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Background: Quality data is a key element for every organization including the organization of the healthcare system. In fact, quality data allows any healthcare system to follow and evaluate the defined objectives in order to meet the needs of their customers. Therefore, it is necessary that the processes of producing these data are well structured and efficient. Unfortunately, in so many sub-Saharan African countries those processes have limits causing a qualitative issue in the collected data in the healthcare sector (for example, the low levels completeness, low levels of accuracy, low levels of promptitude) this is more and more frequent and it undermines the rightness of the intervention choices in the management of any healthcare system. Objective: To assess the level of performance of Gabon's health information system, we undertook to carry out an evaluation study of the processes used to collect quality data. Methods: This qualitative study was implemented using a five-step approach (identification of indicators in the data collection process, specification of data allowing the calculation of indicators, design of the data collection questionnaire, collection of data and health information system performance evaluation). For this assessment, we have chosen to rely on the characteristics (criteria) of three determinants that help ensure data quality (data recording and storage, verification of data accuracy and data processing and analysis). Results: It appears that 58% of the structures do not meet all the criteria that favor the recording and storage of data, 53% do not meet all the criteria that favor the verification of the accuracy of the data and 56% do not meet all the criteria that promote good data processing and analysis. Discussion: Although the dimensions used to assess the quality of the data in our study are not exhaustive, they nevertheless have the merit of describing and giving an idea of the level of performance of the healthcare information system in Gabon. Conclusion: We note from this study that Gabon's healthcare information system has limitations that do not allow it to produce reliable data to support strategic decisions and the results of this study may serve as material for reflection on the improvement of the current health information system.

Background: In Central Africa, it is difficult to fight against antibiotic resistance, because of a lack of data and information on bacterial resistance, due to the low number of studies carried out in the field. To fill this gap, we carried out a systematic review of the various studies, and devise a molecular epidemiology of antimicrobial resistance from humans, animals and the environmental samples.Method: A systematic search of all publications from 2005 to 2020 on bacterial resistance in Central Africa was performed on Pubmed, Google scholar and African journals online. All circulating resistance genes, prevalence and genetic carriers of these resistances were collected. The study area was limited to the 9 countries of Central Africa. Results: Five hundred seventeen studies were identified through a literature search, and sixty studies carried out in 8 countries were included. Among all articles included, 43 articles were from human. Our study revealed not only the circulation of beta-lactamase and carbapenemase genes, but also several other types of resistance genes. To finish, we noticed that some studies reported mobile genetic elements such as integrons, transposons, plasmids, or chromosomes.Conclusion: The scarcity of data poses difficulties in the implementation of effective strategies in the fight against antibiotic resistance, which requires a health policy in a "One Health" approach.

BACKGROUND Every organization, especially healthcare-related ones, must have access to high-quality data. In reality, quality data enables any healthcare system to adhere to and analyze its specified objectives in order to meet the needs of its users. Therefore, it is essential that the processes used to generate these data are well-structured and effective. In so many sub-Saharan African nations, the data management processes are limited, resulting in a quality issue in the collected data in the healthcare sector (such as the low levels of completeness, low levels of accuracy, and low levels of responsiveness). This is becoming increasingly common, and it undermines the accuracy of the intervention decisions made by the management of any healthcare system. OBJECTIVE To evaluate the performance of Gabon's health information system, we conducted a study of the procedures used to collect high-quality data. METHODS This qualitative study followed a five-step methodology (identification of indicators in the data collection process, specification of data allowing the calculation of indicators, design of the data collection questionnaire, collection of data and health information system performance evaluation). We have opted to rely on the qualities (criteria) of three factors that contribute to data quality (data recording and storage, verification of data accuracy and data processing and analysis). RESULTS 58% of the structures do not appear to satisfy all the criteria that encourage the capture and storage of data, 53% do not appear to meet all the criteria that promote the verification of the data's accuracy, and 56% do not appear to meet all the criteria that promote good data processing and analysis. CONCLUSIONS Despite the fact that the characteristics employed to evaluate the quality of the data in our study are not exhaustive, they have the advantage of characterizing the performance level of the healthcare information system in Gabon. We notice from this study that Gabon's healthcare information system has constraints that prevent it from producing trustworthy data to support strategic decisions, and the results of this study may serve as a basis for considering the enhancement of the current health information system.

In Gabon, few data exist on extended-spectrum beta-lactamases-producing Enterobacteriaceae (ESBL-PE). This study investigated ESBL-PE prevalence and the associated resistance genes in clinical samples (

Background: The increasing phenomenon of bacterial resistance to antibiotics is a real public health problem. The main causes are poor management of hygiene and water quality, but also the use of antibiotics without precaution. The objective of this study was to isolate and determine the antibiotic resistance profile of the different bacteria found in the main hospitals and bacteriology laboratories in Gabon. Methods: 6034 samples were taken from hospitals in seven main cities of Gabon, and analyzed according to the usual techniques. The pathogenic strains were identified by Matrix-Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry. Antimicrobial susceptibility testing was performed by the agar disc diffusion method, according to the Antibiogram Committee of the French Society for Microbiology guidelines. Results: 974 pathogenic bacterial strains were found, including 890/974 (91.4%) Gram-negative bacilli. The systematic antimicrobial susceptibility testings identified 160/974 (16.4%) multi-resistant strains. Escherichia coli was the most represented species. 12.5% - 25% of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Citrobacter sedlakii strains were resistant to amoxicillin + clavulanic acid, third and fourth generation cephalosporins. Aminoglycoside resistance rates of 8.5% - 19% were also noted. 4.5% to 25% of the bacteria found were resistant to quinolones and cotrimoxazole. Resistance rates to carbapenems ranged from 1% to 10.5%. 16% of Staphylococcus aureus were methicillin-resistant (MRSA). Rates of extended spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) ranged from 2.5% to 25%. Conclusion: This study showed an increasing evolution of bacterial resistance to antibiotics that are spreading throughout Gabon. This constitutes a threat to the health of Gabonese population.

Introduction Health systems in several countries have integrated information and communication technologies into their operations. Electronic medical records (EMRs) are at the core of patient care. The working of these EMRs requires their acceptance and use by medical and paramedical personnel. The objective of this study was to empirically evaluate the intention of health professionals to use these EMRs. Materials and Methods A questionnaire on the intention of health professionals to use the EMR was developed following a Likert scale. The survey was done via in-person interviews of health professionals in major health facilities in the cities of Libreville and Owendo in Gabon. The technology acceptance model (TAM) was tested using a step-down logistic regression analysis to identify the main factors explaining the intention of health professionals to use the EMR. Results A total of 218 health professionals responded to the questionnaire. Thirty-eight percent (38%) of respondents were male. The average age was 41.33 years (±8.98 years) and the average length of service at work in the system was 12.02 years (±8.47 years). The integrated model showed that the intention to use the EMR was significantly associated with the perceived usefulness, the subjective standard, and experience. No socio-demographic variables explained the intention to use the EMR. Conclusion The perceived ease, familiarity with the computer, and motivation are not associated with the intention to use the EMR. Actions should be taken to raise awareness and train health professionals to motivate them to accept and use EMRs in their medical practices.

Data collection and monitoring of carbapenemase-producing (CP) Gram-negative bacteria (GNB) are often limited. This study determined CP-GNB prevalence in Gabon and the genetic origins of the resistance genes. From January 2016 to March 2018, 869 clinically significant GNB isolates from inpatients and outpatients, and 19 fecal samples (inpatients) were analyzed in the main hospitals of Gabon. Fecal samples were screened using ChromID® CARBA SMART selective chromogenic medium biplates. Species were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antibiotic susceptibility was tested using the disk diffusion method on Müller-Hinton agar, and resistance genes were assessed by multiplex polymerase chain reaction and sequencing. Overall, 1.61% of clinical isolates (14 of 869) and 5.26% of fecal samples (1 of 19) were CP-GNB. The CP-GNB rate was higher among inpatients (2.98%) than outpatients (0.33%), in intensive care units (28.57%, 4 of 14), and in urine samples (35.71%, 5 of 14). The most common CP-GNB were Klebsiella pneumoniae (53.33%) and Acinetobacter baumannii (26.67%). blaOXA-48 was the predominant carbapenemase-encoding gene (40%), followed by blaNDM-5 (33.33%). The A. baumannii multilocus sequence types ST2 and ST78, Enterobacter cloacae ST78, Escherichia coli ST2, and K. pneumonia ST48 and ST147 were found. These data indicate that CP bacteria are present in clinical and carriage samples. Preventive measures are needed to avoid the spread of resistance genes.

Introduction:mainly occurring in low and middle income countries, gestational diabetes mellitus (GDM) represents 84% of hyperglycemia during pregnancy throughout the world. Moreover, being black is a risk factor to develop the disease. Our objective was to determine the prevalence and the associated factors of GDM in Libreville (Gabon). Methods:a cross-sectional study was carried out. Known diabetic women were excluded from the study and we had submitted asymptomatic pregnant women to a 2 steps 75g oral glucose tolerance test (T0-T2H), regardless of the stage of pregnancy at the moment of recruitment. The threshold for positivity was set at blood glucose level ≥ 8.5mmol/L World Health Organization (WHO 2013 threshold) and ≥ 7.8mmol/L (WHO 1999 threshold). Data were analyzed using Statview® for descriptive statistics, for both bivariate and multivariate analysis. Results:among 245 participants, we have found a GDM prevalence of 10.2% according to WHO 1999 threshold and 4.5% according to WHO 2013 threshold. Applying the WHO 1999 threshold, the associated factors were high maternal weight (p= 0.0498), overweight at recruitment (p=0.0246), personal history of GDM (p< 0.0001), age becomes an associated factor only if it is combined with high parity (p=0.0061). ceaserian-section and macrosomia were the two outcomes of GDM. Conclusion:Libreville has a high prevalence of GDM when the WHO 1999 criteria is compared to the WHO 2013 criteria. Discordance is also found with the identified associated factors. Further studies are needed to better appreciate gestational diabetes in Gabon.

Background Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. Objective This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. Methods The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. Results A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93% vs 12%, P Conclusions The proposed model contributes significantly to the improvement of health data quality in Gabon.

BACKGROUND Effective health information systems support decision-making. In some sub-Saharan African countries, including Gabon, there is a problem with data quality. Indeed, the tools supporting the data collection process in health facilities are limited and tend to favour manual data processing. OBJECTIVE This study presents the conceptual approach of an information system model for health decision support in resource-limited countries and the results of the evaluation's model. METHODS The study was conducted in three phases. First, the design and development of a platform based on the analysis of the different processes of data production and indicator generation. Secondly, the implementation of the platform in the health structures in Gabon. Finally, an evaluation of the platform with users. RESULTS A total of 14 users were interviewed, with an average experience of 12 years in health data management. The results show that the use of the proposed model significantly improves the completeness, timeliness and accuracy of data compared to the traditional system. Respectively, 93% versus 12% (p CONCLUSIONS The proposed model contributes significantly to the improvement of health data quality in Gabon.

Background In developing countries, health information system (HIS) is experiencing more and more difficulties to produce quality data. The lack of reliable health related information makes it difficult to develop effective health policies. In order to understand the organization of HIS in African countries, we undertook a literature review. Methods Our study was conducted using the PubMed and Scopus bibliographic search engines. The inclusion criteria were: (i) all articles published between 2005 and 2019, (ii) articles including in their title the keywords "health", "information", "systems", "system", "africa", "developing countries", "santé", "pays en développement", "Afrique", (iii) articles that are written in English or French, (iv) which deals with organizational and technical issues about HIS in African countries. Results Fourteen retrieved articles out of 2492 were included in the study, of which 13 (92.9%) were qualitative. All of them dealt with issues related to HIS in 12 African countries. All 12 countries (100.0%) had opted for a data warehouse approach to improve their HIS. This approach, supported by the DHIS2 system, has enabled providing reliable data. However, 11 out of the 12 countries (92.0%) frameworks were aligned with funding donors’ strategies and lacked any national strategy. Conclusion This study suggests that the lack of a national health information management strategy will always be a threat to HIS performance in African countries. Ideally, rigorous upstream thinking to strengthen HIS governance should be undertaken by defining and proposing a coherent conceptual framework to analyze and guide the development and integration of digital applications into HIS over the long term.

Background: The increasing incidence of recorded stroke cases is straining the economies of many developing countries. Very few studies have assessed the financial burden of stroke management in Gabon. The aim of this study was to assess the direct costs of stroke management in the neurology and cardiology departments at the University Hospital of Libreville.Methods: This retrospective study was based on a detailed review of financial records directly associated with the management of stroke cases admitted and treated in the CHUL between January 2018 and December 2019. The records reviewed were those of all stroke patients admitted and treated in the aforementioned timeframe, regardless of treatment outcome. The analysis of data focused on direct hospital cost.Results: Three hundred and thirteen stroke patients were admitted over the aforementioned period, 72.52% in neurology and 27.48% in cardiology. The average age of the patients was 58.44 (± 13.73) years. 56.23% of patients had health insurance. Ischemic stroke was more common than hemorrhagic stroke, 79.55% and 20.45% respectively. The expenditure per patient was estimated at 570,023 CFA francs.Of this global direct cost, government assistance in the form of health insurance was estimated at 422,883 CFA francs while the balance of approximately 147,140 CFA francs was paid by the patient.Conclusion: The hospital cost of stroke is very high for both patients and administrations. This observation pleads for the implementation of prevention programs for this pathology. The results of this study may be useful for work on the efficiency of these programs.

Introduction: Neurological disorders are an important cause of disability and death worldwide. The distribution of these disorders differs significantly in developing countries. Screening questionnaires have been used as an important tool to detect neurological illnesses. This systematic literature review aimed to report the validity of screening questionnaires for neurological disorders in developing countries. Methods: The PubMed/MEDLINE, Scopus, Science­Direct, and PASCAL databases were searched. All published studies performed in developing countries were eligible. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Summary measures of validity were reported (sensitivity and specificity). Results: Eight hundred and thirty-five records were identified, and 49 articles that met eligibility criteria were selected. The most frequently neurological disorders detected with a screening tool were epilepsy, stroke, and neuropathies (77, 53, and 40%, respectively). Ten screening questionnaires were accessible. Two questionnaires were mainly used to detect neurological disorders: the World Health Organization Protocol for Epidemiologic Studies of Neurologic Disorders and the Ten Questions Questionnaire. The sensitivity of the questionnaires was ranged from 84 to 100% and 56 to 100%, respectively. Conclusion: This systematic review presents evidence that screening questionnaires are valid tools to detect neurological disorders in developing countries. Disease detection provides epidemiological data and the opportunity to implement secondary and tertiary prevention strategies that will contribute to reduce the global burden of neurological disorders.

Introduction La vaccination chez l'adolescent est particulière et le statut vaccinal de ce dernier est peu connu. L'objectif de cette étude était d'apprécier ce statut vaccinal et d'identifier les facteurs associés à la compliance vaccinale chez les adolescents scolarisés à Libreville. Méthodes Une enquête observationnelle transversale descriptive a été réalisée chez les élèves des classes de 6edu Lycée national Léon MBA de Libreville. Résultats Au total, 304 élèves ont été inclus dans l'étude. L'âge moyen des élèves était de 11,60±1,20 ans et le sexe ratio était de 0,6. Deux cent soixante-six enfants (87,5%) vivaient avec leur géniteur direct (père et/ou mère). Le nombre moyen d'enfants par famille était de 4. Le taux de couverture vaccinale était de 78,3%. Le nombre d'enfants par famille n'était pas associée à la couverture vaccinale des vaccins du PEV (p=0,088), par contre les enfants vivant avec au moins l'un des parents avaient une meilleure couverture vaccinale respectivement par les vaccins du PEV (p=0,025) et les vaccins hors PEV (p=0,035). Les facteurs évoqués par les parents pour expliquer la non-vaccination étaient le manque d'information (30,59%), l'oubli (24,67%) et le manque de moyens financiers (12,82%). Conclusion La couverture vaccinale des adolescents scolarisés à Libreville semble relativement proche des objectifs du PEV, mais elle reste associée à la situation familiale. D'autres campagnes de sensibilisation seraient utiles pour améliorer cette couverture vaccinale au Gabon.

Purpose Perceptions, beliefs and culture influence attitude towards epilepsy in sub-Saharan Africa. Misconceptions on epilepsy contribute to the persistence of negative attitudes in children with epilepsy particularly on their school enrollment. The aim of the study was to assess knowledge, attitudes, and sociocultural factors affecting schooling of children with epilepsy in Gabon. Methods Teachers and health workers from two urban and four rural localities of Gabon were assessed using a self-administered questionnaire. Results Overall 1310 subjects filled the survey questionnaire, including 813 teachers and 497 health workers. Knowledge on risk factors and suggestive signs of childhood epilepsy were globally poor. Misconceptions on etiology of epilepsy were significant with contagiousness (27.5%) and demonic possession (16.0%) representing the major prevalent idea about the origin of epilepsy in children. Attitudes of teachers and health workers towards schooling of children with epilepsy were positive (85.0%). However, more than half recommended enrollment of these children in specialized school programs. In multivariate analysis, education level (OR = 1.40; 95% confidence interval 1.01–1.81) and marital status (OR = 1.62; 95% confidence interval 1.18-2.22) were sociocultural factors likely to affect chances of school enrollment of children with epilepsy. Conclusion Understanding the influence of socio-cultural factors surrounding school enrollment of children with epilepsy could enhance public awareness campaigns about epilepsy and to improve school integration of these children.

International audience; Measles is a respiratory disease caused by the measles virus (MV) belonging to the Paramyxovirus family and the Morbillivirus genus. Due to a failure in maintaining immunization coverage in some countries, measles is a re-emerging disease in the human population, especially in Africa. The aim of this study was to describe a measles epidemic in Gabon. At first, a syndromic surveillance was set up. Blood samples from febrile patients with maculopapular rash were taken and sent to the measles reference center in Cameroon for laboratory confirmation. Between March and May 2016, 79 clinically suspected cases were reported including 82.3% (n=65) and 17.7% (n=14) in Oyem and Libreville, respectively. In total, 39.2% (n=31) of children were 11 months-old, 34.2% (n=27) were children aged 1 to 4 years, 11.4% (n=9) were older children from 5 to 9 years, 6.3% (n=5) of children were aged 10 to 15 years and 8.9% (n=7) were 15 years and older. 53.3% (16/30) were laboratory confirmed. This measles outbreak reiterates the importance of maintaining a high level of vaccine coverage in Gabon for vaccine-preventable diseases, as well as the usefulness of a near-real-time surveillance system for the detection of infectious diseases.

International audience; IntroductionLes données épidémiologiques sur les troubles psychiques, les troubles neurocognitifs et l’épilepsie mettent en évidence des maladies ubiquitaires, présentes dans toutes cultures et latitudes, avec des prévalences élevées, notamment dans les pays en développement.ObjectifsL’objectif principal était d’évaluer les connaissances, attitudes et pratiques (CAP) concernant les troubles psychiques, les troubles neurocognitifs et l’épilepsie auprès de futurs médecins, pharmaciens et infirmiers dans plusieurs pays à faible et moyen revenus.Patients et méthodesIl s’agit d’une étude descriptive transversale multicentrique en cours de réalisation dans 12 pays. Nous avons utilisé l’initiative STROBE pour développer la méthodologie d’étude. Le recrutement est exhaustif pour les étudiants qui répondent aux critères d’inclusion. Les investigateurs collectent les réponses auprès des étudiants par le biais d’un auto questionnaire lié à un système de gestion de base de données relationnelle et réalisent une conférence apportant des éléments sur le contexte de la recherche épidémiologique.RésultatsL’étude pilote menée au Gabon a inclus 75 étudiants (45 étudiants en médecine, 2 étudiants en pharmacie et 28 étudiants en soins infirmiers). Un score moyen de 15,37 ± 1,69 points sur 20 points a été retrouvé. Le score de connaissances était plus faible que le score d’attitudes et pratiques (p < 0,001). Les questions avec un pourcentage faible de bonnes réponses portaient sur la définition, le diagnostic des maladies ainsi que les effets indésirables des traitements.DiscussionLe niveau de connaissances, attitudes et pratiques des étudiants en santé était correct au Gabon. Le taux faible de participation observé doit nous amener à porter une attention particulière à la méthodologie de recrutement des étudiants dans l’étude.ConclusionIl est nécessaire de poursuivre cette étude pour évaluer les CAP dans les autres pays.

International audience; ObjectiveEpilepsy is a major public health issue in low‐ and middle‐income countries, where the availability and accessibility of quality treatment remain important issues, the severity of which may be aggravated by poor quality antiepileptic drugs (AEDs). The primary objective of this study was to measure the quality of AEDs in rural and urban areas in 3 African countries. MethodsThis cross‐sectional study was carried out in Gabon, Kenya, and Madagascar. Both official and unofficial supply chains in urban and rural areas were investigated. Samples of oral AEDs were collected in areas where a patient could buy or obtain them. Pharmacological analytical procedures and Medicine Quality Assessment Reporting Guidelines were used to assess quality. ResultsIn total, 102 batches, representing 3782 units of AEDs, were sampled. Overall, 32.3% of the tablets were of poor quality, but no significant difference was observed across sites: 26.5% in Gabon, 37.0% in Kenya, and 34.1% in Madagascar (P = .7). The highest proportions of substandard medications were found in the carbamazepine (38.7%; 95% confidence interval [CI] 21.8‐57.8) and phenytoin (83.3%; 95% CI 35.8‐99.5) batches, which were mainly flawed by their failure to dissolve. Sodium valproate was the AED with the poorest quality (32.1%; 95% CI 15.8‐42.3). The phenobarbital (94.1%; 95% CI 80.3‐99.2) and diazepam (100.0%) batches were of better quality. The prevalence of substandard quality medications increased in samples supplied by public facilities (odds ratio [OR] 9.9; 95% CI 1.2‐84.1; P < .04) and manufacturers located in China (OR 119.8; 95% CI 8.7‐1651.9; P < .001). The prevalence of AEDs of bad quality increased when they were stored improperly (OR 5.4; 95% CI 1.2‐24.1; P < .03). SignificanceNo counterfeiting was observed. However, inadequate AED storage conditions are likely to lead to ineffective and possibly dangerous AEDs, even when good‐quality AEDs are initially imported.

International audience; Most people with epilepsy live in tropical countries. Perinatal factors seem to play a significant role in the occurrence of epilepsy. Available data provide different and sometimes contradictory conclusions on the role and the burden of these factors. The aim of our study was to evaluate the effect of these perinatal factors on the development of epilepsy in tropical countries. The main databases were screened, regardless the language, for all eligible studies published up to March 2017. Exposures were perinatal factors whilst the disease was epilepsy. After selection and data extraction, we calculated a pooled measure of association for each perinatal factor using fixed or random-effect models. We tested the heterogeneity and the publication bias. The degree of significance was 5%. We screened 22,581 articles and identified 13 studies. Among the perinatal factors studied, home birth (OR 1.36, 95%CI: 1.21–1.54), complicated delivery (OR 2.10, 95%CI: 1.05–4.20) and premature birth (OR 2.80, 95%CI: 2.07–3.78) were associated with the occurrence of epilepsy. The attributable risk of premature birth and home birth was estimated to be responsible for 17% and 20% of the cases of epilepsy, respectively, in tropical countries. Despite the limited number of studies identified, we demonstrated that some perinatal factors are risk factors for epilepsy in tropical countries. The three most studied risk factors are modifiable. Therefore, prevention strategies should target them. Further studies are essential to improve the understanding of the burden of these factors in the development of epilepsy.

There are many common denominators that justify carrying out an analysis of neuroepidemiological studies at the level of the sub-Saharan African region. This region is currently in epidemiologic transition. The development of chronic diseases is linked to changes in lifestyle, behavior, aging populations and will dramatically increase in the future. But this region still suffers from a high burden of communicable diseases. This double burden impacts greatly on the economic development of this part of the world. Neuroepidemiology has a big role to play in increasing knowledge on the diseases and risk factors, allowing the sensitization of authorities such that they allocate resources to the highest priorities.

Background In sub-tropical countries, infectious diseases remain one of the main causes of mortality. Because of their lack of active immunity, pregnant women and their unborn children represent the most susceptible people. In Gabon, data on infectious diseases of pregnant women such as syphilis and rubella are either scarce or very old. Few studies have assessed T. gondii infection during pregnancy in the country. Here, we evaluate seroprevalence of HIV, HTVL-1, syphilis and T. gondii and rubella infection during antenatal care among women living in Franceville, Gabon. Methods A retrospective study was conducted on data collected from May 2007 to July 2010. After signing an informed written consent form, all pregnant women consulting in two hospitals of Franceville (Gabon) and in offices of maternity and childbirth health centers were included. Demographic and clinical data were collected. Serum samples were collected and analysed using immunological assays relevant for HIV (Genscreen HIV-1 version 2, Bio-Rad®, Marne la Roquette, France).HTLV-1 (Vironostika HTLV-1, Biomérieux®, Marcy l’Etoile, France), T. pallidum (TPHA/VDRL), BIOLABO®SA), rubella virus (Vidas Biomerieux®, Marcy l’Etoile, France) and T. gondii (Vidas Biomerieux®, Marcy l’Etoile, France) diagnoses were performed. Data analysis was done using the Stat view 5.0 software. Results A total of 973 pregnant women were assessed. The mean age was 25.84 ± 6.9 years, with a minimum age of 14.0 years and a maximum of 45.0 years. Women from 26 to 45 years old and unemployed women were the most prevalent: 41.93% and 77.18%, respectively. The prevalence of studied infectious diseases were 2.50% for syphilis, 2.88% for HTLV-1, 4.00% for HIV with no significant difference between them (p = 0.1). Seropositivity against rubella was higher (87.56%, n = 852) than seropositivity against T. gondii (57.35%, n = 557), (p

The purpose of this paper is to highlight the difficulties of applying neuroepidemiological methods in low income countries or developing countries, which are mostly tropical countries, taking advantage of the experience of the Institute of Neuroepidemiology and Tropical Neurology, which was created in Limoges in 1982. These difficulties could be related to several aspects: methodological, logistical, political or economical, linked to ethical issues, even difficulties to publish the studies. However, concept and neuroepidemiological methods should stay the same worldwide, even if their translation into practice could sometimes raise some problems in developing countries. Study protocol should be more detailed. Some specific epidemiological methods could be useful. Collection of data should be standardized. True cooperation at every level is needed for these researches to be valid.

ERMA; International audience; BACKGROUND: Data supporting epidemiological transition from a predominant burden of infectious diseases to one of chronic diseases in Africa result mostly from hospital surveys. AIM: To estimate the cardiovascular disease (CVD) burden in Gabon. METHODS: The study was conducted in Ntoum (8765 inhabitants). All subjects aged greater or equal to 40 years were invited to participate. Participants were interviewed about CVD history and risk factors; they responded to questionnaires on claudication and angina and had a clinical examination, including lower limb pulse palpation and bilateral brachial pressure measurement. Subjects were considered to have CVD in case of history of CVD (coronary artery, cerebrovascular and peripheral arterial diseases), a positive questionnaire or an abnormal finding during clinical examination. RESULTS: The study included 736 subjects (313 men; 423 women). Systolic hypertension was highly prevalent (up to 47.7% and 53.7% in men and women aged 50 to 60 years, respectively). Of the 382 patients with hypertension, 74 (19.4%) were treated and only 22 (5.8%) were considered to have controlled hypertension. Overall, CVD was identified in 98 (13.3%) cases. Overall and newly diagnosed CVD prevalence rates were 14.7% and 11.5% for men and 14.9% and 8.9% for women, respectively. The presence of CVD was associated with hypertension (hazard ratio [HR] 3.69, 95% confidence interval [CI] 2.21-6.16; P

Resume Objectif Les onychomycoses constituent 50 % des onychopathies. Leur prevalence dans la population generale varie de 2 a 26,9 % en fonction des etudes publiees. Dans les pays temperes, les levures, dermatophytes et moisissures en sont les principaux responsables. Tres peu d’etudes sur les onychomycoses ont ete menees en Afrique subsaharienne. L’objectif de ce travail etait de decrire les aspects cliniques et mycologiques des onychomycoses au Gabon. Patients et methodes Une etude retrospective, descriptive sur dossiers de patients vus en consultation de janvier 1986 a decembre 2009 (24 ans) a ete menee dans le departement de parasitologie-mycologie de la faculte de medecine et des sciences de la sante d’Owendo. Les dossiers retenus devaient comporter une description clinique des lesions, un examen direct avec culture positive, ou un examen direct positif avec culture negative. Les dossiers ne comportant pas le sexe ou l’âge, ainsi que les donnees cliniques ou mycologiques n’ont pas ete inclus. Resultats La population d’etude etait constituee de 1771 patients âges en moyenne de 36,9 ans, dont 1107 (62,5 %) etaient des femmes. L’onychomycose siegeait aux doigts pour 904 d’entre eux (51 %), aux orteils pour 1130 (63,8 %) et sur les deux sites pour 263 (23,3 %). L’atteinte etait bilaterale aux doigts chez 364 patients (40,3 %), aux orteils chez 754 patients (66,7 %), et le nombre moyen d’ongles leses respectivement de 5,3 ± 2,9 et 5,8 ± 3,0. L’onychomycose sous-ungueale distolaterale, principale forme clinique, etait plus frequente aux orteils (52,5 %) qu’aux doigts (35,9 %). Des intertrigos interdigito-plantaires etaient associes aux onychomycoses des orteils dans 68,4 % des cas et une epidermophytie plantaire dans 58,8 % des cas. Chez les patients atteints d’onychomycoses des doigts, les dermatophyties de la peau glabre et les teignes du cuir chevelu ont ete retrouvees respectivement chez 11,1 % et 10 % d’entre eux. L’examen direct et la culture etaient positifs pour 823 prelevements (91 %) des doigts et 965 (85,4 %) de ceux des orteils. Un examen direct negatif avec culture positive a ete note dans 59 cas (6,6 %) aux doigts et 120 cas (10,6 %) aux orteils, un examen direct positif avec culture negative dans 22 cas (2,4 %) aux doigts et 45 cas aux orteils (4 %). Quatre groupes de champignons ont ete isoles en culture pure et mixte. Les levures representaient 77,5 % aux doigts, 48,4 % aux orteils ; les dermatophytes 12,5 % aux doigts, 20,8 % aux orteils ; les pseudodermatophytes 5,6 % aux doigts et 20,5 % aux orteils et les moisissures 4,4 % aux doigts et 10,3 % aux orteils. Candida albicans etait responsable de 48,9 % des onychomycoses a levures aux doigts et de 23,4 % aux orteils. S’agissant des atteintes dermatophytiques, T. soudanense a ete isole dans 43,3 % aux doigts et T. interdigitale dans 54,3 % aux orteils. Conclusion Les patients vus en consultation pour onychomycoses ont, en moyenne, moins de 40 ans et sont en majorite des femmes. Elles predominent aux orteils et sont souvent bilaterales. L’onychomycose sous-ungueale distolaterale est l’aspect clinique le plus frequent. Les levures sont les principaux agents fongiques isoles aux doigts tandis qu’aux orteils les dermatophytes et les pseudodermatophytes le sont dans les memes proportions.

Summary Purpose: The need for comparable epidemiologic data on epilepsy from various locations in tropical areas has led in 1994 to the creation of a questionnaire able to standardize information. The Limoges’ questionnaire was created to collect information independently of the objectives of each survey performed, and since it has been employed in various continents under tropics latitude. In Africa between 1994 and 2004, 13 epidemiologic surveys in 12 countries were performed by this means. Authors of these works were solicited to communicate their raw data on people with epilepsy (PWE). Methods: Information collected was aggregated in a database upon which operations of data management were processed. Undernutrition status was determined using an anthropologic method, according World Health Organization (WHO) recommendations. Factors associated with undernutrition and absence of treatment by phenobarbitone were searched for by using multivariate logistic regression. Key Findings: Information about 2,269 PWE was collected. Mean treatment gap and undernutrition were determined, respectively, to be 30.6% [95% confidence interval (95% CI) 28.7–32.6] and 25.4% (95% CI 22.7–28.2). Factors significantly associated with undernutrition and not being treated with phenobarbitone were determined. Significance: Despite the different purposes of each study, we were able to pool information in order to characterize and study particular traits of PWE in Africa. Some items of particular importance should be collected systematically and will be highlighted in a newer version of this questionnaire. Because many surveys were undertaken using this tool in tropical areas, a backward compatibility should be ensured.

Le paludisme, l'une des maladies parasitaires les plus prevalentes dans le monde, est responsable de pres d'un million de deces d'enfants en Afrique subsaharienne chaque annee. En plus de ces deces, cette hemosporidiose est responsable de complications neurologiques incompatibles avec un developpement harmonieux de l'enfant atteint de neuropaludisme. Dans cet article, nous synthetisons les etudes recentes realisees en Afrique subsaharienne sur l'association entre les atteintes cerebrales du paludisme et l'epilepsie sequellaire. Au total, trois etudes permettent de documenter ce lien et suggerent une association forte, tres probablement causale, entre ces deux pathologies. D'autres etudes restent cependant necessaires afin de determiner une association causale entre les manifestations cliniques et les examens paracliniques pour preciser les bases physiopathologiques. De plus, les interactions avec le role des crises symptomatiques aigues et des convulsions febriles du paludisme meritent d'etre clarifiees.

International audience; The new recommendations to prevent malaria in pregnant women have recently been implemented in Gabon. There is little information on the pregnancy indicators that are useful for their evaluation. A cross-sectional study for the assessment of the prevalence of peripheral, placental, and cord malaria and anemia among delivering women was performed at the largest public hospital of Gabon. Malaria prevalence was 34.4%, 53.6%, and 18.2% for maternal peripheral, placental, and cord blood respectively, with no difference between primigravidae and multigravidae. Submicroscopic infections were frequent and concerned all the positive cord samples. Maternal peripheral, late placental, and cord infections were all associated with a reduced mean birth weight in primigravidae (P = 0.02). Anemia prevalence was 53%, low birth rate was 13%, and prematurity was 25%. The use of intermittent preventive treatment with sulfadoxine-pyrimethamine (greater than or equal to one dose) combined with bed net was associated with a reduction in infection only in multigravidae and with a reduced risk of maternal anemia.

Summary Purpose: The association between cysticercosis and epilepsy has been widely studied in Latin America and Asia and has proven to be one of the main causes of epilepsy. Despite high prevalences of both diseases in Africa, their association remains unclear. In this article we quantified the strength of the association between epilepsy and cysticercosis in Africa and we proposed some guidelines for future studies. Methods: We performed a systematic review of literature on cysticercosis (considered as exposure) and epilepsy (considered as the disease) and collected data from both cross-sectional and case–control studies. A common odds ratio was estimated using a random-effects meta-analysis model of aggregate published data. Results: Among 21 retrieved documents, 11 studies located in 8 African countries were included in the meta-analysis. Odds ratio of developing epilepsy when presenting cysticercosis (defined as Taenia solium seropositivity) ranged from 1.3–6.1. Overall, association between cysticercosis and epilepsy was found significant with a common odds ratio of 3.4 [95% confidence interval (CI) 2.7–4.3; p

INTRODUCTION: Several neurological complications are associated with cerebral malaria (CM). However, few long-term data from childhood survivors have been published. METHODS: A cross-sectional study was carried out in Mali among children followed from 1999 to 2002 after serious and complicated malaria. Our aim was to evaluate the persistent neurological sequelae associated with CM. RESULTS: This study concerned 101 subjects who had had CM. Mean age was 5.6+/-3.6 years. Twenty-eight children presented persistent neurological sequelae (27.7p.cent). Among them eight (7.9p.cent) children had developed these sequelae just after CM and 20 (19.8p.cent) a few months later: headaches, mental retardation, speech delay, bucco-facial dyspraxia, diplegia and frontal syndrome (one case each), dystonia (two cases), epilepsy (five cases) and behavior and attention disorders (15 cases). CONCLUSIONS: In this study, we show that neurological signs due to CM can persist in the long run. Long-term follow-up and proper management after CM are essential.

International audience; Children with epilepsy and their parents face many social and psychological difficulties that remain insufficiently studied in sub-Saharan Africa. The aim here was to assess the quality of life of children with epilepsy and their parents. A community-based cross-sectional survey was conducted in two urban areas and four rural areas of Gabon. Children were screened through key informants, medical sources, and a door-to-door survey. They were clinically selected based on their medical history and a clinical exam conducted by the investigating physician. Electroencephalography had not been carried out because of a lack of material and financial resources. The quality of life of children and their parents was assessed by a structured interview of parents using a questionnaire. Of 317 suspected cases on screening, 83 children with epilepsy were identified. Their mean age was 11.9±4.4years. Twelve percent of the children had neurosensory abnormalities on clinical exam. Sixty-three percent of them attended school; factors associated with schooling were higher score on the sociability subscale, specialized medical advice, and antiepileptic drug treatment. Sociability difficulties, anxiety, cognitive impairment, and behavioral disorders were suspected in 39.8%, 45.8%, 49.4%, and 42.2% of children, respectively. A total of 48.2% of parents expressed a poor quality of life related to their children's illness. A higher score on the cognition subscale, urban residence, specialized medical advice, and a stable income in the household were predictive of poor parental quality of life. Epilepsy influences many aspects of a child's life and the life of the child's parents. Care should incorporate a cognitive assessment of the child and emphasize information for patients and their relatives.

Summary: Purpose: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas. The purpose of this article was to evaluate the relationship between CM and epilepsy in Gabon. Methods: A matched case–control study was carried out on a sample of subjects aged six months to 25 years and hospitalized between 1990 and 2004 in three hospitals in Libreville, Gabon. Cases were defined as patients suffering from epilepsy and confirmed by a neurologist. Controls were defined as patients without epilepsy. The exposure of interest was CM according to WHO criteria. Results: In total, 296 cases and 296 controls were included. Of these, 36 (26 cases and 10 controls) had a CM history. The adjusted odds ratio (aOR) to develop epilepsy after CM was 3.9 [95% CI: 1.7–8.9], p < 0.001. Additional risk factors were identified: family history of epilepsy: aOR = 6.0 [95% CI: 2.6–14.1], p < 0.0001, and febrile convulsions: aOR = 9.2 [95% CI 4.0–21.1], p < 0.0001. Conclusions: This first case–control study on that issue suggests that epilepsy-related CM is an underrecognized problem. It emphasizes the need for further studies to better evaluate the role of convulsions during CM.

Background We reviewed studies that analyzed cysticercosis (CC), neurocysticercosis (NCC) and epilepsy across Latin America, Asia and Sub-Saharan Africa, to estimate the odds ratio and etiologic fraction of epilepsy due to CC in tropical regions. Methodology We conducted a systematic review of the literature on cysticercosis and epilepsy in the tropics, collecting data from case-control and cross-sectional studies. Exposure criteria for CC included one or more of the following: serum ELISA or EITB positivity, presence of subcutaneous cysts (both not verified and unverified by histology), histology consistent with calcified cysts, and brain CT scan consistent with NCC. A common odds-ratio was then estimated using meta-analysis. Principal findings 37 studies from 23 countries were included (n = 24,646 subjects, 14,934 with epilepsy and 9,712 without epilepsy). Of these, 29 were case-control (14 matched). The association between CC and epilepsy was significant in 19 scientific articles. Odds ratios ranged from 0.2 to 25.4 (a posteriori power 4.5–100%) and the common odds ratio was 2.7 (95% CI 2.1–3.6, p, Author summary Cysticercosis is a helminthic infection of the central nervous system (CNS) and the leading cause of late onset epilepsy in low-and middle-income countries. This neurological disease is a public health problem in Sub-Saharan Africa, Asia and Latin America, affecting impoverished rural and peri-urban populations where sanitation is inadequate. Diagnostic criteria for NCC vary according to regional availability and access to imaging and serological tests. This systematic review highlights the lack of appropriate methodology in most observational studies, with few studies including control groups, a basic epidemiological criteria needed to demonstrate an association. EITB for cysticercosis was widely used to measure exposure, and brain CT scan was a non-invasive alternative used to identify cysts. Neurocysticercosis (NCC) is a preventable neurological condition in the tropics despite resource limitations in LMIC regions. Well-designed studies are needed to provide quality evidence to support control interventions and surveillance systems for this important zoonotic disease.

International audience; Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.