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Access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing is limited in rural sub-Saharan Africa. We evaluated the performance of the Siemens CLINITEST® rapid coronavirus disease 2019 antigen test under real-life conditions during the pandemic in rural Gabon. From August 2021 to February 2022, 277 participants were tested in Sindara and Lambaréné, Gabon, via outpatient mobile services. Of these participants, 54.6% were female, with a median age of 29 years (interquartile range: 12-55). The test performance was analyzed for the main population and for SARS-CoV-2 infected sub-populations at both study sites (Lambaréné and Sindara). We further evaluated subpopulations with higher viral loads using a cycle threshold (Ct) value restricted to <35, 30, 25, and 20. Overall test sensitivity in the main population was 33.3% (95% CI: 23.6-44.3%), improving to 83.3% (95% CI: 35.9-99.6%) with a Ct value of <20. Specificity across all populations was 100% (190/190; 95% CI: 98.1-100%). The prevalence of polymerase chain reaction-defined SARS-CoV-2 was 31.4%. The positive predictive value was 100% (95% CI: 88.1-100%), and negative predictive value was 76.6% (95% CI: 70.8-81.7%). Sensitivity in Sindara was 71.4% (95% CI: 29-96.3%) and 30% (95% CI: 20.3-41.3%) in Lambaréné. The Siemens CLINITEST® demonstrated high specificity but low sensitivity overall. However, it exceeded the WHO-defined quality criteria of 80% in participants with high viral loads, making it a useful tool in resource-limited settings.

Introduction: To date, 38.4 million people live with the Human Immunodeficiency virus (HIV) amongst whom 1.7 million are children below fourteen years of age. The highest burden of HIV is in sub-Saharan Africa. Children living with HIV acquired the infection mostly by mother-to-child transmission (MTCT), however the diagnosis is often delayed.In malaria-endemic countries, fever is one of the most frequent symptoms for seeking medical care and it is often primarily suspected as the onset of malaria or respiratory bacterial infections. Here, we report a case of late-onset undiagnosed AIDS in a 13-year-old boy living in rural Gabon in the Gabonese tropical rainforest in the province of Ngounié., Case: A 13-year-old orphan child presented at our routine consultation for fever screening at the Institut de Santé de Sindara (ISSA) in 2021 due to remittent fever episodes, paleness, chronic fatigue and cough. His medical history documented repeated consultations and hospitalisations over the past years, establishing various diagnoses and treatments without significantly improving his condition. Serologic testing established the diagnosis of HIV-1 infection, classifying it as CDC stage 3 AIDS. Given the family history, late-onset symptomatic HIV infection 13 years after mother-to-child transmission was the most likely transmission mode., Discussion: HIV infection may occur in older children and young adolescents and should be considered as an important differential diagnosis of reappearing fevers in regions of malaria transmission. Early diagnosis of HIV, particularly in children and adolescents, improves health outcomes. highlighting the need for HIV testing in children and adolescents., Competing Interests: None., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: More than 20 million people are infected with L. loa, and around 40 million live in high or intermediate-risk areas in West- and Central Africa. Although loiasis is associated with significant morbidity and excess mortality, little is known about the perception of loiasis by affected communities. This study assessed the knowledge, attitudes, and practices in the rural population of Sindara, Gabon, a region characterized by high loiasis prevalence., Methods: A community-based cross-sectional survey was conducted in Gabon between January and June 2022. During systematic door-to-door visits, randomly selected inhabitants were invited to participate in this questionnaire based survey. Venous blood was collected at midday from all participants for microscopic detection of filarial infection and clinical signs of loiasis were assessed., Results: A total of 150 participants were recruited, of which 66% were infected by L. loa. While almost everyone had some knowledge about L. loa, 72% of the participants understood that L. loa is a parasitic worm. The transmission of L. loa via the deer fly was known to only 21% of participants. The most frequently mentioned clinical symptoms attributed to loiasis were itching (84%), eye worm migration (59%), and conjunctivitis-like symptoms (53%). Participants who experienced migratory loiasis had better knowledge of loiasis and considered it as more serious. Traditional and herbal medicine was reported most often as an available treatment option (72%). While the formal healthcare sector was mentioned as the preferred treatment provider, 60% of the reported infections were treated by traditional medical practitioners., Conclusion: Loiasis is in general well known by this community residing in a region of high L. loa transmission. Important gaps in knowledge were discovered foremost regarding the mode of transmission. The available healthcare system does not seem to provide adequate management for loiasis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hildebrandt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Snakebite envenoming (SBE) is a neglected tropical disease (NTD). Community-based studies from sub-Saharan Africa are urgently required as data on the incidence are scarce. This study aimed to determine the lifetime prevalence of snakebites in rural Gabon by preparing the conduct of a larger regional survey. A cross-sectional community-based epidemiological survey in Sindara, Ngounie province, was conducted. Households were interviewed about the history of snakebites of household members to calculate lifetime prevalence. In addition, the average annual incidence rate per 100,000 over the last 5 years was calculated. A total of 771 inhabitants were enrolled, of which 5 (0.65%; 95% confidence interval (95% CI: 0.2-1.5%)) were victims of snakebites. Over the past 5 years, annual incidence was 77 bites per 100,000 (95% CI: 0-620). This study provides a first rough estimate of the incidence of SBE from rural central Gabon, demonstrating the importance of this NTD. Key Contribution: The estimated annual incidence of snakebites found was 77 per 100,000. Snakebites occurred mainly during agricultural activities.

Background: There is no recent epidemiological data on HIV infection in Gabon, particularly in pregnant women. To close this gap, an HIV-prevalence survey was conducted among Gabonese pregnant women, followed by a cross-sectional case-control study in which the prevalence of various co-infections was compared between HIV-positive and HIV-negative pregnant women., Methods: Between 2018 and 2019, data for the HIV-prevalence survey were collected retrospectively in 21 Gabonese antenatal care centres (ANCs). Subsequently, for the prospective co-infection study, all HIV-positive pregnant women were recruited who frequented the ANC in Lambaréné and a comparator sub-sample of HIV-negative pregnant women was recruited; these activities were performed from February 2019 to February 2020. The mean number of co-infections was ascertained and compared between HIV-positive and HIV-negative women. Additionally, the odds for being co-infected with at least one co-infection was evaluated and compared between HIV-positive and HIV-negative women., Results: HIV-positivity was 3.9% (646/16,417) among pregnant women. 183 pregnant women were recruited in the co-infection study. 63% of HIV-positive and 75% of HIV-negative pregnant women had at least one co-infection. There was a trend indicating that HIV-negative women were more often co-infected with sexually transmitted infections (STIs) than HIV-positive women [mean (standard deviation, SD): 2.59 (1.04) vs 2.16 (1.35), respectively; P = 0.056]; this was not the case for vector-borne infections [mean (SD): 0.47 (0.72) vs 0.43 (0.63), respectively; P = 0.59]., Conclusions: Counterintuitively, the crude odds for concomitant STIs was lower in HIV-positive than in HIV-negative women. The change of magnitude from the crude to adjusted OR is indicative for a differential sexual risk factor profile among HIV-positive and HIV-negative women in this population. This might potentially be explained by the availability of sexual health care counselling for HIV-positive women within the framework of the national HIV control programme, while no such similar overall service exists for HIV-negative women. This highlights the importance of easy access to sexual healthcare education programmes for all pregnant women irrespective of HIV status., (© 2023. The Author(s).)