Epidemiology of alcohol use disorder in the general population of Togo and Benin: the ALCOTRANS study.

INTRODUCTION: Access to data concerning mental health, particularly alcohol use disorders (AUD), in sub-Saharan Africa is very limited. This study aimed to estimate AUD prevalence and identify the associated factors in Togo and Benin. METHODS: A cross-sectional study was conducted between April and May 2022, targeting individuals aged 18 years and above in the Yoto commune of Togo and the Lalo commune of Benin. Subjects were recruited using a multi-stage random sampling technique. AUD diagnoses were made using the MINI adapted to DSM-5 criteria. Our study collected sociodemographic information, data on psychiatric comorbidities, stigmatization, and assessed cravings, using a series of scales. The association between AUD and various factors was analyzed using multivariable logistic regression. RESULTS: In Togo, 55 of the 445 people investigated had AUD (12.4%; [95% CI: 9.5-15.7%]). Among them, 39 (70.9%) had severe AUD and the main associated comorbidities were suicidal risk (36.4%), and major depressive disorder (16.4%). Associated factors with AUD were male gender (aOR: 11.3; [95% CI: 4.8-26.7]), a higher Hamilton Depression Rating Scale (HDRS) score (aOR: 1.2; [95% CI: 1.1-1.3]) and a lower Stigma score measured by the Explanatory Model Interview Catalogue (EMIC) (aOR: 0.9; [95% CI: 0.8-0.9). The stigma scores reflect perceived societal stigma towards individuals with AUD. In Benin, 38 of the 435 people investigated had AUD (8.7%; [95% CI: 6.4-11.7]), and the main associated comorbidities were suicidal risk (18.4%), tobacco use disorder (13.2%) and major depressive episode (16.4%). Associated factors with AUD were male gender (aOR: 6.4; [95% CI: 2.4-17.0]), major depressive disorder (aOR: 21.0; [95% CI: 1.5-289.8]), suicidal risk (aOR: 3.7; [95% CI: 1.2-11.3]), a lower Frontal Assessment Battery (FAB) score (aOR:0.8; [95% CI: 0.8-0.9]) and a lower perceived stigma score (by EMIC )(aOR: 0.9; [95% CI: 0.8-0.9]). CONCLUSION: In these communes of Togo and Benin, AUD prevalence is notably high. A deeper understanding of the disease and its local determinants, paired with effective prevention campaigns, could mitigate its impact on both countries.

[Depression in patients on chronic hemodialysis at the Sylvanus Olympio University Hospital of Lomé (Togo)]. / Hémodialyse chronique et dépression au Centre Hospitalier Universitaire Sylvanus Olympio de Lomé (Togo).

INTRODUCTION: The aim of our study was to estimate the prevalence of depression and to investigate its associated risk factors in patients with chronic renal failure on hemodialysis. METHODS: We conducted a descriptive cross-sectional study in the hemodialysis unit of the Division of Nephrology at the University Hospital of Sylvanus Olympio Lomé (Togo) from 1 January 2014 to 31 December 2014. Self-evaluation Scale as calibrated using the Beck Depression Inventory in his simplified version was our screening tool. RESULTS: During the study period, 88 patients were enrolled of whom 61.4% were men with a sex ratio of 1.6. The average age was 38.80 ± 13.24 years ranging from 12 to 66 years. The majority of patients (90.9%) were workers. Arterial hypertension was the most common somatic comorbidity (45.4%) recorded. Forty-six patients (52.3%) had hemodialysis duration between 1-4 years; 68.2% of patients had depression; 47.7% of depressed patients had severe depression. The occurrence of the depression is significantly related to the hemodialysis length (p= 0,008). CONCLUSION: The management of chronic hemodialysis patient should be multidisciplinary including nephrologist and psychiatrist.

Is it acceptable for a physician to request informal payments for treatment? Lay people's and health professionals' views in Togo.

The people's views regarding informal payments for healthcare is essential if we are able to develop publicly supported interventions to address this phenomenon. We recruited a convenience sample of 300 lay people and health practitioners in Togo, a developing country experiencing this practice, and asked them how acceptable it would be for a physician to request informal payments for treatment in 36 scenarios. The scenarios were all combinations of three levels of the physician's income (relatively well-paid, average, or underpaid); two levels of the patient's wealth (wealthy vs. poor); two levels of the frequency of the practice in the area (common vs. rare); and three levels of the amount of payment requested ($50, $30, or $10). Two contrasting positions were found. A substantial minority of participants rejected the practice of informal payments, irrespective of circumstances. In contrast, a majority of them were of the opinion that when patients were wealthy and physicians were underpaid, this practice was acceptable. Health practitioners more frequently adhered to the ethical position than lay people. Implications for health policy are discussed.

Willingness to seek malaria treatment among Togolese people.

The way Togolese people judge their willingness to seek malaria treatment in health facilities as a function of a set of concrete circumstances was examined. Three hundred and thirty-one people in Lomé, Togo, were presented with 32 scenarios of a few lines depicting a situation of illness strongly suggestive of malaria, and were instructed to judge their willingness to consult in each case. The scenarios were developed according to a five within-subject factor design: (1) severity of symptoms, (2) cost of treatment, (3) caregivers' attitudes, (4) availability of traditional treatment and (5) family's attitude with regards to use of formal health services. All these factors had significant effects. The severity factor had the strongest effect, and attitude of the family had the weakest effect. The other three factors had more or less the same impact. Implications for health policy are discussed.