavior in sub-Saharan Africa. Using data from the 1988 Togo Demographic and Health Survey, this article explores the linkages between various indicators of women's position and spousal communication about family planning and contraceptive use. The results highlight the importance to their contraceptive behavior of women's economic power and individual control over choice of partner. The likelihood of spousal communication about family planning and modern contraceptive use is significantly higher among women who exercised complete control over selection of partner than among those with arranged marriages. Women who work for cash are significantly more likely than those who do not to communicate with their spouses about family planning, particularly if they participate in rotating credit or savings schemes. Such participation also increases significantly the likelihood of ever using traditional and modern methods of contraception.

PIP: Two main hypotheses were examined: 1) the greater the influence of family over a woman's choice of partner, the lower the likelihood of spousal communication about family planning and her use of modern contraceptives; 2) women who work for cash are more likely to discuss family planning and use modern methods than those who do not. The data came from the 1988 Togo Demographic and Health Survey (DHS). A total of 3360 women 15-49 years old were interviewed, of whom 2454 were currently married. Four ethnic groups were distinguished: Adja-Ewe, Kabye-Tem, Para-Gourma, and others. Substantial ethnic differences existed regarding women's position. At least 1 in 4 women was living in an arranged marriage with more than 50% of women among the Para-Gourma ethnic group in arranged marriages. Cash employment rates were substantially higher among the Adja-Ewe than among the Para-Gourma and Kabye-Tem. Fewer than 40% of currently married Togolese women had ever discussed family planning with their husbands. About half of the educated women had discussed it compared with fewer than a third of uneducated women. Such communication ranged from 25% among the Para-Gourma to 43% among the Adja-Ewe. 10% of currently married women had ever used modern contraceptives, but only 3% were currently using them. Those who first married at age 18 or later were less likely than those who married earlier to have ever used traditional contraceptives. The use of modern methods was twice as prevalent among women who first married at age 18 or older than among those who married before age 16. The Para-Gourma and Kabye-Tem had the lowest proportion of currently married women who had ever used modern methods. Multivariate analyses showed that the Adja-Ewe women were most likely to discuss family planning with their spouses; and cash work and control over earnings were significant determinants of the likelihood of spousal communication about family planning.

[Diarrheal morbidity: what therapeutic recourses?]. / Morbidite par diarrhee: quels recours therapeutiques?

PIP: An analysis of the types of treatment sought by mothers for their young children with diarrhea was carried out in 2 different regions of West Africa. The case of diarrhea was selected for study of therapeutic choices because it is a serious public health problem, the descriptions of symptoms provided by mothers usually correspond to biomedical terms, and supernatural causes are not usually assumed for it. The 2 study sites were the Akye country located in the forest zone of southeast Ivory Coast in the periurban area of abidjan, and the Moba-Gurma country in the savannah of northern Togo. In both study locations the population had similar alternatives for care, either modern biomedical services or traditional therapies of different types. Family therapies based on self medication without medical advise or on family therapies utilizing popular knowledge of plants were also available. The data were based on surveys of fertile-aged women about the most recent illnesses of their children and the treatment sought, surveys of traditional practitioners, and examinations of dispensary records in the Akye country. The 2 Akye villages studies had health dispensaries, traditional healers who were usually women, and family therapies based on local plants. Neither village had a pharmacy dispensing modern drugs, which locally available only through the dispensaries. The extent of treatment at home appeared to be underestimated by the mothers. 75% of Akye mothers sought modern treatment exclusively and 6% sought traditional treatment exclusively, of which 4% was provided by the family. 12% sought modern treatment 1st followed by traditional treatment based on plants, and 7% sought traditional treatment 1st followed by modern treatment. A regional hospital, dispensaries, maternal child health centers, and state pharmacies are available in Moba-Gurma country but do not yet cover the entire territory. In the traditional sectors, diviners are a principal element of Moba-Gurma social organization. They may direct their clients to counter-sorcerers or curers. Family therapies based on plants and passed down through generations are also common, especially for frequent ailments like diarrhea. Drugs smuggled in from Ghana or Nigeria are also available in small quantities in the markets. Among 120 cases of diarrhea in children analyzed in the Moba-Gurma country, 38 were treated exclusively by traditional therapies, 33% exclusively by modern therapies, 46 by traditional and then modern therapies, and 3 by modern and then traditional therapies. The symptoms had to be considered serious to prompt attendance at the dispensary or payment for medication. For disorders accompanied by vomiting or other symptoms, immediate attention at the dispensary was more common and became dependent on the availability of facilities and the distance. It appears that the type of care available conditions the choice of therapies.^ieng