Lonzozou Kpanake

Skin Bleaching Among Togolese: A Preliminary Inventory of Motives:

The motives underlying the practice of regular skin bleaching among Togolese people were examined, using Apter’s metamotivational theory as the framework. Factor analysis using scree test and a varimax rotation showed eight independent types of basic motives that are characteristic of this theory. Four motives appeared as clearly dominant. Participants practiced skin bleaching on a regular basis mainly (a) to appear important, (b) to look attractive, (c) because they enjoyed their light-colored skin, and (d) because skin bleaching was fashionable. They did not practice skin bleaching as a demonstration of opposition to African culture or to their relatives or as a demonstration of compliance with others’ wishes. They also sometimes practiced skin bleaching as a means of securing a job. Implications in terms of health policy are discussed.

Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education.

To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea.

Togolese lay people's and health professionals’ views about the acceptability of physician-assisted suicide

Aim To study the views on the acceptability of physician-assisted-suicide (PAS) of lay people and health professionals in an African country, Togo. Method In February–June 2012, 312 lay people and 198 health professionals (75 physicians, 60 nurses and 63 health counsellors) in Togo judged the acceptability of PAS in 36 concrete scenarios composed of all combinations of four factors: (a) the patients age, (b) the level of incurability of the illness, (c) the type of suffering and (d) the patients request for PAS. In all scenarios, the patients were women receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Results Most lay people (59%) were not systematically opposed to PAS, whereas most health professionals (80%) were systematically opposed to it. The most important factors in increasing acceptability among people not systematically opposed were advanced age of the patient and incurability of the illness. Additional acceptability was provided by the patients request to have her life ended, although much less so than in studies in Western countries, and by suffering characterised by complete dependence rather than by extreme physical pain. Conclusions These empirical findings—the first ones gathered in the African continent—suggest that most Togolese lay people are not categorically for or against PAS, but judge its degree of acceptability as a function of concrete circumstances.

Criminal prosecution of a male partner for sexual transmission of infectious diseases: the views of educated people living in Togo

Objective To examine the views of educated people in Togo on the acceptability of criminal prosecution of a male partner for sexual transmission of infectious diseases (STIDs) to his female partner. Methods 199 adults living in Kara, Togo judged acceptability of criminal prosecution for STID in 45 scenarios composed of combinations of five factors: (a) severity of disease; (b) awareness and communication of ones serological status; (c) partners’ marital status; (d) number of sexual partners the female partner has and (e) male partners subsequent attitude (supportive or not). Results Acceptability was lower (a) when the male partner decided to take care of his female partner he had infected than when he decided to leave, (b) when both partners were informed but decided not to take precautions than when none of them was informed or when only the male partner was informed and (c) when the female partner has had several male sexual partners than when she has had only one. Two qualitatively different views were identified. For 66% of participants, when the male partner accepts to take care of his partner, he should not be sued, except when he did not disclose his serological status. For 34%, when both partners were informed, the male partner should not be sued, irrespective of other circumstances. Conclusions Regarding criminal prosecution for STID, most people in the sample endorsed the position of the Joint United Nations Programme on HIV/AIDS that urges governments not to apply criminal law to cases where sexual partners disclosed their status or were not informed of it.

Misconceptions about hepatitis C in the Togolese public

OBJECTIVE To characterize the Togolese publics understanding of hepatitis C (HC). METHOD Two convenience samples in Togo-282 lay people and 30 health professionals (22 nurses, 8 physicians)-indicated in 2006 their level of agreement with the same 94 statements about HC evaluated by French hepatologists (the reference group of experts) in 2003 and by French lay people in 1997. Their mean responses were compared using Students T-test, and correlations were calculated between each groups series of responses and between their significant differences from the experts. RESULTS The mean absolute differences between experts and Tologese lay persons, nurses, and physicians were 4.33, 3.72, and 2.57 (on a scale of 0-10). The correlations between the mean responses of experts and Togolese lay persons, nurses, and physicians were .34, .42, and .44. For the significant differences from experts, the correlation between Tologese lay persons and French lay people in 1997 was .94, and the correlations between Tologese lay persons and Togolese nurses and doctors were .94 and .74. For all these results, p<.001. CONCLUSIONS Togolese lay persons, and even health professionals, appear to have misconceptions about HC that may lead to stigmatization and incorrect treatment of persons infected with HC.

Cultural concepts of the person and mental health in Africa

People in different cultures have different concepts of the person that underlie self-understanding and self-representation. These concepts influence many aspects of individuals’ life experience, including illness and expectations toward recovery. Psychotherapies aim to promote adaptive change in experience and behavior. This goal is embedded in a social and cultural context that promotes or sanctions a particular notion of personhood. If every system of psychotherapy depends on implicit models of personhood, which varies cross-culturally, then the goals and methods of therapeutic change must consider the cultural concept of the person. This paper reviews cultural concepts of the person in relation to communal values, practices, and systems of thought observed across many African cultural contexts. It presents a practical framework that can inform therapists working with African clients. Many African cultures promote a relational-oriented personhood, in which an individual manifests his or her personhood through connections to three distinct forms of agency: (a) spiritual agency, including God, ancestors, and spirits that influence the person; (b) social agency, including the family, the clan, and the community, with extension to humanity; and (c) self-agency, which is responsible for the person’s inner experience. This distinctive form of personhood underlies concepts of the “normal” person, understandings of mental illness, help-seeking behavior, and clients’ needs and expectations. Implications of this cultural concept of the person for psychotherapy with African clients are discussed.

Breaking Bad News to Togolese Patients

ABSTRACT The aim of this study was to map Togolese people’s positions regarding the breaking of bad news to elderly patients. Two hundred eleven participants who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the acceptability of the physician’s conduct in each case. The vignettes were all combinations of five factors: (a) the severity of the disease, (b) the patient’s wishes about disclosure, (c) the level of social support during hospitalization, (d) the patient’s psychological robustness, and (e) the physician’s decision about how to communicate the bad news. Five qualitatively different positions were found. Two percent of the participants preferred that the physician always tell the full truth to both the patient and her relatives, 8% preferred that the truth be told depending on the physician’s perception of the situation, 15% preferred that the physician tell the truth but understood that in some cases nondisclosure to the patient was not inappropriate, 33% preferred that the physician tell the full truth to the relatives but not as much information to the patient, and 42% preferred that the physician tell the full truth to the relatives only. These findings present a challenge to European physicians taking care of African patients living in Europe or working in African hospitals, and to African physicians trained in Europe and now working in their home countries. If these physicians respect the imperative of always telling the truth directly to their patients, their behavior may trigger anger and considerable misunderstanding among African patients and their families.

Acceptability of vaccination against HIV: A mapping of Togolese people's positions.

In anticipation of a future HIV vaccine, we mapped the different personal positions regarding HIV vaccination of people in Togo. In early 2014, 363 adults indicated their willingness to receive a future HIV vaccine under different conditions varying as a function of five factors: perceived susceptibility to HIV, vaccine effectiveness, perceived severity of AIDS, vaccine cost, and family’s influence. We found five qualitatively different positions: unconditional acceptance (49%), depends on cost/effectiveness ratio (20%), depends on cost (18%), total indecision (10%), and complete reluctance (3%). Accordingly, HIV vaccination strategies in Togo and elsewhere in Africa need to be multifaceted and tailored.

Judgments of risk of becoming HIV-infected through sexual contact in Lomé, Togo

The way Togolese people estimate the risk of becoming HIV-infected as a result of sexual contact was examined. The participants were presented with scenarios depicting a number of sexual acts, use of protective devices, and the probability that the partner is infected. Findings support the appropriate use of protective behavior information, as well as the appropriate use of probability information. Number of sexual acts was, however, perceived to have minimal impact on risk. Togolese people should be made aware, through systematic information campaigns, of the relationship between number of sexual acts and risk.

Allocation of Antiretroviral Drugs to HIV-infected Patients in Togo: Perspectives of People Living with HIV and Healthcare Providers

Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patients family responsibilities and (d) the time elapsed since the first consultation. Results Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. Conclusions WHOs guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.