Libreville Hospital

Background: Perinatal asphyxia (PNA) is a common condition in neonatology. Objective of the study was to describe the short- and medium-term outcome of newborns presenting with PNA at the Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori (CHUME-FJE) in 2022. Methods: A prospective longitudinal and analytical study was conducted over a 16-month period. Newborns were included, regardless of gestational age, had presented with PNA. The statistical significance threshold was set at p<0.05. Results: 96/464 newborns hospitalized for PNA (20.7%). The sex ratio was 1.26. The mean resuscitation time was 9.1±7.1 min. Neurological complications accounted for 73.3% (n=63), with an AEI classified as Sarnat II (27.0%) and Sarnat III (22.2%). The mean hospital stay was 12.6 days. The overall death rate was 32.6%. During the course of the study, 50.0% of infants recovered to normal weight for their age at 9 months and a proportion of 7.7% presented with PML developmental delay and 11.5% with PCVM taking into account the corrected age for preterm newborns. Conclusion: APN remains a public health problem in sub-Saharan countries with high neonatal mortality and long-term neurodevelopmental sequelae. Prevention of this condition relies on better monitoring of pregnancy and delivery and a training program for healthcare personnel in newborn resuscitation in the delivery room.

Although radiotherapy is an essential part of comprehensive cancer care, access is heavily limited in most sub-Saharan African (SSA) countries. Patients' barriers to care can be grouped as availability, accessibility, accommodation, affordability, and acceptability. We aimed to assess cancer patient- and caregiver-reported barriers in nine SSAn countries (Republic of the Congo, Ethiopia, Gabon, Kenya, Mali, Nigeria, Tanzania, Uganda, and Zimbabwe). We conducted a telephone-based survey among 553 randomly selected patients with breast, cervical, colorectal, and prostate cancer, Kaposi sarcoma and non-Hodgkin lymphoma diagnosed between 2018 and 2019 registered in population-based registries of the African Cancer Registry Network. We inquired about receipt of radiotherapy and barriers irrespective of recalling a recommendation. Among all categories, 21.6% (Use of alternative medicine) to 39.6% (Cost of treatment) of patients reported severe barriers. Most common was problematic Cost of treatment (69.0% overall). A high share of patients from Congo, Kenya, Nigeria, and Tanzania reported barriers. Higher education and wealth were associated with reduced problems in all categories except increased problems with Fear and Use of alternative medicine. Receipt of radiotherapy was associated with fewer problems with Availability of transport (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.13-0.88) and Trust in healthcare workers (OR: 0.44; 95% CI, 0.24-0.8), and increased Fear (OR: 2.33; 95% CI, 1.33-4.05). Seeing that one-third of the patients reported severe problems in all dimensions, shortage of radiotherapy units is not the only problematic aspect of access to radiotherapy. Improvements in affordability, patient-healthcare worker communication, and psychosocial support are needed.

Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-limited settings. Cryptococcosis, toxoplasmosis and cerebral malaria often present with overlapping neurological symptoms, complicating diagnosis where confirmatory tests are unavailable. This study aimed to determine the prevalence and associated signs and symptoms of parasitic and fungal infections with neurological tropism in PLWHIV hospitalized in Libreville. A retrospective review was conducted at the Infectious Diseases Ward of the Centre Hospitalier Universitaire de Libreville (IDW-CHUL) between April and September 2021. Data were recorded from the medical files of PLWHIV hospitalised for suspected cryptococcal meningoencephalitis presenting with fever and headache alone or associated with other neurological signs. Diagnoses of cryptococcosis, toxoplasmosis, and malaria were based on microscopy, cryptococcal antigen testing, and brain CT scan. Cases of tuberculosis, other bacterial or viral meningitis were not included. Sociodemographic, clinical, and immunological data were analysed, and associations between symptoms and CNS infections were assessed. Among 255 hospitalised PLHIV, most were aged under 55 years (86.3%, n = 220), female (72.5%, n = 185), and severely immunosuppressed (CD4 < 200 cells/mm³, 57.2%, n = 127). Parasitic or fungal infections were identified in 32.9% (n = 84) of cases: cryptococcosis (14.5%), cerebral toxoplasmosis (13.7%), and complicated malaria (9.8%), with 5.1% presenting co-infections. Advanced HIV disease (WHO stage III-IV) was significantly associated with cryptococcosis and toxoplasmosis (p < 0.01). Fever and headache (81.2%, n = 207) were the most common symptoms. According to diagnosis, fever, headache, seizures, and/or focal deficits were more suggestive of toxoplasmosis (cOR 3.5, 95%CI [1.0-12.4], p = 0.05), while prostration was more frequent in malaria (cOR 2.9, 95%CI [0.98-9.0], p = 0.05), and neck stiffness was characteristic of cryptococcosis. Parasitic and fungal CNS infections remain frequent and severe in hospitalised PLWHIV in Libreville, mainly in advanced disease with profound immunosuppression. In the absence of diagnostic tools, recognition of symptom clusters may guide syndromic triage and empirical therapy.

Background: According to the literature, adverse drug reactions (ADRs) account for 5–10% of hospital admissions and affect 25–30% of hospitalized patients, but no data are available for Gabon. Objectives: To estimate the incidence of ADRs among hospitalized patients at the Libreville University Hospital Center (CHUL) and to classify them according to their frequency, severity, mechanism and preventability, while proposing appropriate risk minimization strategies. Patients and Methods: A 14-month, single-center, prospective study included all patients experiencing ADRs, excluding those without ADRs or with intentional overdoses. ADRs were analyzed using the World Health Organization (WHO) causality assessment, the ATC classification, and Rawlins and Thompson criteria. Data were actively collected from patients and hospital records. Results: Among 4999 patients, 105 experienced 177 adverse events (incidence: 3.5%, 95% CI: 1.7–2.5%). Among the identified ADRs, 42% were serious. Nausea and vomiting were the most frequent ADRs, mainly caused by analgesics (nefopam, tramadol) and antibiotics (amoxicillin–clavulanic acid). The gastrointestinal and nervous systems were the most affected. According to the Rawlins and Thompson classification, 90% of ADRs were type A, 8% type B, and 2% type E (withdrawal syndrome). Overall, 90% of ADRs were preventable. Conclusions: This study highlights the importance of pharmacovigilance at CHUL, Gabon, and emphasizes the role of healthcare professionals in ADR reporting and risk minimization.

Hepatitis B virus (HBV) and specifically occult HBV infection (OBI) remains concerning in transfusion medicine in many countries. This study aimed to determine the burden of overt and occult HBV infections and characterize the circulating viral genotypes among blood donors in Gabon. A facility-based study was conducted among blood donors at the Gabon National Blood Transfusion Centre in 2022. Screening for HBsAg and anti-HBc was done using ELISA; characterization of OBI (defined serologically as HBsAg- but anti-HBc+) was done using HBV DNA viral load (VL); and HBV Pol/S sanger-sequencing was performed for the analysis of immune-escape and drug resistance mutations. Data were analyzed with p < 0.05 considered significant. Overall, 283 participants were enrolled: 218 (77.0%) males, median age 31 (26–35) years and 264 (93.3%) frequent donors. HBV seropositivity revealed 25.1% (71/283) overt infection (i.e. HBsAg + and anti-HBc+) and 5.7% (16/283) OBI (HBsAg- but anti-HBc+). All OBI cases (16/16) had HBV DNA VL < 10 IU/ml versus 37.5% (6/16) VL < 10 IU/ml, 25% (4/16) VL between ]10–500] IU/ml, and 37.5% (6/16) VL > 500 IU/ml among controls (overt infections). Genotyping was successful for 15.6% (5/32) participants with VL > 500 IU/ml (p = 0.02). Following genotyping, 80% (4/5) participants (VL > 2000 IU/ml) had at least one immune escape mutation (sT131N, sR122K, sG145A) and rtI169L mutation associated with drug resistance was detected in one donor. Molecular phylogeny revealed genotypes A (80%; 4/5) and E (20%; 1/5). HBV seropositivity was 25.1%, markedly higher than the estimated prevalence in the general population and therefore of significant concern. Likewise, the observed OBI prevalence of 5.7% represents a substantial risk to transfusion safety.

Abstract Drug-resistant tuberculosis (DR-TB) remains a major health concern, especially in high-burden areas like Gabon’s Haut-Ogooué region. This study investigates the prevalence of drug-resistant tuberculosis (TB) and associated factors in the Haut-Ogooué region. Drug resistance poses a significant threat to global TB control efforts. We conducted a retrospective and prospective study at Centre Hospitalier Universitaire de Franceville from August 2022 to August 2024. A total of 1,792 participants were included. Sputum samples were collected and analyzed using GeneXpert MTB/RIF ULTRA and MTB/XDR assays. Data on demographic characteristics, HIV status, and previous TB treatment history were collected and analyzed using R software. The majority of participants were male (62.1%). Multidrug-resistant TB (MDR-TB) was the predominant resistance profile (94.44% of resistant isolates). A significant association was found between previous TB treatment history and drug-resistant TB (p &lt; 0.001). No significant associations were observed between drug-resistant TB and sex or age. A high proportion of participants had unknown HIV status (47.8%), and most resided in urban areas (85.5%). The high prevalence of MDR-TB and its association with previous TB treatment highlight the urgent need to strengthen TB control programs, improve treatment practices, and address the social determinants of TB in Gabon.

ABSTRACTThe Congo Basin and its contiguous forests harbor globally significant carbon stocks, estimated at 65 gigatons of C (GtC) above and belowground. Despite rising temperatures and intensifying droughts, they have remained a carbon sink, albeit weak: 0.26–0.50 GtC yr.−1 carbon uptake since 1980. However, these forests' carbon stocks and fluxes, including gross primary productivity, respiration, net primary productivity, and riverine carbon transport, remain poorly quantified. This limits understanding of the region's role in the global carbon cycle, its vulnerability to environmental change, and its potential as a long‐term carbon sink. We review and quantify Congo Basin and contiguous forest carbon stocks and fluxes and synthesize the current knowledge on how key global change drivers shape the region's carbon cycle. We find limited responses to long‐term precipitation variability, but declining stocks and fluxes in response to long‐term and increasing temperature and drought frequency. Land cover and land use changes, largely driven by small‐scale agriculture, logging, and agro‐industrial expansion, reduce carbon stocks, ecosystem structure and functioning, and animal‐mediated ecosystem services. In contrast, large‐scale savanna biomass burning delivers phosphorus and nitrogen to Congo Basin forests via cross‐equatorial winds, providing additional nutrients and supporting carbon sequestration. In situ studies suggest that CO2 fertilization has increased intrinsic water‐use efficiency, although its effects may be modulated by climate change, and its impacts on biomass accumulation remain uncertain. Legacy effects from historical land use and climate change likely shaped present‐day vegetation structure, yet their relative influence is unclear. High‐resolution carbon monitoring, improved remote sensing, and strengthened in situ measurement networks are needed to quantify the impacts of these key drivers and their interactions on the Central African carbon cycle. This is needed to inform conservation strategies and advance understanding of the region's future as a carbon sink under global change pressures.

Abstract The Congo Basin is more highly urbanized than most of the African continent. Gabon, Cameroon, Equatorial Guinea, and Congo have been majority urban populations for decades, and DRC will pass beyond 50% by 2030. CAR will also reach that mark within 20 years. The rapid growth of urban populations in the Congo Basin nations is discussed and key challenges for city-dwellers are assessed. Unplanned, rapid urbanization and the development of extensive slums with few services and weak political voice is the norm in the larger cities, increasing social inequity and causing crippling damage to human well-being and environmental health in peri-urban haloes, sometimes extending hundreds of kilometers from the urban center. Solutions to this growing challenge are evaluated and recommendations are made which, if implemented, could help to improve health, resilience, quality of life, and security in urban settings, as well as improving biodiversity outcomes. In the light of the sparse literature on the subject, the authors call for an urgent increase in scientific research on this pressing topic within the Congo Basin, which is a clear priority for the region’s majority urban population of the future.

Breast cancer is an escalating public health concern in Sub-Saharan Africa (SSA), where mortality rates remain disproportionately high despite lower incidence compared to Western countries. The combination of late-stage diagnoses, limited healthcare infrastructure, and socioeconomic inequalities severely compromises patient outcomes. We conducted a systematic review and meta-analysis of 85 studies encompassing 33,053 patients across SSA to characterize breast cancer profiles, focusing on age at diagnosis, cancer stage, molecular subtypes, and survival outcomes. The mean age at diagnosis was 48.7 years, notably younger than in high-income regions. Half of the patients were diagnosed at stage III, and only 4% at stage I. Luminal A was the most prevalent molecular subtype (30%), followed closely by triple-negative breast cancer (29%), known for its aggressive course and limited treatment options. Survival analysis revealed a pooled 5-year survival rate of 44%, with substantial regional disparities: survival was poorest in West Africa and comparatively better in East Africa and South Africa. Our findings expose the critical need for regionally tailored interventions to improve early detection, expand access to comprehensive treatment, and address underlying social determinants of health. This study delivers essential epidemiological benchmarks that should inform targeted strategies for reducing the breast cancer burden and improving survival across Sub-Saharan Africa.