Standards and regimentations of biosafety and biosecurity in medical biology laboratories in Togo, 2021

Legal instruments are necessary for the regulation of programs such as the biosafety and biosecurity (BSS) system in a country, yet little information is available in this sector in Togo. The study conducted aimed to take an analytical look at the normative and regulatory environment of biosafety and biosecurity in medical biology laboratories in Togo. A documentary review was carried out on the web, in the Official Journal, and on governmental sites between January and June 2021. A total of 76 documents were initially identified and then 14 were included in the synthesis. Of the 14 texts regulating the biosafety and biosecurity sector worldwide, 10 have been ratified or are being used in Togo. In total, 05 laws and 02 decrees are in force in the area of BSS in Togo on June 30, 2021. Our study has also allowed us to highlight several activities to be regulated. The approach adopted has revealed a current deficit in terms of regulations in the area of biohazard management in Togo in a multisectoral framework. It is necessary to strengthen the existing regulatory texts by taking into account the areas required internationally.

Testers' compliance to the quality standards of HIV rapid testing services in Primary Health Care Facilities in Makete District, Tanzania

Background: HIV rapid testing services is one among key interventions in the controlling of HIV/AIDS. Despite availability of quality standards, the quality of HIV rapid testing services remains questionable since non-laboratory testers are allowed to conduct testing while they are not specialized in providing testing services. Objective: To evaluate the compliance to the quality standards of HIV rapid testing services provided by non-laboratory testers in Makete District, Tanzania Methods: An explanatory descriptive study employing quantitative approach of data collection was used. An observation of 23 non-laboratory testers performing HIV rapid tests, observation of HIV testing points and documents review was done in 23 testing points to collect data. Data were analyzed using a programmed excel sheet and a three-point scale was used to determine the level of compliance to quality standards. Results: Analysis shows that out of 23 testing points visited, the level of compliance to quality standards was lower for 22 (95.6%) testing points and moderate in 1 (4.4%) testing point. None of the testing point was highly complied to quality standards for HIV rapid testing services. Conclusion: The quality of HIV rapid testing services provided by non-laboratory testers is below the established quality standards for HIV rapid testing services.

Quest to Improve Management of Prostate Cancer in West Africa Development of a Clinical Audit Tool

In 2010 and during the following decade, two guidelines werepublished for the management of prostate cancer in West Africa.A key recommendation of the guidelines was the need for thedevelopment of a Clinical Audit Tool which should helpsurgeons and institutions to identify the gaps between therecommended standards and current practice. In this paper, aClinical Audit Tool, WAPCAT, was developed to facilitate andimplement the audit process for the management of Prostatecancer in a West African healthcare institution

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa

Background: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa's current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. Aim: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. Setting: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. Methods: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. Results: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. Conclusion: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance

Improving quality in national reference laboratories: the role of SLMTA and mentorship

Background: The Nigerian Institute of Medical Research houses two reference laboratories: the virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. Objective: To describe the impact of SLMTA and discuss factors affecting the results; with an emphasis on mentorship Methods: The SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however; the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme; spending two to four weeks embedded within the laboratory during each visit. Results: There was an overall improvement in the performance of both laboratories; with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit) and the tuberculosis laboratory increasing 29% (from 66% to 95%). These scores were maintained nine months later at the surveillance audit. Conclusion: The SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops

Innovative strategies for a successful SLMTA country programme: the Rwanda story

Background: In 2009; to improve the performance of laboratories and strengthen healthcare systems; the World Health Organization Regional Office for Africa (WHO AFRO) and partners launched two initiatives: a laboratory quality improvement programme called Strengthening Laboratory Management Toward Accreditation (SLMTA); and what is now called the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Objectives: This study describes the achievements of Rwandan laboratories four years after the introduction of SLMTA in the country; using the SLIPTA scoring system to measure laboratory progress.Methods: Three cohorts of five laboratories each were enrolled in the SLMTA programme in 2010; 2011 and 2013. The cohorts used SLMTA workshops; improvement projects; mentorship and quarterly performance-based financing incentives to accelerate laboratory quality improvement. Baseline; exit and follow-up audits were conducted over a two-year period from the time of enrolment. Audit scores were used to categorise laboratory quality on a scale of zero ( 55%) to five (95% - 100%) stars. Results: At baseline; 14 of the 15 laboratories received zero stars with the remaining laboratory receiving a two-star rating. At exit; five laboratories received one star; six received two stars and four received three stars. At the follow-up audit conducted in the first two cohorts approximately one year after exit; one laboratory scored two stars; five laboratories earned three stars and four laboratories; including the National Reference Laboratory; achieved four stars.Conclusion: Rwandan laboratories enrolled in SLMTA showed improvement in quality management systems. Sustaining the gains and further expansion of the SLMTA programme to meet country targets will require continued programme strengthening

Maximising mentorship: variations in laboratory mentorship models implemented in Zimbabwe

Background: Laboratory mentorship has proven to be an effective tool in building capacity and assisting laboratories in establishing quality management systems. The Zimbabwean Ministry of Health and Child Welfare implemented four mentorship models in 19 laboratories in conjunction with the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.Objectives: This study outlines how the different models were implemented; cost involved per model and results achieved.Methods: Eleven of the laboratories had been trained previously in SLMTA (Cohort I). They were assigned to one of three mentorship models based on programmatic considerations: Laboratory Manager Mentorship (Model 1; four laboratories); One Week per Month Mentorship (Model 2; four laboratories); and Cyclical Embedded Mentorship (Model 3; three laboratories). The remaining eight laboratories (Cohort II) were enrolled in Cyclical Embedded Mentorship incorporated with SLMTA training (Model 4). Progress was evaluated using a standardised audit checklist.Results: At SLMTA baseline; Model 1-3 laboratories had a median score of 30%. After SLMTA; at mentorship baseline; they had a median score of 54%. At the post-mentorship audit they reached a median score of 75%. Each of the three mentorship models for Cohort I had similar median improvements from pre- to post-mentorship (17 percentage points for Model 1; 23 for Model 2 and 25 for Model 3; p 0.10 for each comparison). The eight Model 4 laboratories had a median baseline score of 24%; after mentorship; their median score increased to 63%. Median improvements from pre-SLMTA to post-mentorship were similar for all four models.Conclusion: Several mentorship models can be considered by countries depending on the available resources for their accreditation implementation plan

Etat nutritionnel des enfants de moins de 5 ans apparemment sains recus pour vaccination a Lome (Togo) selon les nouvelles normes de l'OMS

Introduction : Les infections et les pratiques alimentaires inadequates; et plus souvent les deux associees; constituent les principaux facteurs qui nuisent a la croissance physique et au developpement mental de l'enfant.L'objectif de l'etude etait d'evaluer l'etat nutritionnel des enfants de moins de 5 ans apparemment sains recus pour vaccination selon les nouvelles normes de l'OMS; afin de depister une eventuelle malnutrition inapparente.Population et methode d'etude : Etude transversale du 14 Avril au 14 Mai 2010 dans 2 sites de vaccination de Lome. Les parametres: poids pour taille (P/T) et indice de masse corporelle (IMC) ont ete calcules et interpretes selon les nouvelles normes de croissance de l'OMS chez 530 enfants.Resultats : Cinq cent trente enfants ont ete inclus dans l'etude. L'age median etait de 9 mois; 2/3 des enfants etaient ages de moins d'un an. Les familles de 3 a 6 enfants etaient les plus nombreuses (61;1%). Selon le P/T; 12;5% des enfants etaient emacies; 2;6% avaient un surpoids. Parmi les emacies; 34;8% appartenaient a la tranche de 1 a 5 mois et 27;7% avaient un age compris entre 6 et 11 mois. L'obesite ne concernait que les tranches d'age de 1 a 5 mois (57;1%) et de 12 a 23 mois (42;8%). Des resultats similaires etaient obtenus avec l'IMC.Conclusion : La malnutrition est d'observation courante chez les enfants de moins de 5 ans apparemment sains; surtout les nourrissons. Le non respect des conseils pour l'alimentation en est le facteur de risque majeur

Assurance de la qualite de la chaine d'imagerie scintigraphique dans le service de medecine nucleaire de l'hopital general de Yaounde

Objectif : Comparer le programme d'assurance qualite de la chaine d'imagerie scintigraphique du service de medecine nucleaire de l'Hopital General de Yaounde (HGY) aux normes internationales admises. Materiel et Methode : L'etude etait retrospective et transversale descriptive couvrant la periode de novembre 2002 a octobre 2007. Le materiel etait constitue du personnel; des documents;des radiopharmaceutiques et des equipements. L'approche normative de l'audit a ete utilisee pour l'analyse des donnees; et les taux de conformite (Tc) ont ete calcules. Resultats : Le personnel etait bien forme et suffisant (Tc= 100 ). La documentation etait bien organisee et disponible (Tc= 90;9). Les resultats des tests de controle qualite sur l'activimetre et la gamma camera ont rassure que ces instruments fournissaient des mesures valides et fiables (Tc= 99;94 et 95;16) et ceux obtenus des tests sur les radiopharmaceutiques ont revele que les preparations administrees etaient de qualite a fournir de bonnes images a moindre dose d'irradiation (Tc= 98;87 ) et ceux obtenus des tests sur les radiopharmaceutiques ont revele que les preparations administrees etaient de qualite a fournir de bonnes images a moindre dose d'irradiation (Tc= 98;87) et ceux obtenus des tests sur les radiopharmaceutiques ont revele que les preparations administrees etaient de qualite a fournir de bonnes images a moindre dose d'irradiation (Tc= 98;87). Conclusion : Le programme d'assurance qualite de la chaine d'image scintigraphique de l'HGY etait conforme aux normes internationales admises

Gender Norms and Family Planning Decision-Making in Tanzania: a Qualitative Study

Experience suggests that the incorporation of gender approaches into family planning (FP) and reproductive health (RH) programs may increase their impact and sustainability; but further work is needed to examine the interactions between gender norms and family planning and to incorporate this understanding into behavior change communication (BCC) in specific social contexts. We conducted open-ended; in-depth interviews with 30 young currently married men; 30 young married women and 12 older people who influenced FP decisions. Six focus group interviews were also conducted. The interviews focused on the role of gender norms in reproductive decision-making and contraceptive use among young married men and women in Tanzania. The findings suggest that gender factors; such as men's dominance in decision-making do function as barriers to the use of modern contraceptives; but that fear of side effects; by both men and women; may be even more important deterrents. Results from this research will inform the development of BCC interventions to be tested in a subsequent intervention study in which gender factors and poor information about contraceptive methods will be addressed

Essai de mise au point d'un code de la pharmacie au Mali : partie legislative

Du fait de la colonisation (1895-1960) le Mali a ete soumis au plan legislatif et reglementaire a un corpus de textes nombreux et epars se rapportant au secteur de la pharmacie. Il s'agit entre autre de la Loi An XI du 21 Germinal ou Loi du 11 avril 1803; du contenu du livre V du Code de la Sante Publique relatif a l'exercice de la pharmacie; dont certaines dispositions ont ete etendues aux territoires d'Outre-Mer; au Togo et au Cameroun en 1953 ; de l'Arrete de 1955 sur la repartition des officines en AOF ; de la Loi de 1960 portant creation de l'Ordre des pharmaciens dans la federation du Mali etc.. Apres l'accession a la souverainete internationale; le nouvel Etat Malien tout en reconduisant la legislation pharmaceutique issue de l'Etat anciennement tuteur qui n'etait pas contraire a la nouvelle loi fondamentale; a egalement mis en place; conformement aux orientations politiques de l'heure; de nouveaux textes. Dans le cadre de ce travail; nous avons recense l'ensemble des textes legislatifs et reglementaires qui ont ete pris au Mali dans le secteur pharmaceutique et celui des etudes en pharmacie. Nous avons fait l'examen critique de ces textes et procede a la codification de la partie legislative. Le present code est presente en 189 articles repartis en 5 titres disposes en chapitres et en sections

Mise en place de l'assurance qualite dans un etablissement de transfusion sanguine : l'experience du centre national de transfusion sanguine du Mali

But : Le but de ce travail etait d'aider le CNTS du Mali a mettre en place son systeme d'assurance qualite. Materiels et methodes : Il s'est deroule de 2007 a 2008 au Centre National de Transfusion Sanguine du Mali a Bamako. Nous avons fait d'abord l'etat des lieux ; etudie les connaissances et attitudes pratiques du personnel du CNTS en matiere d'assurance qualite; elabore un plan d'action qui a ete mis en execution. Ensuite nous avons effectue une evaluation de la chaine de froid et du processus de prelevement de sang total en cabine fixe. Resultats : De l'etat des lieux il est ressorti que le systeme d'assurance qualite du CNTS presentait de nombreuses insuffisances comme l'absence de politique qualite; de referentiels; des procedures essentielles; d'organigramme et de fiches de fonction pour le personnel. Par ailleurs l'enquete CAP a montre que 66;6du personnel avaient une connaissance de l'assurance qualite parmi lesquels 36;7avaient recu au moins une formation en AQ. Le plan d'action a ete realise a 58;5. L'evaluation de deux processus critiques dans la transfusion sanguine a montre de nombreuses anomalies. Ce qui necessite une formation du personnel a l'application des procedures. Les bonnes pratiques transfusionnelles et les normes des produits sanguins labiles ont ete adoptees. Conclusion : Malgre ces avancees quelques insuffisances a corriger demeuraient telles que; l'absence de circuit securise des donneurs et des PSL; l'absence d'indicateurs de qualite fiables; et la non adoption de la politique transfusionnelle

Characterisation and Quantification of Anatomy Concepts in a Standard Clinical Methods Textbook: a Content Analysis Approach

"Aim: To analyse the nature and quantity of anatomy concepts intrinsic in a standard clinical methods textbook; used for teaching medical students clinical methods; in order to identify anatomy concepts to be taught to medical students in preparation. Methods: Five categories of anatomy indicators developed in consultation with and accepted by an international panel of anatomists were used to content analyse the 19th Edition of Hutchinson's Clinical Methods. The five categories were subdivided into two classes designated ""General Anatomy Terms"" and ""Technical Anatomy Terms"". The inter-rater reliability of coding instructions was 0.76 (P value = 0.0005). Results: A total of 17; 223 recording units were coded of which 10;162 were anatomy indicators and 6;980 were technical anatomy terms. The average total anatomy indicators ratio (TAIR = total anatomy indicators/total recording units) was 0.55 and the technical anatomy terms ratio (TATR = technical anatomy terms/total anatomy terms) was 0.68 respectively. There was variability in requirement for technical anatomical terms between the 17 different chapters in the textbook. Sixty-five anatomy themes emerged from the 17 chapters. Conclusions: These results suggest that a student cannot benefit sufficiently from Hutchinson's Clinical Methods without substantial knowledge of anatomy. The implications for medical educationists are that 1) educators must be wary of teaching methods that consider anatomy learning in a superficial and simplistic manner; and 2) educators must ensure that students attain adequate depth and scope of anatomy knowledge before or concurrently to learning clinical methods."

Effect of Grewia gum on the mechanical properties of Paracetamol tablet formulations

Grewia gum has been evaluated as a binder in paracetamol tablet formulations. Compressional properties of the formulations were analyzed using density measurements and the compression equations of Heckel and Kawakita as assessment parameters. Formulations containing Grewia gum as a binder show a slower onset and lower amount of plastic deformation than those containing PVP. The Db values for formulations containing Grewia gum; increased with increased concentration up to 4w/w. Formulations containing Grewia gum were also found to exhibit higher degree of packing than those containing PVP. Yield values for formulations containing Grewia gum was found to be at variance with the binder concentration. The values increased between 1 and 2w/w and decreased between 2 and 4w/w. A linear relationship was found to exist between N/C and N for formulations containing Grewia gum at all concentrations. Grewia gum was found to improve the fluidity of paracetamol granulation better than PVP. This study suggests that Grewia gum compares favorably with the standard binder PVP used hence could be a useful substitute binder in paracetamol tablet formulations

Building Consensus on Clinical Procedural Skills for South African Family Medicine Training Using the Delphi Technique

Background: The development of registrar training as part of the newly created speciality. Methods: This study utilized a Delphi technique to establish a national consensus between 35 experts from training institutions; those already in family practice and managers who might be employing family physicians in both private and public sector contexts of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes.Results: Consensus was reached on 214 core skills at different levels of desired competency and 23 elective skills. The core skills were divided into 58 that should be taught by family physicians; 101 that should be performed independently and 55 that should be performed during training under supervision. The panel were unable to reach consensus on a further 21 skills.Conclusion: This is the first study that has proposed a set of essential clinical procedural skills for the training of family physicians in South Africa. The findings will act as a benchmark for programmes in South Africa and through the new initiative of 'FaMEC in Africa' may influence curriculum development in other African countries. They may be used as a guide for curriculum planning; as a way of monitoring skills development and as an indication to registrars of the skills they need to achieve for assessment purposes. The findings may also inform the planning of training programmes for the proposed mid-level health worker (clinical associate) in South Africa as their skills will be a sub-set of these skills and will be taught by family physicians within district hospitals. Training programmes for undergraduates and interns in family medicine may also want to position themselves as stepping stones in line with these final outcomes of postgraduate training