BackgroundHealth practitioners frequently encounter dying, death and suffering. While providing health care can be stressful, the literature on how different health practitioners cope with the emotional challenges associated with their work is sparse. Further, much of this literature is based on studies conducted in high-income countries. In this study, we explored emotional distress and associated coping strategies among health practitioners working in a pediatric oncology department in a large teaching hospital in Lomé, Togo.MethodsWe undertook a cross-sectional qualitative research involving in-depth interviews with 21 health practitioners (doctors, nurses, and nursing assistants) as well as facility-based observations Interview data were collected using a semi-structured discussion guide. All interviews were audio-recorded while observational notes were hand-written and ultimately typed. All data were transcribed, coded and analyzed thematically.ResultsWe found that practitioners experienced significant emotional distress. Their emotional distress was compounded by the seriousness of the illnesses they treated, the lack of appropriate medical equipment, and treatment failures that caused their patients to suffer. The health practitioners’ narratives suggested that a key reason for their emotional distress was a mismatch between their professional training and the realities of providing care in a resource-constrained setting. They also reported not receiving any training on how to cope with the emotional stresses associated with care and preventable patient deaths.ConclusionCaring for patients is a source of significant emotional distress. The emotional stress experienced by health practitioners is compounded in resource-limited settings where weak health systems undermine practitioners’ ability to provide quality care. Results underscore the need to train health professionals to positively cope with the emotional stresses associated with patient care and for health systems improvements to ensure quality care.

Chronic non-specific low back pain has an important psychological impact. Objectives: To determine the prevalence of anxiety and depressive disorders (ADD) and factors associated to their apparition in patients suffering from chronic non-specific low back pain in rheumatological consultation in Lomé. Patients and Methods: It was a cross-sectional study, conducted from October 1 st , 2015 to 31 st March 2016. This study focused on all patients suffering from common chronic low back pain without psychiatric history in the Rheumatology Ward at the Sylvanus Olympio's Teaching Hospital of Lomé and who have given their consent. The psychological evaluation was carried out through Hamilton scale. The processing, the statistical treatment and analysis of our data have been carried out using Epiinfo software, version 7.1.5. The investigation was approved by the local Ethics Committee. Results: 48 (39 women and 09 men) out of 123 patients with chronic lower back pain presented anxiety and depressive disorders (ADD) accounting for a prevalence rate of 39%. Their average age was 50.3 years old. The most frequent ADD was: psychic anxiety (58.6%), depressive mood (51.3%), difficulties to feel asleep (47.9%) and disturbed or agitated sleep (43.1%). Factors associated with the anxiety and depressive disorders in common chronic low back pain were: female gender (p = 0.02), dependent children (p = 0.02), occupation (reseller (p = 0.002), liberal profession (p = 0.009), monthly financial income (p = 0.002), surroundings family (0.009), medical history (p = 0.0002) and pain's intensity > 7 (p = 0.04). Conclusion: This study shows the high frequency of anxiety and depressive disorders in common chronic low back pain and their influence by socio-economic and demographic factors.

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Introduction: This work aims to identify and analyze the anxio-depressive morbidity that the renal insufficiency in hemodialysis can present. Methodology: The framework of this work was the department of nephrology and the hemodialysis unit of the CHU Sylvanus Olympio of Lome. This was a crosssectional, single-pass, descriptive and analytical study that ran from January 1 st , 2016 to June 30 th , 2016. Included were all chronic hemodialysis patients who gave their free and well-informed consent and who have no psychiatric history. To assess anxiety and depression, the Hospital Anxiety and Depressive Scale of Zigmond and Snaith was used. The processing of the data was done with the software Epi Info 7 (version 7.1.2.0). Results: The number of patients was 91 and all were included. The mean age at 46.51 ± 14.41 years with extremes of 11 and 84 years and a sex ratio at 1.6 were observed. Anxiety (A3) was in 52.8% of women and depressed (D3) in 63.2% of men. The absence of social security increases the risk of anxiety disorders among respondents by three (RR = 2.6, p = 0.04). A duration of change of Chronic Renal Failure (CRF) less than 6 months was associated with the occurrence of depression (p = 0.04) with hemodialysis patients. The relative risk of depressive episodes increased threefold with the hemodialysis patients (RR = 2.7). Conclusion: Collaboration between psychiatrists, psychologists and somaticians (doctors of the body) can occur at different times during dialysis, in order to overcome the difficulties that may arise during the treatment.

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