Background: Rotaviruses are among the most common causal pathogens of severe dehydrating diarrhoea in children. Little is known about the burden of rotavirus diarrhoea in Gabon. Aim: This study aimed to determine the proportion of rotavirus infection in children under 5 years with diarrhoea in Lambaréné and seen at the hospital and factors associated with rotavirus infection. Setting: The data used in this study were collected between February 2020 and February 2021 in children presenting with acute diarrhoea in the Albert Schweitzer Hospital paediatric ward. Methods: A cross-sectional study was carried out. Stool samples were tested for rotavirus antigens using the rotavirus Standard Diagnostic (SD) BIOLINE Rota and Adeno enzyme immunoassay detection kit. Results: A total of 178 children were included in the study. The proportion of rotavirus infection was 22% (n = 39/178; 95% confidence interval [CI]: 16% – 29%). In the multivariate analysis, the rotavirus was independently associated with dehydration (adjusted odds ratio [aOR] = 2.65; 95% CI: 1.09–6.86), vomiting (aOR = 3.15; 95% CI: 1.29–8.25), lethargy (aOR = 3.12; 95% CI: 1.16–8.71) and hospitalisation (aOR = 4.63; 95% CI: 1.7–13.65). Conclusion: Rotavirus infection was associated with severe diarrhoea and hospitalisation. This study shows the need to integrate and support free rotavirus vaccination into the expanded vaccination programme in Gabon. Contribution: This study provides evidence that could guide public health strategies and inform vaccine policies that could ultimately reduce the burden of rotavirus-associated diarrhoea in children.

BACKGROUND:The emergence of Plasmodium falciparum strains with reduced susceptibility to the artemisinin component of artemisinin combination therapies poses a serious threat to the treatment and control of malaria in sub-Saharan Africa. Regimens consisting of combinations of three or more conventional antimalarials have been proposed as a new treatment paradigm to overcome the impending problem of drug-resistant malaria. It was the aim of the MultiMal study to assess the safety, tolerability, and efficacy of the two novel multidrug antimalarial combination therapies, artesunate-pyronaridine-atovaquone-proguanil (APAP) and artesunate-fosmidomycin-clindamycin (AFC), in comparison with standard artesunate-pyronaridine (AP). METHODS:This open-label, randomised, controlled, clinical, phase 2 trial was done in Lambaréné, Gabon, and Kumasi, Ghana. Patients with uncomplicated malaria who had fever or a history of fever in the preceding 24 h and a parasitaemia in the range of 1000-100 000 per μL of blood were enrolled. Random permuted blocks of variable block sizes stratified by country were computed to generate a treatment allocation sequence. Recruitment was done across three age groups: children aged 6 months to 10 years, adolescents aged 11-17 years, and adults aged 18-65 years. Weight-adjusted oral, once-daily therapy was administered for 3 consecutive days for AP and APAP regimens dosed according to the recommendations of the manufacturer and twice daily for AFC (dose: artesunate 2 mg/kg, fosmidomycin 30 mg/kg, and clindamycin 10 mg/kg). Participants were followed up over a 42-day period. The primary endpoints of the trial, related to pharmacokinetic analyses, are being reported elsewhere; this Article reports the secondary endpoints-safety, tolerability, and efficacy of the treatment regimens (defined as adequate clinical and parasitological response [ACPR]) at days 28 and 42 after treatment initiation. ACPRs were calculated in the intention-to-treat and PCR-corrected per-protocol populations at these timepoints, whereas safety and tolerability outcomes were assessed continuously over the 42-day follow-up period in the safety population. This trial is registered with pactr.samrc.ac.za, PACTR202008909968293 and is complete. FINDINGS:Recruitment and follow-up took place between Jan 5 and Nov 5, 2021. Of 309 screened individuals, 100 patients with uncomplicated malaria were recruited into this clinical trial: 20 semi-immune patients aged 18-65 years, 40 adolescents aged between 11 and 17 years, and finally 40 patients aged 6 months to 10 years. PCR-corrected ACPR in the per-protocol set was 100% (95% CI 80-100) for AP, 100% (90-100) for APAP, and 97% (86-100) for AFC for day 28, and 87·5% (62-98) for AP, 85·3% (69-95) for APAP, and 94·4% (81-99) for AFC on day 42. Uncorrected ACPR in the intention-to-treat set was 85% (95% CI 62-97%) for AP, 87·5% (73-96) for APAP, and 82·5% (67-93) for AFC on day 28, and 70% (46-88) for AP, 75% (59-87) for APAP, and 75% (59-87) for AFC on day 42. There was no evidence for a differential efficacy across AP, APAP, and AFC. The proportion of patients with treatment-emergent adverse events (TEAEs) did not differ across study groups (p=0·37) and all treatment regimens were safe. Three (7%) of 46 TEAEs in the APAP group were severe compared with two (10%) of 20 in the AP control group and zero of 56 in the AFC group; all severe TEAEs were haematological alterations. The other TEAEs were mild or moderate. Moreover, there were two serious adverse events (SAEs) in the APAP group (peptic ulcer disease and chest contusion) and none in the other groups; these SAEs were rated as not related to the study medication. INTERPRETATION:Antimalarial regimens of APAP and AFC have unique characteristics to tackle the development and spread of drug-resistant P falciparum malaria. Given that APAP and AFC were safe, well tolerated, and highly efficacious in this clinical phase 2 study, they constitute promising multidrug combination regimens for further clinical development. FUNDING:German Center for Infection Research.

Abstract Background The increasing prevalence of artemisinin resistance in Plasmodium falciparum malaria highlights the urgent need for new, effective treatment strategies. The combination of fosmidomycin and clindamycin has shown promise, but further investigation is required, particularly regarding its pharmacokinetics. This study aimed to develop population pharmacokinetic models for fosmidomycin and clindamycin administered alongside artesunate, to evaluate the adequacy of weight-based dosing in children and adults with uncomplicated malaria and to identify relevant covariates influencing drug disposition. Methods This analysis was conducted within an open-label, randomized clinical trial in Lambaréné, Gabon. Forty patients aged 3–57 years with uncomplicated P. falciparum malaria received an oral combination of artesunate (2 mg/kg), fosmidomycin (30 mg/kg), and clindamycin (10 mg/kg) administered every 12 h for three days. Plasma samples were collected at various time points and analyzed via LC–MS/MS. Population pharmacokinetic models for fosmidomycin and clindamycin were developed using non-linear mixed-effects modeling to characterize drug exposure and identify significant covariates. Results Pharmacokinetic data were best described by one-compartment models with first-order absorption for both drugs. Allometric scaling based on body weight was a significant covariate influencing clearance and volume of distribution for both fosmidomycin and clindamycin. Notably, body temperature was identified as a significant covariate affecting fosmidomycin clearance. Dosing based on body weight resulted in consistent exposure (AUCτ) of fosmidomycin across all age groups. However, clindamycin exposure was substantially lower in children under 12 years of age compared to older patients. Conclusion We successfully developed robust population pharmacokinetic models for both fosmidomycin and clindamycin. These models confirmed that body weight is a key determinant of drug disposition for both agents, and that body temperature influences fosmidomycin clearance. While the current fosmidomycin dosing appears adequate across age groups, the standard 10 mg/kg dose of clindamycin results in lower exposure in young children compared to adolescence and adults. Dose simulation suggests that increasing clindamycin to 12 mg/kg in children under 35 kg would provide equal drug exposure in all age groups.

Background Helminth and protozoan infections are prevalent in Gabon, yet their epidemiology among women of reproductive age (WRA) has not been described. The objective of the present study is to describe the epidemiological profile of these parasites as well as anemia among these nonpregnant women. Methods We conducted a cross-sectional study in which helminth, intestinal protozoan, and Plasmodium spp. infections were assessed using microscopy, and hemoglobin was measured using a Pentra ABX60 analyser to evaluate anemia in 208 nonpregnant WRA participants. Results The prevalence of helminth infection was 25% (95%CI: 20–32). Specifically, 4% (95%CI: 2–8) of WRA had filariasis, 14% (95%CI: 10–20) had urogenital schistosomiasis which was of severe intensity in 28% of cases, and 12% (95%CI: 7–17) had soil-transmitted helminth infection with Trichirus trichiura (6%, 95%CI: 3–11) and Ascaris lumbricoides (3%, 95%CI: 1–6) as the main species, with light and moderate intensities in 67% and 60% of cases, respectively. The prevalence of Plasmodium spp. and intestinal protozoa was 8% (95%CI: 4–12) and 23% (95%CI: 18–30), respectively. The main species of intestinal protozoa was Blastocystis hominis (10%, 95%CI: 6–16). The prevalence of anemia was 69% (95%CI: 61–76), predominantly mild (52%) to moderate (38%). No significant associations were found between anaemia and helminth ( p = 0.78) or protozoan ( p = 0.47) infections, whereas Hb level was associated with parity ( p = 0.01) and smoking status ( p = 0.03). Conclusion Parasitic infections and anemia are prevalent among WRA in Gabon. Although parasitosis was not linked to anemia, these findings underscore the need for targeted public health strategies addressing parasitic diseases and anemia in this population.

BACKGROUND:Protozoa and helminths cause significant morbidity and mortality, particularly in tropical and subtropical regions where an accurate understanding of their epidemiological profile is needed to improve their control. In Gabon, a country endemic for a diverse range of both helminths and protozoa, epidemiological data for protozoa are lacking, whereas updated data for helminths are needed. This study aimed to describe the distribution of helminth and protozoan infections in the Moyen-Ogooué province of Gabon. METHODS:This cross-sectional study included individuals aged one year and older living in the study areas for at least one year. The participants were selected via a stratified sampling procedure. Blood, urine, and stool samples, along with sociodemographic data, were collected. Soil-transmitted helminths (STHs) were diagnosed using the Kato-Katz, coproculture and Harada-Mori techniques. Urogenital schistosomiasis was diagnosed using the urine filtration technique. Intestinal protozoa were diagnosed using the mercurothiolate-iodine-formol technique. Plasmodium spp. and filarial infections were diagnosed by thick blood smear microscopy, and, in addition for filaria, by leucoconcentration technique. RESULTS:A total of 1,084 participants were included, with a mean age of 31.6 years (SD: 23.6) and a female-to-male sex ratio of 1.15. The overall prevalence of helminth infections was 36% (95%IC: 33-39), with STHs being most common (21%; 95%CI: 18-23), followed by schistosomiasis (11%; 95%CI: 8 - 13) and filariasis (9%; 95%CI: 7-10). The most prevalent STH species were Trichuris trichiura (11%; 95%CI: 10-14), followed by hookworm (9%; 95%CI: 8-11). The prevalence of Plasmodium spp. was 13% (95%CI: 11-15), and the overall prevalence of intestinal protozoa was 28% (95%CI: 25-31), with Blastocystis hominis (11%; 95%CI: 9-13) and Entamoeba coli (8%; 95%CI: 7-10) being the most common intestinal protozoan species. Coinfections with multiple parasite species were observed in 42% of the infected participants, predominantly involving T. trichiura, Schistosoma haematobium, and Plasmodium spp. infection prevalence varied with age, gender, location, and occupation. CONCLUSION:This study reveals a moderate prevalence of helminths and protozoa in our community, with age, gender, and location playing a significant role in their distribution, as do common coinfections between helminths and protozoa. These findings call for further research to provide valuable insights for controlling helminth transmission in the region.

Purpose: To assess the efficacy of three proposed anthelminthic combination regimens for the treatment of strongyloidiasis using real-time polymerase chain reaction (real-time PCR) diagnostic method. Methods: We conducted an interventional randomized assessor-blinded clinical trial in which participants positive for strongyloidiasis were treated with three different therapeutic regimens: albendazole (ABZ) once a day for three days, and ABZ on days 1 and 3 associated with mebendazole (MBZ) or pyrantel (PYR) on day 2, respectively. All participants were seen after treatment for drug efficacy assessment. Microscopy methods and real-time PCR analysis were used for the diagnosis of strongyloidiasis, and the proportions of positive cases were compared between the two tests. Cure rate (CR) was reported to describe the efficacy of each treatment regimen. Risk factors for strongyloidiasis were assessed. Results: Fifty-nine of the 272 participants included in the study were positive for S. stercoralis infection at baseline as determined by either microscopy and/or PCR. The PCR-positive cases were 3.92 times higher than microscopy positive cases. The microscopy- and PCR-based corrected CRs were 100

Background Soil-transmitted helminth (STH) infections are a public health concern in endemic areas. For efficient control, the epidemiology of the disease needs to be monitored. This report assesses the prevalence, incidence, post-treatment infection (PTI) rate, and risk factors for STH infections in two rural areas of Gabon. Method In this longitudinal and prospective study, participants aged six to 30 years from the vicinity of Lambaréné and selected households using a simple randomization process were included and followed in two consecutive periods of six and nine months. Stool samples were obtained at the beginning and the end of each follow-up phase (FUP). The Kato-Katz technique was used for the detection of STH eggs, while the Harada-Mori technique and coproculture were used for the detection of larvae in stool processed within a maximum of four hours of collection. Prevalence was determined at the three main time points of the study, incidence was assessed during the two study phases, and PTI was defined as an infection detected nine months post-treatment. Results A total of 262 participants were included. The overall prevalence of STH infections was 42% (95%CI: 34–50) and 44% (95%CI: 37–51) at baseline for the six and nine month FUPs, respectively. Trichuris trichiura was the most prevalent species at each time point of assessment. The cumulative incidence of STH at the 6- and 9-month follow-ups was 18% (95%CI: 12–27) and 35% (95%CI: 27–43), respectively, while the incidence rates were 41 (95%CI: 28–55) and 56 (95%CI: 46–67) per 100 person-years, respectively. The PTI rates at the 9-month follow-up for T. trichiura , hookworm, and Ascaris lumbricoides were 58% (95%CI: 41–74), 31% (95%CI: 11–59) and 18% (95%CI: 5–40), respectively. The STH infection intensity was generally light. Conclusion The prevalence level of STH infection is moderate in the vicinity of Lambaréné, with T. trichiura being the most prevalent species. Our results reveal a rapid spread of the disease in the population mainly following intervention, particularly for trichuriasis, and therefore call for the full implementation of the World Health Organization’s recommendations in the area. Trial registration clinicaltrials.gov Identifier NCT02769013. Registered 21 April 2016, https://clinicaltrials.gov/study/NCT02769013

Objectives: Despite evidence of praziquantel's (PZQ) safety for treating schistosomiasis in pregnancy, many countries withhold treatment. Only two randomized controlled trials have investigated PZQ in pregnancy, none involving Schistosoma haematobium. Methods: Pregnant women during the second trimester in Lambaréné (Gabon) were screened for S. haematobium infection using urine microscopy and circulating anodic antigen detection. Participants positive for either test were randomized (3:1) to single-dose PZQ 40 mg/kg during pregnancy versus no treatment during pregnancy. Investigators were blinded for allocation. Primary outcomes were reduction of egg (egg reduction rate [ERR]) and antigen production (infection reduction rate [IRR]) while explorative outcomes included assessment of cure rate, adverse events, maternal hemoglobin levels, maternal anemia prevalence at delivery, pregnancy outcomes, and newborn anthropometric parameters. Results: Of 761 women screened 165 were eligible and randomized (intervention n = 124, control n = 41). Of them, 124 completed the study (n = 90 and n = 34, respectively). Treatment led to a significantly higher ERR (95.0% [91-97%] vs 27.0% [−42-63%]) and IRR (95% [91-97%] vs 56% [14-78%]). Common adverse events were dizziness, nausea, and vomiting. Maternal anemia at delivery was significantly lower in the intervention group (odds ratio: 0.40 [0.16;0.96], P = 0.04). No increased risk for adverse pregnancy outcomes was observed. Conclusions: This first randomized controlled trial investigating PZQ in pregnant women with S. haematobium found PZQ to be safe, effective, and reducing maternal anemia. We recommend treating confirmed infections to prevent morbidity in pregnant women.

BackgroundA human hookworm vaccine is being developed to protect children against iron deficiency and anaemia associated with chronic infection with hookworms. Necator americanus aspartic protease-1 (Na-APR-1) and N americanus glutathione S-transferase-1 (Na-GST-1) are components of the blood digestion pathway critical to hookworm survival in the host. Recombinant Na-GST-1 and catalytically inactive Na-APR-1 (Na-APR-1[M74]) adsorbed to Alhydrogel were safe and immunogenic when delivered separately or co-administered to adults in phase 1 trials in non-endemic and endemic areas. We aimed to investigate the safety and immunogenicity of these antigens in healthy children in a hookworm-endemic area.MethodsThis was a randomised, controlled, observer-blind, phase 1, dose-escalation trial, conducted in a clinical research centre, in 60 children aged six to ten years in Lambaréné, a hookworm-endemic region of Gabon. Healthy children (determined by clinical examination and safety laboratory testing) were randomised 4:1 to receive co-administered Na-GST-1 on Alhydrogel plus Na-APR-1(M74) on Alhydrogel and glucopyranosyl lipid A in aqueous formulation (GLA-AF), or co-administered ENGERIX-B hepatitis B vaccine (HBV) and saline placebo, injected into the deltoid of each arm. Allocation to vaccine groups was observer-masked. In each vaccine group, children were randomised 1:1 to receive intramuscular injections into each deltoid on two vaccine schedules, one at months 0, 2, and 4 or at months 0, 2, and 6. 10 μg, 30 μg, and 100 μg of each antigen were administered in the first, second, and third cohorts, respectively. The intention-to-treat population was used for safety analyses; while for immunogenicity analyses, the per-protocol population was used (children who received all scheduled vaccinations). The primary outcome was to evaluate the vaccines' safety and reactogenicity in healthy children aged between six and ten years. The secondary outcome was to measure antigen-specific serum IgG antibody levels at pre-vaccination and post-vaccination timepoints by qualified ELISAs. The trial is registered with ClinicalTrials.gov, NCT02839161, and is completed.FindingsBetween Jan 23 and Oct 3, 2017, 137 children were screened, of whom 76 were eligible for this trial. 60 children were recruited, and allocated to either 10 μg of the co-administered antigens (n=8 for each injection schedule), 30 μg (n=8 for each schedule), 100 μg (n=8 for each schedule), or HBV and placebo (n=6 for each schedule) in three sequential cohorts. Co-administration of the vaccines was well tolerated; the most frequent solicited adverse events were mild-to-moderate injection-site pain, observed in up to 12 (75%) of 16 participants per vaccine group, and mild headache (12 [25%] of 48) and fever (11 [23%] of 48). No vaccine-related serious adverse events were observed. Significant anti-Na-APR-1(M74) and anti-Na-GST-1 IgG levels were induced in a dose-dependent manner, with peaks seen 14 days after the third vaccinations, regardless of dose (for Na-APR-1[M74], geometric mean levels [GML]=2295·97 arbitrary units [AU] and 726·89 AU, while for Na-GST-1, GMLs=331·2 AU and 21·4 AU for the month 0, 2, and 6 and month 0, 2, and 4 schedules, respectively). The month 0, 2, and 6 schedule induced significantly higher IgG responses to both antigens (p=0·01 and p=0·04 for Na-APR-1[M74] and Na-GST-1, respectively).InterpretationCo-administration of recombinant Na-APR-1(M74) and Na-GST-1 to school-aged Gabonese children was well tolerated and induced significant IgG responses. These results justify further evaluation of this antigen combination in proof-of-concept controlled-infection and efficacy studies in hookworm-endemic areas.FundingEuropean Union Seventh Framework Programme.

ABSTRACT Helminthiasis remains a public health issue in endemic areas. Various drugs have been proposed to improve efficacy against helminths. The study aimed to assess the safety and efficacy of three different anthelmintic combinations to treat Trichuris trichiura infections. We conducted a randomized assessors-blind clinical trial involving children aged 2–17 years with T. trichiura . Participants were randomly assigned to one of three treatment arms. On the first and third days, all participants got albendazole 400 mg, and on the second day, albendazole (arm A), mebendazole 500 mg (arm B), or pyrantel 125 mg/kg (arm C). We assessed treatment efficacy using the cure rate (CR) and egg reduction rate (ERR) at 3 and 6 weeks post-treatment. At 3 weeks post-treatment, ERR and CR were highest in study arm A [ERR = 94%, 95% confidence interval (CI): 92–95; CR = 71%; 95% CI: 58–81] compared to the B and C arms. Decrease in ERR was significant only for arm B versus arm A ( P -value <0.001); decrease in ERR was significant for arms B and C ( P -value <0.001). No statistical difference was observed in CR when comparing arms A and B ( P -value =1.00) and C ( P -value =0.27). At 6 weeks, a decrease in ERR was observed in three arms, significant only for arm C, 81% (95% CI: 78–83). A significant increase in egg counts was observed between 3 and 6 weeks post-treatment. All treatments were safe with mild adverse events. Albendazole 400 mg/day (arm A) showed the highest efficacy against trichuriasis. Nonetheless, this treatment regimen was able to cure half of the treated individuals highlighting concerns about controlling the transmission of T. trichiura . CLINICAL TRIAL Registered at ClinicalTrials.gov ( NCT04326868 ).

Background Non-tuberculous mycobacteria (NTM) are a group of bacteria that cause rare lung infections and are increasingly recognized as causative agents of opportunistic and device-associated infections in humans. In Gabon, there is a lack of data on NTM species identification and drug susceptibility. The aim of this study was to identify the frequency of NTM species and their genotypic susceptibility pattern to commonly used antibiotics for NTM infections in Gabon. Methods A cross-sectional study was conducted at the CERMEL TB laboratory from January 2020 to December 2022, NTM subspecies identification and drug susceptibility testing to macrolides and aminoglycosides were performed using the genotype NTM-DR kit. Results The study found that out of 524 culture-positive specimens, 146 (28%) were NTM, with the predominant group being Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC). All MAC isolates were fully susceptible to macrolides and aminoglycosides, while five MABC isolates carried mutations indicative of reduced susceptibility to macrolide and aminoglycoside drugs. Conclusions These findings suggest that clinicians may use macrolides and aminoglycosides to manage NTM infections caused by MAC, but further investigation is required to determine MABC drug susceptibility.

Abstract Background Soil-transmitted helminth (STH) infections are of public health concern in endemic areas. For efficient control, the epidemiology of the disease needs to be updated. This report assesses the prevalence, incidence, post-treatment infection (PTI) rate, and risk factors of STH infections in two rural areas of Gabon. Method In this longitudinal and prospective study, participants aged six to 30 years from Lambaréné and vicinity were included and followed in two consecutive periods of six and nine months. Stool samples were obtained at the beginning and at the end of each follow-up phase (FUP). The Kato Katz technique was used for the detection of STH eggs while harada-mori technique and coproculture were used for the detection of larvae. Prevalence was determined at the three main time points of the study, incidence was assessed during the two study phases, and PTI was defined as an infection detected nine months post-treatment. Results A total of 262 participants were included. The overall prevalence of STH infections was 42% (95%CI: 34–50) and 44% (95%CI: 37–51) at baseline of both FUPs, respectively. Trichuris trichiura was the most prevalent species at each time point of assessment. The cumulative incidence at six- and nine-months follow-up of STH was 18% (95%CI: 12–27) and 35% (95%CI: 27–43), respectively, while the incidence rate was 41 (95%CI: 28–55) and 56 (95%CI: 46–67) per 100 person-years, respectively. The PTI rate at nine-months follow-up for T. trichiura, hookworm, and Ascaris lumbricoides was 58% (95%CI: 41–74), 31% (95%CI: 11–59) and 18% (95%CI: 5–40), respectively. The STH infection intensity was generally light. Conclusion The prevalence level of STH infection is moderate in the vicinity of Lambaréné, with T. trichiura being the most prevalent species. Our results reveal a rapid spread of the disease in the population mainly following intervention and particularly for trichuriasis, and therefore call for the full implementation of the World Health Organisation’s recommendations in the area, particularly adequate sanitation and hygiene activities. Trial registration: clinicaltrials.gov Identifier NCT02769013. Registered 21 April 2016, https://clinicaltrials.gov/study/NCT02769013

Background Plasmodium infection remains a public health issue in endemic areas, with anaemia being one of the main indicators of disease morbidity. In areas co-endemic for helminths, both infections very often occur in the same individual and interactions have been reported. The present analysis aimed to assess the effect of helminth infections on haemoglobin concentration in Plasmodium infection in a population of children and young adults living in rural areas of Gabon. Methods The study was longitudinal where participants were followed for six months. Urogenital schistosomiasis (UGS), soil-transmitted helminths (STH), and filariasis were assessed by microscopy at baseline and at month six. Plasmodium infection status and haemoglobin concentration were assessed at month six, only. Anaemia was defined using the recommendation of the WHO. Results A total of 217 participants were included in this analysis. Of them, 73% (160, 95%CI: 67–79) were anaemic. Anaemia was associated with Plasmodium infection (p-value=0.04), but not with UGS (p-value=0.12), STH infection (p-value=0.16), and filariasis (p-value=0.59). Adjusted to age, sex, ascariasis, and UGS, participants with Plasmodium infection had an odds of 2.44 (95%CI: 1.07–6.13) of anaemia, compared to those without Plasmodium infection. In the stratified analysis on STH and adjusted to age and sex, participants with Plasmodium infection had a significant decrease in haemoglobin concentration as compared to those without (β= -0.90, 95%CI: -1.36 – -0.43, p-value<0.001) among participants infected with STH, while no difference was observed between both groups among participants negative for STH (p-value=0.051). Conclusion Our results reveal a high prevalence of anaemia making it a serious public health issue in our community. We found Plasmodium infection as the main parasitic infection associated with anaemia in our community, with STH infections showing a protective effect on the reduction of haemoglobin concentration in Plasmodium infection. Funding source: Deutsche Forschungsge-meinschaft (DFG), grant number: MO 1071/12–1.

The notion of professors and students working together to achieve knowledge and the idea that research should inform teaching is sacrosanct in higher education, but in reality, this has been difficult to maintain as universities have expanded. Moreover, now, there is an increasing separation of personnel into research or teaching roles. The purpose of this study is to investigate the COVID-knowledge, attitudes, and perceptions (KAP) a pilot model for student-led, low-cost, high-impact international collaborative research. The COVID-KAP project is a student-led hybrid social science qualitative research project that seeks to use individual interviews and focus group discussions to collect data on KAPs of the government’s response to COVID-19. These results will be compared between rural and urban communities in each country, as well as between the four different countries involved. This study has a standardized data collection instrument used in four countries. The project was carried out by a team of academics and postdoctoral researchers from the University of Lincoln in the UK, the University of Johannesburg in South Africa and Herpezi, a research organization based in Lusaka, Zambia, in equitable partnership with research institutions in Cameroon, Gabon, and the Democratic Republic of Congo. Such student-led collaborative projects can be incorporated into a wide range of observational and interventional research studies. Furthermore, the COVID-KAP model is innovative as it seeks to use established research networks to implement collaborative student-led research projects. Supervising academics at each site will also benefit from the outputs and research networks and support provided by the consortium to their students. The student-led model presented by the COVID-KAP study would be adoptable in many research fields, including but not limited to biomedical and bioveterinary research, clinical trials, psychology, social science, geology, geography, conservation, and ecological research.

Background Pyrethroids are the main insecticides used in vector control for malaria. However, their extensive use in the impregnation of long-lasting insecticidal nets (LLINs) and indoor residual spraying has led to the development of resistance, threatening its success as a tool for malaria control. Baseline data prior to large scale distribution of LLINs are important for the implementation of efficient strategies. However, no data on the susceptibility of malaria vectors is available in the Moyen-Ogooué Province in Gabon. The aim of this study was to assess the susceptibility to pyrethroids and organochlorides of malaria vectors from a semi-urban and rural areas of the province and to determine the frequency of insecticide resistance genes. Methods Larvae were collected from breeding sites in Lambaréné and Zilé and reared to adults. Three to five-day old female Anopheles gambiae sensu lato mosquitoes were used in cone tube assays following the WHO susceptibility tests protocol for adult mosquitoes. A subsample was molecularly identified using the SINE200 protocol and the frequency of Vgsc-1014 F and − 1014 S mutations were determined. Results Anopheles gambiae sensu stricto ( s.s .) was the sole species present in both Lambaréné and Zilé. Mosquito populations from the two areas were resistant to pyrethroids and organochlorides. Resistance was more pronounced for permethrin and DDT with mortality lower than 7% for both insecticides in the two study areas. Mosquitoes were statistically more resistant ( P < 0.0001) to deltamethrin in Lambaréné (51%) compared to Zilé (76%). All the mosquitoes tested were heterozygous or homozygous for the knockdown resistance ( Kdr ) mutations Vgsc-L1014F and Vgsc-L1014S with a higher proportion of Vgsc-L1014F homozygous in Lambaréné (76.7%) compared to Zilé (57.1%). Conclusion This study provides evidence of widespread resistance to pyrethroids in An. gambiae s.s. , the main malaria vector in the Moyen-Ogooué Province. Further investigation of the mechanisms underlining the resistance of An. gambiae s.s. to pyrethroids is needed to implement appropriate insecticide resistance management strategies.

Background The development of vaccines for SARS-CoV-2 had a major impact on the COVID-19 pandemic, protecting and vulnerable and dramatically reducing mortality and severe morbidity due to SARS-CoV-2 infection in countries where vaccine coverage was high. African countries faced various challenges in rolling out SARS-CoV-2 vaccination campaigns, with poorer access to vaccines, vaccine hesitancy and the logistical challenges of reaching communities in rural areas. Rural communities might have differential access to information that results in different levels of vaccine hesitancy compared with urban populations. The aim of this study was to compare the knowledge, attitudes and practices of urban and rural communities regarding immunisation. Methods We used a mixed-methods design combining individual surveys with focus group discussions. The 240 participants included healthcare workers and lay members of the community (patient carers & relatives), recruited through participating health centres in both rural and urban locations in each country. Results Preliminary findings suggest that in urban areas, participants were overwhelmed by the multiplicity and contradiction of information sources. In rural areas, there was less access to information, and participants questioned the rationale for vaccination, less so because of anti-vaxx hysteria, but more because of a rational perception that they were at lower risk of COVID-19 due to to the lower population density. The majority of diagnoses were confirmed in urban settings, but this is deceptive, because that is where the greatest diagnostic capacity is. Conclusion There are disparities in knowledge, attitudes and perceptions between communities living in urban areas compared to those in villages. An in-depth analysis across all 4 participating countries will be presented. We will demonstrate how EDCTP networks of excellence can be used to implement impactful student-led multi-site research studies at low cost.

Background Tuberculosis (TB) is a major public health issue in resource-limited settings, including Gabon, which it is one of the top 30 countries worldwide with a high burden of the disease. Managing multidrug-resistant TB (MDR-TB) in these settings is challenging due to limited access to rapid diagnostics and drug susceptibility testing. Early detection of drug-resistant TB is crucial to controlling transmission of resistant strains and initiating appropriate treatment. The study aimed to determine the proportion and resistance patterns of pre-extensively drug-resistant (Pre-XDR) and extensively drug-resistant (XDR) TB among MDR-TB patients in Gabon and to identify the distribution of their lineages. Methods In this cross-sectional study, we collected 92 TB isolates from rifampicin-resistant (RR) patients based on Genexpert. We performed BD MGIT liquid culture and whole-genome sequencing using the MinION according to standard procedures. Results Our findings showed that the HIV-TB co-infection rate was 14.1%, and the mean age of the participants was 31.94 years. We observed that 65.2% of patients had MDR-TB, 19.6% had Pre-XDR, 14.1% had RR-TB, and 1.1% had XDR-TB. We identified three main lineages, with Lineage 4 being the most common (81.52%), followed by Lineage 5 (14.13%) and Lineage 2 (3.26%). The dominant genotypes were Cameroon, LAM, Harleem, West Africa 1b, and Beijing, accounting for 47.82%, 19.56%, 17.39%, 6.5%, and 4.3% of cases, respectively. Conclusion Our study reveals a high proportion of Pre-XDR patients, underscoring the need to enhance laboratory capacities to monitor Pre-XDR and XDR-TB patients. This is the first detection of Lineage 2, the most virulent TB strain in Gabon, Further studies are needed to investigate the transmission dynamics of the Lineage 2 TB strain in Gabon. TB programs should prioritize the effective and rational use of second-line drugs for newly diagnosed MDR-TB patients to prevent the emergence of Pre-XDR/XDR-TB strains.

Background In the early months of 2020 as the COVID-19 pandemic took hold in Europe, there was much concern about how the pandemic would impact populations in Africa, both in terms of how the infection would interact with endemic diseases, and also with respect to the capacity for public health response. Initial case finding activities centred on urban travel hubs where the infection and transmission risk were highest. Rural communities were considered lower risk but were also given less access to diagnostics and other IPC measures. The aim of this study was to compare the knowledge, attitudes and practices of urban and rural communities regarding the government response to the pandemic. Methods We used a mixed-methods design combining individual surveys with focus group discussions. The 240 participants included healthcare workers and lay members of the community (patient carers & relatives), recruited through participating health centres in both rural and urban locations in each country. Results Preliminary analysis suggested that rural dwellers were less satisfied with the government response than those in urban settings. Proactive government management and logistical organisation prevented the spread of the COVID-19 pandemic but there were challenges with respect to communication crisis and financial management. Results from both the individual interviews and focus group discussions across 4 countries will be presented. Conclusion There were clear gaps identified between the response to COVID-19 between rural and urban communities. The lessons learned should be incorporated into epidemic risk management plan in readiness for response to new and emerging threats. We will demonstrate how EDCTP networks of excellence can be used to implement impactful student-led multi-site research studies at low cost.