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  1. Gédéon P Manouana1,2,
  2. Gedeon Bingoulou Matsougou1,3,
  3. Natalie Byrne4,
  4. Philipp Hofmann5,
  5. mirabeau Mbong Ngwese1,
  6. Pau A Nguema Moure1,
  7. Jeannot Fréjus Zinsou1,
  8. Jean Claude Dejon Agobe1,
  9. Bayode R Adegbite1,
  10. Jean R Edoa1,
  11. Yabo J Honkpehedji1,
  12. Matthew B.B. Mccall1,
  13. Abraham S Alabi1,
  14. Daniel Eibach6,7,
  15. Peter G Kremsner1,2,
  16. Steffen Borrmann2,
  17. Ayola A Adegnika1,2
  1. 1Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
  2. 2Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
  3. 3Faculté de médecine, Université des Sciences de la Santé, Libreville, Gabon
  4. 4Faculty of Medicine, Universität Tübingen, Germany
  5. 5Charité-Universitätmedizin Berlin, Germany
  6. 6Bernhard Nocht Institute for Tropical Medicine
  7. 7German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany


Background Diarrhoeal disease remains the second leading cause of death in children under five years, being associated with about 525,000 deaths every year. The most common pathogens worldwide are Shigella spp/EIEC, rotavirus, adenovirus 40/41, ST-ETEC and Cryptosporidium spp. Public health interventions rely on estimates of pathogen-specific burden for prioritisation. Sadly, comprehensive data on the aetiology of diarrhoea in children is lacking for Gabon. This study aimed to identify the spectrum of pathogens found in Lambaréné, Gabon and provide baseline data on their prevalence, needed for implementation of effective control measures.

Methods A cross-sectional study was conducted at Albert Schweitzer and Georges Rawiri Regional hospitals in Lambaréné from February 2017 to February 2018. A consecutive sample of children under 5 year old with diarrhoea or a history of diarrhoea within the previous three days were prospectively studied. A single stool sample was collected from each study participant and processed using commercial rapid immunoassays to detect antigens of rotavirus, adenovirus, and Cryptosporidium spp. Multiplex PCR was used for Cryptosporidium spp., Giardia lamblia and Cyclospora cayetanensis detection, and characterisation of E. coli strains.

Results Out of 188 participants who provided stool samples, one or more pathogens could be detected in 34.6% of the cases. The most prevalent parasites were Giardia lamblia (14.9%), Cryptosporidium spp. (11.7%), and Cyclospora cayetanensis (2.7%). Enteric viruses also were identified in these children: 10.6% and 1.6% of rotavirus and adenovirus, respectively. Multiple pathogens were detected in 5.3% of samples.

Conclusion This analysis of the causes of diarrhoea in children under 5 years of age in our setting showed three main pathogens: Giardia lamblia, Cryptosporidium spp. and rotavirus. Our study confirms major agents of acute diarrhoeal diseases in children, highlights research needs (Cryptosporidium) and supports the introduction of new tools such as the implementation of the rotavirus vaccine in the national immunisation programme.

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