Central African Region Research Articles

A comprehensive survey of the prevalence and spatial distribution of ticks infesting cattle in different agro-ecological zones of Cameroon

BackgroundTicks and tick-borne diseases are a major impediment to livestock production worldwide. Cattle trade and transnational transhumance create risks for the spread of ticks and tick-borne diseases and threaten cattle production in the absence of an effective tick control program. Few studies have been undertaken on cattle ticks in the Central African region; therefore, the need to assess the occurrence and the spatial distribution of tick vectors with the aim of establishing a baseline for monitoring future spread of tick borne-diseases in the region is urgent.ResultsA total of 7091 ixodid ticks were collected during a countrywide cross-sectional field survey and identified using morphological criteria. Of these, 4210 (59.4%) ticks were Amblyomma variegatum, 1112 (15.6%) Rhipicephalus (Boophilus) microplus, 708 (10.0%) Rhipicephalus (Boophilus) decoloratus, 28 (0.4%) Rhipicephalus (Boophilus) annulatus, 210 (3.0%) Hyalomma rufipes, 768 (10.8%) Hyalomma truncatum, and 19 (0.3%) Rhipicephalus sanguineus. Three ticks of the genus Hyalomma spp. and 33 of the genus Rhipicephalus spp. were not identified to the species level. Cytochrome c oxidase subunit 1 (cox1) gene sequencing supported the data from morphological examination and led to identification of three additional species, namely Hyalomma dromedarii, Rhipicephalus sulcatus and Rhipicephalus pusillus. The finding of the invasive tick species R. microplus in such large numbers and the apparent displacement of the indigenous R. decoloratus is highly significant since R. microplus is a highly efficient vector of Babesia bovis.ConclusionsThis study reports the occurrence and current geographical distribution of important tick vectors associated with cattle in Cameroon. It appears that R. microplus is now well established and may be displacing native Rhipicephalus (Boophilus) species, such as R. decoloratus. This calls for an urgent response to safeguard the livestock sector in western central Africa.

Provenancing Central African copper croisettes: A first chemical and lead isotope characterisation of currencies in Central and Southern Africa

The Copperbelt is one of the richest copper deposits in the world and has been an important primary metal source for Central African cultures for over a millennium. The technology underlying this exploitation and the trade networks through which copper was exchanged, however, have not yet received much attention in archaeological research. This paper presents the first geochemical dataset for archaeological copper currencies in Central and Southern Africa: croisette ingots. Chemical and lead isotope analysis have been carried out for 45 precolonial copper artefacts with the aim of illuminating their provenance and production technology. The results show that highly pure copper with very low trace element content was produced, indicating the selection, beneficiation and smelting of specific Copperbelt ores. The variable croisette compositions and shapes reflected in burial assemblages support their suggested use as currencies over a large area. This study offers a highly novel contribution to provenance research in Central and Southern Africa, shedding new light on the broader trade networks associated with copper provisioning in these regions. The exploitation of a range of ore sources throughout the 2nd millennium CE has been identified, with a marked shift around the mid-15th century CE largely correlating to croisette typologies. Furthermore, these different geochemical copper signatures can be tentatively related to different Copperbelt zones. Combining these results with archaeological and historical evidence for regional copper production and consumption, this study provides a framework for the future study of copper production and exchange systems in the wider Central and Southern African region.

Malignant mesothelioma in Sub-Saharan Africa: A case report from Lubumbashi, DR Congo.

Although asbestos has been used throughout Africa in the past decades, no reports of asbestos-related malignant mesothelioma are available from sub-Saharan Africa, except from South Africa and Zimbabwe. We present a case of a 39-year-old man who died from a histologically proven malignant mesothelioma of the peritoneum in Lubumbashi, DR Congo. No occupational exposure to asbestos could be found in his history. In view of his young age, we speculated that he had been exposed to asbestos as a child, which was highly plausible because he had grown up in one of the numerous mining estates of the region. The houses of these estates were often built with asbestos-containing materials, notably roofs made of corrugated asbestos-cement. The possibility of past domestic or environmental exposure to asbestos was substantiated by the identification of chrysotile and crocidolite fibres in samples of asbestos-cement collected from the home where the patient had lived as a child. To our knowledge, this is the first report of malignant mesothelioma from a country in the Central African region. We expect that heightened awareness and improved diagnosis will lead to the detection of more asbestos-related diseases in Africa.

Neglected Tropical Diseases in the Central African Region: A Review of their Mass Treatment Coverage

Background: The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 600 million people living in sub-Saharan Africa (SSA) of which the Central African region is part and parcel, and together produce a burden of disease that may be equivalent to one-half of SSA’s malaria disease burden and more than double that caused by tuberculosis. Establishing specific information on the mass treatment coverage would provide a basis for prioritizing control strategies as a means to address the Sustainable Development Goals (SDGs). The objective of this review was to determine the mass treatment coverage trend resulting from 5 NTDs amenable to mass treatment in the Central African region. Methods: A search on PubMed, ScienceDirect, Uniting to Combat NTDs, Cochrane Library, African Journals Online, MEDLINE, Scopus and Google Scholar with the following Keywords: “Neglected Tropical Diseases”, “Mass Treatment Coverage”, “Control”, “Elimination”, “Lymphatic filariasis”, “Onchocerciasis”, “Schistosomiasis”, “Soil-transmitted helminthiases”, “Trachoma was conducted, with the Medical Subject Headings (MeSH), with specific diseases listed as 5 NTDs amenable to mass treatment per Central Africa region country. Studies to assess the mass treatment coverage resulting from 5 NTDs amenable to treatment in Central Africa as the primary outcome variable, were included. Our search was limited to, articles published from the year 2013 to 2018 (A 5 years review) in English and French. The search identified a total of 140 articles amongst which 10 data-based reports and 5 original articles met the inclusion criteria to give a total of 15 papers that were considered. Results: Our review shows that, in the Central African region, Cameroon has the highest mass treatment coverage index (58/100) for 5 NTDs while Rwanda, Gabon, Equatorial Guinea, Sao Tome and Principe had mass treatment coverage indexes of 3/100, 1/100, 0/100, 0/100 respectively indicating the need for coordinated action in filling the missing gaps. Also, in the Central African region; over 66 million people received NTD treatment and those who didn’t receive NTD treatment were over 27 million. Conclusion: There is a need for more data on progress made in reaching people in need of NTD Mass treatment. The way forward paradigm in achieving the control and elimination of NTDs amenable to mass treatment in Central African countries will be to establish, and sustain a task force on NTDs at the African Union, set up a sustainable fund for neglected tropical diseases at the Africa Union, Regularly monitor and report on progress on neglected tropical diseases while recognizing and celebrating countries as they achieve elimination goals. Equally, operational studies on assessing the rate and impact of NTDs mass treatment coverage in the Central African region should be carried out.

Antimicrobial Resistance in the Central African Region: A Review

Background: The impact of antimicrobial resistance (AMR) has placed it among one of the top public health problems worldwide. AMR has increased the global infectious disease burden and put a greater strain on health systems. This review sought to contribute more evidence on this issue of AMR in the Central African Region, by determining the overall bacterial pathogens resistance rate and pathogen specific resistance rate with respect to antimicrobial agents common in the region. Methods: Pubmed and other relevant databases were searched using the Boolean strategy. We reviewed articles from 2008 to 2018 and in accordance with an adapted PRISMA guideline. Article retrieval and screening were done using a structured search inclusion/exclusion criteria. Median and interquartile ranges of percentage resistance were calculated for each antibiotic-bacterium combination. Results: Limited AMR data was available for Central African countries with no reported data for Burundi. A total of 30 articles were included in the final analysis. The most commonly reported bacterium was Salmonella spp that has been reported from 16 studies with median resistance rate of 45.5 (IQR 9.1-81.0). It was also observed that bacterium Staphylococcus aureus had the highest resistance rate with a median resistance of 90 (IQR 86.4-95.2). In general, median resistance rate higher above 50% were observed for the following bacteria; Staphylococcus aureus, Shigella spp, Klebsiella spp, Enterococci, E. Coli and Acinetobacter spp. Conclusion: The review highlights two important findings: first, there is a huge gap of data regarding Antimicrobial resistance in the Central African Region. Second, a high level of drug resistance exists for commonly prescribed Antimicrobial drugs in the Central African region. We recommend the standardization and quality of microbiological identification and susceptibility/resistance testing methods as well as surveillance of AMR to be improved to allow national and international organizations, to monitor the extent of the AMR problem. All of the identified areas of concern need urgent attention by the global health community in order to halt the public health threat associated with spreading AMR.

Infant Mortality in the Central African Region: A Time Trend Descriptive Analysis

Background: The infant mortality rate (IMR) represents a pertinent indicator of a country’s wellbeing, given its relation with different determinants, such as public health policies, socioeconomic conditions, maternal health, quality and access to medical services. The objective of this review was to assess the trend of infant mortality rate in the 2007-2017 period of the Central African Region member states.

Barriers and incentives for conducting research amongst the ophthalmologists in Sub-Sahara Africa.

BackgroundResearch is a critical component amongst the strategies to improve health outcomes of any country. The role of research assumes greater importance in Africa as it carries a larger share of the global burden of diseases, blindness, and low vision. “Vision 2020- the Right to Sight” is a WHO-IAPB collaborated initiative aiming to eliminate preventable blindness by the year 2020. High quality research in eye care is imperative for the initiative to succeed, however, there is a dearth of research in eye care in sub-Saharan Africa in general and specifically in the Eastern, Central, and Southern African (ECSA) region. Identifying the barriers that hamper research in this region is an important step towards the elimination of preventable blindness.MethodsA structured questionnaire using the SurveyMonkey program was sent to ophthalmologists in the ECSA region and South Africa through their respective regional professional bodies.ResultsLack of funding, inadequate time and poor research knowledge were the main research barriers while the ability to improve eye health care through research was the main incentive for conducting research. The response rate for South Africa was low, restricting comparisons with other ECSA countries.ConclusionThe barriers mainly center on financial, human and administrative infrastructure and resources. In spite of the barriers, ophthalmologists in the study region are enthusiastic in research aiming to increase evidence—based knowledge to improve eye health care in line with the goals of “Vision 2020- the Right to Sight” initiative.

Antitubercular evaluation of root extract and isolated phytochemicals from Lophira lanceolata against two resistant strains of Mycobacterium tuberculosis

Context: The roots of Lophira lanceolata Van Tiegh. Ex Keay (Ochnaceae) have numerous medicinal values in the Central African region. Even though the MeOH extract of the roots has shown antimycobacterial activities, the constituents responsible for this inhibitory activity remain unknown.Objective: Phytochemical investigation of the MeOH root extract of L. lanceolata and determination of the antimycobacterial activities of that extract and constituents against the growth of Mycobacterium tuberculosis.Materials and methods: Column chromatography was used to provide bioactive phytoconstituents. Those compounds were elucidated using MS and NMR spectroscopic data. Antimycobacterial screening of the extract (4.882–5000 µg/mL in DMSO during 24 h at 37 °C) and isolated compounds (0.244–250 µg/mL in DMSO during 24 h at 37 °C) was performed by microplate alamar blue assay (MABA) against two mycobacterial strains.Results: The investigation of L. lanceolata MeOH roots extract provided of mixture of unseparated biflavonoids with a newly described one, dihydrolophirone A (1a) associated to lophirone A (1b). The bioactive compounds that effectively inhibited the growth of M. tuberculosis AC45 were found to be compounds 1 and 2. They exhibited MIC values of 31.25 and 15.75 µg/mL, respectively, and their MIC was found to be 62.5 µg/mL against resistant strain AC83.Discussion and conclusions: It is clearly evident from the results obtained that the mycobacterial activity of L. lanceolata could be related mainly to its steroid and flavonoid contents. Therefore, this study suggests the potential of the above-mentioned classes of compounds as promising candidate agents for developing new anti-tuberculosis drugs.

The Assessment of Systemic Risk in the Kenyan Banking Sector

The present paper aims to assess the systemic risk of the Kenyan banking system. We propose a theoretical framework to reveal the time evolution of the systemic risk using sequences of financial data and use the framework to assess the systemic risk of the Kenyan banking system that is regarded as the largest in the East and Central African region. Firstly, we estimate the bilateral exposures matrix using aggregate financial data on loans and deposits from annual reports and analyze the interconnectedness in the market using network centrality measures. Next, we extend the Eisenberg–Noe method to a multiperiod setting to the systemic risk of the Kenyan banking system, in which the multiperiod includes the dynamic evolutions of the Kenyan banking system of every bank and the structure of the interbank network system. We apply this framework to assess dynamically the systemic risk of the Kenyan banking system between 2009 and 2015. The main findings are the following. The theoretical network analysis using network centrality measures showed several banks displaying characteristics of systematically important banks (SIBs). The theoretical default analysis showed that a bank suffering a basic default will trigger a contagious default that caused several other banks in the sector to go bankrupt. Further stress test proved that the KCB bank theoretically caused a few contagious defaults due to an unusually high interconnectedness. This methodology can contribute by being part of monitoring system of the Central Bank of Kenya (regulatory body) as well as the implementation of policies (such as bank-internal stress tests) that assist in preventing default contagion.

Optimal Cropping Sequence in Pluriactive Non-specialised Vegetable Farms in the Northwest Region of Cameroon

Cameroon champions the vegetable subsector in the Central African sub region both in output levels, export quantities and foreign exchange earnings. The country exports, formally and informally, fresh vegetables to neighboring countries like Nigeria, Central African Republic, Gabon and Equatorial Guinea. Besides ensuring food self-sufficiency, the primary intention of these pluriactive non-specialized vegetable farmers who also cultivate staple energy food crops as complementary and supplementary enterprises is to maximize farm profits subject to the numerous constraints. These constraints are further compounded by an acute incidence of climate variability, seasonal price fluctuations and poor farm planning. This study sought to find out an annual cropping pattern or sequence that maximizes annual returns and enhances the optimal allocation and utilization of farm resources. The study adopted the stratified random sampling technique to interview 120 vegetable farmers in the Northwest Region of Cameroon, from which pluriactive non-specialized were identified. This data was subjected to inferential statistical and dynamic programming analytical techniques. Theresults identified sixteen species of vegetable crops cultivated alongside energy food crops in the study area. The study further identified three cropping seasons in a year (March-June, July-October, and November-February) and suggested the prioritization of the tuber vegetable during the first cropping season, the leafy vegetables during the second cropping season and the fruit vegetables during the third cropping season. This optimal cropping pastern is highly responsive to climate weather risks and market shocks thus presenting potentials of yielding higher profits of up to 5 256 614.8 FCFA ((US$ 8761.0) per annum from pluriactive vegetable farming.

Commercialization of Cattle in the Urban Markets of Yaoundé, Center Region of Cameroon: Policy Implication for an Informal Activity

This article analyzes the functioning of the Yaounde market through an analysis of the role of the public authorities in the functioning of the Yaounde market, the types of economic actors involved in the commercial exchanges, the sources and the supply routes of the different marketed cattle breeds, The financial analysis of the actors involved and constraints to the development of this market through a survey of the various actors was carried out. Data was collected using a questionnaire administered to 121 respondents who were selected by the multi-stage random sampling technique. The analysis of the collected data revealed that the lifting of the health barrier established between the Far North and the Great South of Cameroon against the diseases of plague, trypanosomiasis and foot-and-mouth disease plays an essential role in the development of the Yaounde markets. Lately, it has assumed a regional economic importance since it hosts not only the animals of North Cameroon but also those of the Central African Republic. Not according to their race or their geographical origin, the commercial value of the animals is appreciated according to their life weight, or their morphology. The financial analysis of the actors shows that this activity is profitable. However, the gross margin generated by the big butchers (52,700 CFA francs / beef) and the small butchers (43,500 CFA / leg of 64 kg) were the most interesting. Although the market has become a supply hub for some major cities of Cameroon (Douala) and the Central African Sub Region (Libreville and Malabo), it suffers from infrastructural difficulties and a lack of transfer of competence through decentralization.

The Hub Status and Transportation Network of Kribi Port

In this paper, a study on four African ports was taken out that all have the ca-pability to become a hub port that can serve the central African region. The paper sort to determine which port was most suitable and port indexing was the method that was used to evaluate these ports. The ports evaluated were the port of Kribi, the port of Bata, the port of Libreville and the port of Pointe-Noire. There were other models that were also used which included linear regression and linear programming which all contributed to providing the final results of the port with the most suitable potential to serve as a hub port and meaningful results were obtained. The final results showed that the port of Pointe-Noire was the most suitable port to serve the central African region as a hub port.

Prevalence and sources of polychlorinated biphenyls in the atmospheric environment of Lake Victoria, East Africa

The large surface area of Lake Victoria (about 68,800 km2) makes it vulnerable to high atmospheric deposition of chemical pollutants. We present measurements of polychlorinated biphenyls (PCBs) from the lake's atmospheric environment. High volume air (24 h) samples were collected within the northern Lake Victoria watershed in Uganda over two periods; 1999–2004 [at Kakira (KAK) and Entebbe (EBB)] and 2008–2010 (at EBB only). Precipitation samples were also collected monthly during the 2008–2010 period at EBB. Analysis for PCBs was done using GC-μECD in a dual column approach. The ranges of ΣPCB concentrations in the KAK air samples were 154–462 pg m−3 (KAK 1999–2000), 26.7–226 pg m−3 (KAK 2003–2004), 27.0–186 pg m−3 (EBB 2003), 46.8–174 pg m−3 (EBB 2004), 19.2–128 pg m−3 (EBB 2008), 45.8–237 pg m−3 (EBB 2009) and 65.6–244 pg m−3 (EBB 2010). The di-, tri-, tetra- and penta-PCBs were predominant in air sample sets while the tetra- and penta-PCBs were predominant in precipitation samples. The mean flux of ΣPCBs in the precipitation samples was 26.9 ng m−2 (range of 14.8–41.5 and median of 27.5). Concentrations at EBB were lower than those reported elsewhere for urban sites in the East and Central African region. Multivariate analysis and analysis of air mass movements suggested influence of combustion sources on the PCB profiles from the region, especially, from the major East African urbanized regions.

Elections still a weak spot in Central Africa - Interview: François Loucény Fall, the Special Representative of the Secretary-General and head of the United Nations Regional Office for Central Africa (UNOCA) and his team briefing the Security Council

The special representative of the Secretary-General and head of the United Nations Regional Office for Central Africa (UNOCA), Francois Lounceny Fall, appeared before the UN Security Council in June to brief it on the situation in the Central African region. He talked about political tension caused by February’s controversial elections, in addition to security threats by rebels and terrorist groups such as Boko Haram. Africa Renewal’s Franck Kuwonu sat down with Mr. Fall after the briefing to discuss the situation in the region.

Preliminary report of an autochthonous chikungunya outbreak in France, July to September 2017.

In August 2017, an autochthonous chikungunya case was reported in south-east France. By mid-September, eight additional autochthonous cases were found in the index case’s neighbourhood, where the chikungunya virus vector Aedes albopictus was observed. Genomic characterisation identified an East-Central South African (ECSA) lineage strain, probably from the Central African region and carrying an adaptive mutation facilitating transmission by Ae. albopictus. The event confirms we need early case detection and response to contain chikungunya in Europe.

Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

Introduction: Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC).Methods: A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges.Results: Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076–16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12–255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and peer support activities.Conclusions: The principles of differentiated HIV care for high-quality ART delivery can successfully be applied in challenging operating environments. However, success heavily depends on specific adaptations to each setting.

Potential of Central, Eastern and Western Africa Medicinal Plants for Cancer Therapy: Spotlight on Resistant Cells and Molecular Targets.

Cancer remains a major health hurdle worldwide and has moved from the third leading cause of death in the year 1990 to second place after cardiovascular disease since 2013. Chemotherapy is one of the most widely used treatment modes; however, its efficiency is limited due to the resistance of cancer cells to cytotoxic agents. The present overview deals with the potential of the flora of Central, Eastern and Western African (CEWA) regions as resource for anticancer drug discovery. It also reviews the molecular targets of phytochemicals of these plants such as ABC transporters, namely P-glycoprotein (P-gp), multi drug-resistance-related proteins (MRPs), breast cancer resistance protein (BCRP, ABCG2) as well as the epidermal growth factor receptor (EGFR/ErbB-1/HER1), human tumor suppressor protein p53, caspases, mitochondria, angiogenesis, and components of MAP kinase signaling pathways. Plants with the ability to preferentially kills resistant cancer cells were also reported. Data compiled in the present document were retrieved from scientific websites such as PubMed, Scopus, Sciencedirect, Web-of-Science, and Scholar Google. In summary, plant extracts from CEWA and isolated compounds thereof exert cytotoxic effects by several modes of action including caspases activation, alteration of mitochondrial membrane potential (MMP), induction of reactive oxygen species (ROS) in cancer cells and inhibition of angiogenesis. Ten strongest cytotoxic plants from CEWA recorded following in vitro screening assays are: Beilschmiedia acuta Kosterm, Echinops giganteus var. lelyi (C. D. Adams) A. Rich., Erythrina sigmoidea Hua (Fabaceae), Imperata cylindrical Beauv. var. koenigii Durand et Schinz, Nauclea pobeguinii (Pobég. ex Pellegr.) Merr. ex E.M.A., Piper capense L.f., Polyscias fulva (Hiern) Harms., Uapaca togoensis Pax., Vepris soyauxii Engl. and Xylopia aethiopica (Dunal) A. Rich. Prominent antiproliferative compounds include: isoquinoline alkaloid isotetrandrine (51), two benzophenones: guttiferone E (26) and isoxanthochymol (30), the isoflavonoid 6α-hydroxyphaseollidin (9), the naphthyl butenone guieranone A (25), two naphthoquinones: 2-acetylfuro-1,4-naphthoquinone (4) and plumbagin (37) and xanthone V1 (46). However, only few research activities in the African continent focus on cytotoxic drug discovery from botanicals. The present review is expected to stimulate further scientific efforts to better valorize the African flora.

Low incidence of the immune reconstitution inflammatory syndrome among HIV-infected patients starting antiretroviral therapy in Gabon: a prospective cohort study

There is a paucity of data on the immune reconstitution inflammatory syndrome (IRIS) in the Central African region. We followed ART-naive HIV-infected patients initiating antiretroviral therapy in an HIV clinic in Gabon, for 6 months. Among 101 patients, IRIS was diagnosed in five. All IRIS cases were mucocutaneous manifestations. There were no cases of tuberculosis (TB) IRIS, but active TB (n = 20) was associated with developing other forms of IRIS (p = 0.02). Six patients died. The incidence of IRIS is low in Gabon, with mild, mucocutaneous manifestations.

Evaluation of simulations with the regional climate model REMO over Central Africa and the effect of increased spatial resolution

ABSTRACTSimulations of the regional climate model REMO at 25 and 50 km (0.44° and 0.22°, respectively) grid spacing are evaluated over Central Africa for the period 1998–2010. The model's ability to simulate various aspects of the observed climate is assessed with a main focus on precipitation characteristics. The results show that the REMO model has a good skill to reproduce the main regional features of the mean climate fields as well as seasonal and annual cycles, although some biases still exist. The model captures the variability in precipitation anomalies between different events associated with El Niño/Southern Oscillation. Generally, the findings remain largely insensitive to the refinement of the horizontal resolution, especially when considering the regional scale. This points the fact that the model dynamical and physical setup may have to be adjusted when setting a focus on the Central African region, in order to better represent the climate mechanisms. It is further found that REMO is capable of capturing the basic features of climatic extremes and accurately represents the shape of the frequency distribution of daily precipitation data. Daily characteristics of precipitation are simulated much better by REMO at 25 km.

Demography, maternal health and the epidemiology of malaria and other major infectious diseases in the rural department Tsamba-Magotsi, Ngounie Province, in central African Gabon

BackgroundSub-Saharan Africa is undergoing an epidemiological transition from a predominance of infectious diseases to non-communicable and lifestyle related conditions. However, the pace of this transition and the pattern of disease epidemiology are uneven between affluent urban and rural poor populations. To address this question for a remote rural region located in the central African rainforest region of Gabon, this study was conducted to assess reasons for health care attendance and to characterize the epidemiology of malaria and other major infectious diseases for the department of Tsamba Magotsi.MethodsMajor causes for health care attendance were collected from local hospital records. Cross sectional population based surveys were performed for the assessment of local malaria epidemiology. Pregnant women attending antenatal care services were surveyed as a sentinel population for the characterization of chronic viral and parasitic infections in the community.ResultsInfectious diseases were responsible for 71% (7469) of a total of 10,580 consultations at the formal health care sector in 2010. Overall, malaria – defined by clinical syndrome – remained the most frequent cause for health care attendance. A cross sectional malaria survey in 840 asymptomatic individuals residing in Tsamba Magotsi resulted in a Plasmodium spp. infection prevalence of 37%. The infection rate in 2–10 year old asymptomatic children – a standard measure for malaria endemicity – was 46% (100 of 217) with P. falciparum as predominant species (79%). Infection with other plasmodial species (P. ovale and P. malariae) presented most commonly as coinfections (23.2%). Prevalence of HIV, HBV, and syphilis were 6.2, 7.3, and 2.5%, respectively, in cross-sectional assessments of antenatal care visits of pregnant women. Urogenital schistosomiasis and the filarial pathogens Loa loa and Mansonella perstans are highly prevalent chronic parasitic infections affecting the local population.ConclusionsDespite major improvements in the accessibility of Tsamba Magotsi over the past decade the epidemiological transition does not appear to have majorly changed on the spectrum of diseases in this rural Gabonese population. The high prevalence of Plasmodium infection indicates a high burden of malaria related morbidity. Infectious diseases remain one of the most important health issues and further research activities in the field of tropical medicine and infectious diseases could help improve health care for the local population.