Demography, maternal health and the epidemiology of malaria and other major infectious diseases in the rural department Tsamba-Magotsi, Ngounie Province, in central African Gabon

Abstract

BackgroundSub-Saharan Africa is undergoing an epidemiological transition from a predominance of infectious diseases to non-communicable and lifestyle related conditions. However, the pace of this transition and the pattern of disease epidemiology are uneven between affluent urban and rural poor populations. To address this question for a remote rural region located in the central African rainforest region of Gabon, this study was conducted to assess reasons for health care attendance and to characterize the epidemiology of malaria and other major infectious diseases for the department of Tsamba Magotsi.MethodsMajor causes for health care attendance were collected from local hospital records. Cross sectional population based surveys were performed for the assessment of local malaria epidemiology. Pregnant women attending antenatal care services were surveyed as a sentinel population for the characterization of chronic viral and parasitic infections in the community.ResultsInfectious diseases were responsible for 71% (7469) of a total of 10,580 consultations at the formal health care sector in 2010. Overall, malaria – defined by clinical syndrome – remained the most frequent cause for health care attendance. A cross sectional malaria survey in 840 asymptomatic individuals residing in Tsamba Magotsi resulted in a Plasmodium spp. infection prevalence of 37%. The infection rate in 2–10 year old asymptomatic children – a standard measure for malaria endemicity – was 46% (100 of 217) with P. falciparum as predominant species (79%). Infection with other plasmodial species (P. ovale and P. malariae) presented most commonly as coinfections (23.2%). Prevalence of HIV, HBV, and syphilis were 6.2, 7.3, and 2.5%, respectively, in cross-sectional assessments of antenatal care visits of pregnant women. Urogenital schistosomiasis and the filarial pathogens Loa loa and Mansonella perstans are highly prevalent chronic parasitic infections affecting the local population.ConclusionsDespite major improvements in the accessibility of Tsamba Magotsi over the past decade the epidemiological transition does not appear to have majorly changed on the spectrum of diseases in this rural Gabonese population. The high prevalence of Plasmodium infection indicates a high burden of malaria related morbidity. Infectious diseases remain one of the most important health issues and further research activities in the field of tropical medicine and infectious diseases could help improve health care for the local population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4045-x) contains supplementary material, which is available to authorized users.

Behavioural and clinical predictors for Loiasis

“…This cross-sectional survey was conducted in rural central Gabon in the province of la Ngounié, a region covered by tropical rain forest [ 17 ]. Between December 2015 and February 2016 study teams visited rural villages surrounding the administrative capital Fougamou and actively recruited villagers in this survey.…”

Species and genotype diversity of Plasmodium in malaria patients from Gabon analysed by next generation sequencing

“…Parasite DNA for this study was extracted from dried blood spots on filter paper of 46 patients with uncomplicated, microscopically diagnosed non- falciparum or mixed species malaria, which represents a minority of malaria cases in the region but was found in more than 20% in a cross-sectional survey in the area [ 13 ]. Blood samples from two clinical studies were used.…”

“…Here, a metagenomics sequencing based approach was applied using three pan- Plasmodium primer sets for nucleus (18S rRNA), mitochondrion ( cytb ), and apicoplast ( clpC ) encoded genes to characterize the different Plasmodium species that infect patients with microscopically diagnosed non-falciparum malaria in the department of Tsamba-Magotsi, Gabon, a remote area of rural Central Africa [ 13 ]. By this approach, parasite diversity in 46 Gabonese symptomatic patients is described, that are sampled over a time period of 3 years and provide a baseline for research on the epidemiology and potential influence of non-falciparum malaria on disease burden in Central Africa.…”

Efficacy and Safety of Fosmidomycin–Piperaquine as Nonartemisinin-Based Combination Therapy for Uncomplicated Falciparum Malaria: A Single-Arm, Age De-escalation Proof-of-Concept Study in Gabon

“…This phase 2, proof-of-concept, open-label, uncontrolled study of fosmidomycin combined with piperaquine for 3-day oral treatment in adults and children with uncomplicated P. falciparum malaria was carried out at the Centre de Recherches Médicales de Lambaréné (CERMEL) between March 2014 and June 2016 in Lambaréné and Fougamou, Gabon. The study region is within the equatorial rainforest and highly endemic for P. falciparum malaria, which is perennial with little seasonal variation [ 9 , 10 ]. Local strains of P. falciparum show high levels of resistance against chloroquine and sulfadoxine–pyrimethamine [ 10 , 11 ].…”

“…The study region is within the equatorial rainforest and highly endemic for P. falciparum malaria, which is perennial with little seasonal variation [ 9 , 10 ]. Local strains of P. falciparum show high levels of resistance against chloroquine and sulfadoxine–pyrimethamine [ 10 , 11 ].…”