Causes of Infertility of Couples Residing in Libreville

Introduction: According to the World Health Organization, globally one in six people experience infertility in their lifetime. Infertility is considered as a major and global public health issue. In most cases, women bear the burden of infertility to protect the male ego. Although men and women are equally likely to have fertility problems. The aim of this study was to identify the causes of infertility of couples residing in Libreville. Patients and Methods: This was a retrospective descriptive study performed over 2 years, from 1st January 2021 to 31st December 2022. Data was obtained from 162 couples attending the assisted reproduction department of the mother and child hospitals in Libreville. Statistical analysis was done using IBM SPSS Statistics version 22.0 software. Results: During the study period, 28.5% of couples could afford IVF treatment. The average for woman age was 39.1 ± 4.06 while the average age for male patients was 41.53 ± 7.08 years with minimum and maximum age of 34 et 66 years. More than half (58.6%) of female partners were employed in the public sector. Half of the male partners (50%) were employed in the private sector. The median duration of infertility was 6 years. Approximately 49.4% of couples were diagnosed with primary infertility. The most common causes of infertility in female patients were Fallopian tubes obstruction (53.2%), uterine factors (24.2%) and hormonal problems (19.6%). With regards to male factors infertility, testicular causes were predominant (53.6%). Oligoasthenoteratozoospermia were the major semen abnormalities (55.7%) found after semen evaluation. Both male and female partners were sub-fertile in 47.5% of cases. Unexplained infertility was found in 11% of couples. Conclusion: This study showed that the diagnostic of infertility faced by couples residing in Libreville should involve both male and female partner.

Analysis of malaria diagnosis discrepancies between RDTs and microscopy by nested PCR

A total of 415 samples from febrile children exhibiting either concordant (n = 108) or discordant (n = 307) results between microscopy, the gold standard diagnostic test, and two Rapid Diagnostic Tests (RDTs), OptiMAL-IT?(pLDH) and Acon?HRP2, were analysed using polymerase chain reaction (PCR) from May to December 2011 in Gabon. The aim of the study was to analyse these discrepancies using poly-merase chain reaction (PCR). Nested PCR targeting the Plasmodium ssrRNA gene was used to distinguish P. falciparum, P. malariae and P. ovale. Plasmodium falciparum was the only malaria species identified. Discrepancies frequently involved samples that were negative by microscopy and positive by Acon?HRP2 (90%) or Optimal-it?(86%). The PCR assay detected submicroscopic infection in almost 23% of the microscopy-negative samples, whereas plasmodial DNA was not found in 77% of the Acon?HRP2 positive-microscopy negative samples. Although results obtained with Optimal-it? were more frequently concordant with those of PCR genotyping, the low specificity of Optimal-iT?for non-falciparum malaria parasite detection resulted in a high proportion of false negative RDTs (90%) and a high frequency of tests with faint line intensity. The present study highlights the specific attributes of the different methods used to identify malaria parasite below the microscopy level of detection. RDT results that were discordant with either microscopy or PCR as the gold standard could represent a challenge for rapid, accurate fever case management in malaria endemic areas. It is necessary to pursue the development of more precise and more sensitive point-of-care diagnostic tools for malaria.

Completeness and Timeliness of Hepatitis B Vaccination in Preschool Children: Determinants for Good and Timely Uptake in Libreville, Gabon

Background: Gabon is endemic for hepatitis B, but they have still not reached the WHO goal for Hepatitis B vaccination coverage. We aimed to determine the rate of completeness and timeliness of hepatitis B vaccination among children under 15 years of age in Libreville. Methods: Cross-sectional study conducted over 9 months, including children randomly selected from vaccination centres, nurseries and kindergartens. We collected data on the child, socio-economic characteristics of the families, and dates of administration of hepatitis B vaccines. We determined the compliance of the vaccination dates according to the vaccination start pattern. Results: We included 453 children, of whom 236 were girls, for a sex ratio of 0.92. A total of 87% (95% CI [83.9% - 90.1%]) of children had started and completed their 3 doses of vaccine before the 12th month of age. 149 subjects had received their 3 doses on time according to the original vaccination schedule, i.e. 32.9% (95% CI [28.6% - 37.2%]). Factors significantly associated with completeness were vaccination in a public centre OR = 114 [47.2 - 347] p st dose OR = 3 [1.6 - 5.5] p < 0.001. Age at first dose was the predictor of timeliness aOR = 1.3 (95% CI [1.2 - 1.5] p 0.001). Conclusion: The respect for the vaccination deadlines is insufficient in our context, solutions exist to improve this situation.

Management and Development of Newborns from Mothers Carrying HBsAg at the El Rapha Polyclinic in Libreville, Gabon

Introduction: Hepatitis B is a significant public health problem. Infected children <6 years represent a risk population of evolution to chronicity. Objective: We aimed to assess newborns’ management and outcome from reactive HBs Ag mothers at the El Rapha Polyclinic in Libreville, Gabon. Methodology: Prospective longitudinal study, carried out over four years, including all neonates born from reactive HBsAg mothers admitted in the delivery room. The parameters studied were maternal age, gestation, marital status, pregnancy follow-up, hepatitis B vaccination status, knowledge of hepatitis B, anti-Hbc antibodies’ levels, HBeAg. For the newborn: term, birth weight, management at birth, and hepatitis B serological status at 12 months. Results: We included 45 newborns. Mothers’ mean age was 30.9 ± seven years. In 32.6% of cases, antenatal consultations were ≤4, and 9.3% were vaccinated for hepatitis B. Mothers had chronic hepatitis in 74.4% of cases. All neonates were vaccinated for hepatitis B at birth;68.9% received hepatitis B immunoglobulin. At 12 months, 77.8% had HBs antibody positive, and 6.7% were HBsAg positive. Conclusion: Hepatitis B prevalence is significant among parturients. It is essential to set up a national strategy for managing the mother-child couple in a context of positive HBsAg.

Phenotipic Prevalence of Antibiotic Resistance in Gabon

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.

Determinants of Neurocognitive Impairment in HIV in a Cohort of Patients on Antiretroviral Therapy Followed in Bangui (Central African Republic)

Infection with HIV is one of the deadliest epidemics of our time and its type is widespread in the Central African Republic. It is frequently accompanied by neurological complications. Objective: To contribute to a better understanding of neurocognitive disorders in patients living with HIV (PLHIV) in Bangui, and to identify associated factors using the International HIV Dementia Scale (IHDS) as a screening tool. We conducted a descriptive and analytical cross-sectional study from 1 December 2014 to 30 January 2015, in a cohort of patients seen on one of the supported sites in Bangui. A total of 400 patients were received in follow-up visit during the study period of which 244 met the inclusion criteria. The prevalence of neurocognitive disorders was 25%, 95% CI [19.70 - 30.92]. The mean age of subjects was 42.77 ± 9.58 with extremes ranging from 24 - 64 years. The sex ratio (F/M) was 4.5 in. The average score for different tests was 10.93 ± 1.13 with extremes of 7 and 12. The disorder was more about the gestural sequence. Determinants of neurocognitive disorders in the cohort were older age and lower educational level (p < 0.05). It is useful to conduct further studies to confirm these results by combining a battery of neuropsychological tests to recommend this test for all the support sites of PLHIV in the country.