Assessment of the direct hospital cost of medical care for patients hospitalized for a stroke in Gabon.

While the incidence of stroke is increasing in developing countries, resulting in an extremely high economic burden, very few costing studies have been carried out to date. This study aims to measure the direct hospital costs of stroke management in Gabon. The study adopts a retrospective approach, based on a review of patient records in the Neurology and Cardiology Departments of the University Hospital of Libreville (CHUL) between January 2018 and December 2019. It focuses on all patients received for stroke at the CHUL during the study period, regardless of the outcome, analyzing direct hospital costs. Three hundred and thirteen (313) patients were admitted during the period in question, 72.52% in neurology and 27.48% in cardiology. The average age was 58.44 (±13.73 years). Fifty-six percent (56.23%) had health coverage. Ischemic stroke was more common than hemorrhagic stroke, at 79.55% and 20.45%, respectively. The average expenditure per patient was estimated at 619,633 CFA francs (€944.62). From the point of view of social security coverage, the average out-of-pocket expense per patient was 147,140 CFA francs (€224.31), for a reimbursement of 422,883 CFA francs (€644.68). The average direct cost of stroke is very high for both patients and administrations. This argues for the implementation of prevention programs for the disease. The results of this study may be useful for work on the efficiency of such programs.

Assessment of genetic polymorphisms associated with malaria antifolate resistance among the population of Libreville, Gabon.

BACKGROUND: Gabon is a malaria-threatened country with a stable and hyperendemic transmission of Plasmodium falciparum monoinfection. Malaria drug resistance is widely spread in many endemic countries around the world, including Gabon. The molecular surveillance of drug resistance to antifolates and artemisinin-based combination therapy (ACT) is one of the strategies for combating malaria. As Plasmodium parasites continue to develop resistance to currently available anti-malarial drugs, this study evaluated the frequency of the polymorphisms and genetic diversity associated with this phenomenon among the parasites isolates in Gabon. METHODS: To assess the spread of resistant haplotypes among the malaria-infected population of Libreville, single nucleotide polymorphisms linked to sulfadoxine-pyrimethamine (SP) and artemisinin drugs resistance were screened for P. falciparum dihydrofolate reductase (Pfdhfr), P. falciparum dihydropteroate synthase (Pfdhps), and P. falciparum kelch 13-propeller domain (Pfk13) point mutations. RESULTS: The analysis of 70 malaria-positive patient samples screened for polymorphism showed 92.65% (n = 63) mutants vs. 7.35% (n = 5) wild parasite population in Pfdhfr, with high prevalence mutations at S108N(88.24%, n = 60), N51I(85.29%, n = 58), C59R(79.41%, n = 54); however, I164L(2.94%, n = 2) showed low frequency mutation. No wild haplotype existed for Pfdhps, and there were no mutations at the K540E, A581G, and A613T/S positions. However, the mutation rate at A437G(93.38%, n = 62) was the highest, followed by S436A/F(15.38%, n = 10). A higher frequency of quadruple IRNI-SGKAA (69.84%) than quintuple IRNI-(A/F)GKAA (7.94%) mutations was observed in the Pfdhfr-Pfdhps combination. Furthermore, none of the mutations associated with ACT resistance, especially those commonly found in Africa, were observed in Pfk13. CONCLUSIONS: High polymorphism frequencies of Pfdhfr and Pfdhps genes were observed, with alternative alanine/phenylalanine mutation at S436A/F (7.69%, n = 5) for the first time. Similar to that of other areas of the country, the patterns of multiple polymorphisms were consistent with selection owing to drug pressure. Although there was no evidence of a medication failure haplotype in the studied population, ACT drug efficacy should be regularly monitored in Libreville, Gabon.

Assessment of malaria transmission intensity and insecticide resistance mechanisms in three rural areas of the Moyen Ogooué Province of Gabon.

BACKGROUND: Vector control is considered to be the most successful component of malaria prevention programs and a major contributor to the reduction of malaria incidence over the last two decades. However, the success of this strategy is threatened by the development of resistance to insecticides and behavioural adaptations of vectors. The aim of this study was to monitor malaria transmission and the distribution of insecticide resistance genes in Anopheles populations from three rural areas of the Moyen Ogooué Province of Gabon. METHODS: Anopheles spp. were collected using human landing catches in Bindo, Nombakélé and Zilé, three villages located in the surroundings of Lambaréné, during both the rainy and dry seasons. Mosquitoes were identified morphologically, and DNA was extracted from heads and thoraces. Members of the Anopheles gambiae complex were identified by molecular methods using the PCR SINE200 protocol and by sequencing of the internal transcribed spacer 2 region. Taqman assays were used to determine Plasmodium infection and the presence of resistance alleles. RESULTS: Anopheles gambiae sensu lato (97.7%), An. moucheti (1.7%) and An. coustani (0.6%) were the three groups of species collected. Anopheles gambiae sensu stricto (98.5%) and An. coluzzii (1.5%) were the only species of the An. gambiae complex present in the collection. Of the 1235 Anopheles collected, 1193 were collected during the rainy season; these exhibited an exophagic behaviour, and consistently more mosquitoes were collected outdoor than indoor in the three study areas. Of the 1166 Anopheles screened, 26 (2.2%) were infected with Plasmodium species, specifically Plasmodium falciparum (66.7%), P. malariae (15.4%), P. ovale curtisi (11.5%) and P. ovale wallikeri (3.8%). Malaria transmission intensity was high in Zilé, with an average annual entomological inoculation rate (aEIR) of 243 infective bites per year, while aEIRs in Bindo and Nombakélé were 80.2 and 17 infective bites per year, respectively. Both the L1014F and L1014S mutations were present at frequencies > 95% but no Ace1G119S mutation was found. CONCLUSION: Our results demonstrate that malaria transmission intensity is heterogeneous in these three rural areas of Moyen Ogooué Province, with areas of high transmission, such as Zilé. The exophagic behaviour of the mosquitoes as well as the high frequency of resistance mutations are serious challenges that need to be addressed by the deployment of control measures adapted to the local setting.

Funding patterns for biomedical research and infectious diseases burden in Gabon.

BACKGROUND: Biomedical research plays an important role in improving health. There seems to exist a negative correlation between the amount of biomedical research funding and disease burden from all Sub-Saharan African countries. In this study, we describe funding patterns for biomedical research, explore the correlation between funding and burden of diseases, and quantify inequalities in funds distribution across diseases in Gabon over the period 2005-2015. METHODS: Data on medical research funds from 2005 to 2015 were retrieved through a structured questionnaire distributed to Gabonese biomedical research institutions and by consulting online databases. Data on the burden of diseases were gathered from the World Health Organization and the Institute for Health Metrics and Evaluation. We used Kendall rank correlation coefficient to explore the correlation between cumulative funds over time and the burden of disease. The inequality distribution of funding across diseases was assessed through Gini coefficient and Lorenz curve. RESULTS: Biomedical research funding was characterized by a remarkable growth from 2005 to 2010 and a decline from 2010 to 2014. Funds were mostly from external sources and from partnerships. There was inequality in research funds allocation across diseases and malaria was far the most funded disease. There was a significant negative correlation between cumulative funding and the burden of HIV, tuberculosis, and of Helminthiasis (from 2006 to 2010) suggesting that research may be contributing to the management of such diseases. A positive, although not significant, correlation was found between cumulative funds and malaria burden. CONCLUSIONS: The negative correlation between HIV and tuberculosis cumulative funding and burden suggests that research may be contributing to the management of such diseases but further research is needed to assess the causal direction of such as relationship. As the burden of non-communicable diseases is increasing, more research funds should be focused on those. While research partnerships have been and will remain fundamental, Gabon should increase the amount of national funds to overcome periods of reduced research funding flows from abroad.

Evaluation of direct costs associated with the management of clinical stage of malaria in children under five years old in Gabon.

BACKGROUND: Malaria is one of the leading causes of morbidity and mortality in African countries. It is one of the leading causes of hospital visits and hospitalization in pediatric wards for children under 5 years old. Interestingly however, the economic burden of this disease remains unknown in these endemic countries including Gabon. The purpose of this study is to assess the direct hospital cost for the management of malaria in children under 5 years old at the Libreville University Hospital Centre (CHUL, Centre Hospitalier Universitaire de Libreville) in Gabon. METHODS: This research work is a retrospective study using a comprehensive review of medical records of patients seen at the CHUL over a two-year period extending from January 2018 through December 2019. The study focused on children under 5 years old, admitted for malaria in the paediatric ward of the CHUL. The analysis targeted specifically direct hospital costs, which excluded salary and wages of health care workers. The monetary currency used in this study was the CFA francs, as that currency is the one used in Central Africa (as reference, 1 Euro = 656 CFA francs). RESULTS: For the set timeframe, 778 patient records matched the study criteria. Thus, out of 778 admitted patients, 58.4% were male while 41.5% were female. Overall, the average age was 13.2 months (± 13.8 months). The total cost incurred by the hospital for the management of these 778 malaria patients was 94,922,925 CFA francs (144,699.58 €), for an average expense per patient topping at 122,008 CFA francs (185.99 €). The highest expenditure items were hospitalizations (44,200,000 CFA francs, 67,378.1 €), followed by drugs (26,394,425 CFA francs, 40,235.4 €) and biomedical examinations (14,036,000 CFA francs, 21,396.34 €). CONCLUSION: The financial burden for managing malaria in the paediatric ward seems to be very high, not only for the hospital, but also for families in spite of the government medical insurance coverage in some cases. These findings bring new insights as to the urgency to develop policies that foster preventive initiatives over curative approaches in the management of malaria in children in endemic countries.

Burden of disease in Gabon caused by loiasis: a cross-sectional survey.

BACKGROUND: Loiasis is a highly prevalent helminth infection found in distinct regions of sub-Saharan Africa. The disease has been considered to be of minor clinical significance, but this belief is being increasingly challenged by recent evidence. We aimed to prospectively quantify the overall burden of disease caused by loiasis in an endemic region of Gabon, using disability-adjusted life years (DALYs). METHODS: We did a cross-sectional survey during 2017 and 2018 in rural Gabon. Volunteers underwent diagnostic tests for loiasis and were given a standardised questionnaire on symptoms. Participants reporting eye worm migration or harbouring Loa loa microfilariae were defined as loiasis positive. Morbidity-based DALYs associated with loiasis were estimated for the rural population of Gabon. FINDINGS: Between Sept 1, 2017 and May 31, 2018, 1235 participants residing in 38 villages in the Gabonese departments of Tsamba-Magotsi and Ogooué et des Lacs were screened. 626 (50·8%) of 1232 eligible participants had loiasis. 520 (42·2%) of 1232 participants reported eye worm migration. 478 (93·9%) of 509 individuals with eye worm migration also reported associated pain, and 397 (78·6%) of 505 reported vision disturbances. After correcting for age and sex, loiasis was significantly associated with a variety of symptoms, including transient painful oedema (adjusted odds ratio 1·76 [95% CI 1·37-2·26]) and arthralgia (1·30 [1·01-1·69]). Application of attributable fractions of correlating symptoms resulted in 412·9 (95% CI 273·9-567·7) morbidity-based DALYs per 100 000 people in rural Gabon. INTERPRETATION: Loiasis, with the pathognomonic sign of eye worm migration, appears to not be benign, but severely impeding to affected individuals. Furthermore, loiasis is associated with substantial morbidity, comparable to that of other neglected tropical parasitic diseases. These findings call for reconsideration of L loa as a relevant pathogen in affected populations, with a need for more concerted research and control of these infections. FUNDING: Federal Ministry of Science, Research and Economy of Austria, and the European Union.

Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon.

BACKGROUND: To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. METHODS: The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)-2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women's utilization of health care. RESULTS: Mean (+/- SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p ≤ 0.001), facility-based delivery (Conc. Index = 0.069; p ≤ 0.001), and postnatal care (Conc. Index = 0.075; p ≤ 0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). CONCLUSION: Women enrollment in health insurance and improved household's financial status can improve key maternal health services utilization.

Lupus: evidence of environmental degradation? Assessment from 60 patients followed up in the Internal Medicine Department at the Libreville University Hospital, Gabon.

Lupus is an autoimmune disease of the connective tissue that occurs predominantly in women and blacks and whose expression is influenced by environmental factors, especially ultraviolet rays. The rising temperature in Gabon for nearly two decades led us to look for correlations between the onset of lupus, the patients' regions of origin, and environmental temperatures before and at diagnosis. retrospective, descriptive, and analytic study conducted in the Department of Internal Medicine of the CHU of Libreville (Gabon), from 01/01/2016 to 31/05/2016, based on the files of patients with diagnosed lupus receiving care in the department since 01/2002. Data collection forms listed for each patients age, sex, occupation, date and season of diagnosis, and place of residence (during childhood, adolescence, and adulthood). We looked for correlations between these data and temperatures, based on meteorological data from the country's seven main weather stations over a period from 1996 to 2015. The study included 53 women and 7 men (sex ratio 0.13), with a mean age of 32.7 +/- 8.9 years. The population included students (n = 25), civil servants (n = 15), the unemployed (n = 8), private-sector employees (n = 6), and shopkeepers (n=6). Diagnoses varied according to season, with 56.6% of the cases in the dry season and 43.4% in the rainy season. From 1 to 4 cases of lupus were diagnosed annually before 2011, 7 each year from 2011 to 2014, and at least 14 per year since 2015. Most patients (62.5%) had spent their childhood, adolescence, and adulthood in the country's capital (industrial zone par excellence), 17.8% in mining regions, and 12.5% in oil-drilling areas. The increase in the number of cases of lupus appears to be correlated with their greater prevalence in regions with higher temperature exposures, that is, in industrial, mining and petroleum regions, which are the regions of greatest exposure among our lupus patients.

Diabetes in Sub-Saharan Africa: Distribution Based on Social Status in Libreville (Gabon).

OBJECTIVE: Many researchers continue to believe that urbanization is a major contributor to diabetes. We seek to demonstrate that the social status associated with urbanization has an impact on the prevalence of diabetes in Libreville, Gabon in sub-Saharan Africa. METHODS: Our study was conducted in Libreville, the capital of Gabon; the city has a population of 397,000. Our study analyzed data from the registries of patients hospitalized in 2013 in the main diabetes center in Libreville. RESULTS: The results revealed that, for 2013, 798 patients were hospitalized with diabetes at a prevalence of .2%. We found differences (P<.05) between women (423) and men (375). Mean age for women was 52.02 years and 48.88 years for men. The number of existing cases hospitalized was significantly more than new cases. All levels of society were represented in our study: students (42); military (36); administratives (99); technicians (180); unemployed (295); and retired (146). The results showed that the unemployed (36%), particularly women (29.40%) are most affected by diabetes. CONCLUSIONS: Our results show the impact of social status on the increase of diabetes in Libreville. We found that urbanization, associated with insecurity especially in women, had an effect on the prevalence of diabetes in Libreville. These results indicate that, apart from the non-modifiable factors (age, race, ethnicity), insecurity is a modifiable factor that should be taken into account.

Prevalence and risk factor assessment of Tropheryma whipplei in a rural community in Gabon: a community-based cross-sectional study.

Tropheryma whipplei is the causative agent of Whipple's disease and has been detected in stools of asymptomatic carriers. Colonization has been associated with precarious hygienic conditions. There is a lack of knowledge about the epidemiology and transmission characteristics on a population level, so the aim of this study was to determine the overall and age-specific prevalence of T. whipplei and to identify risk factors for colonization. This molecular epidemiological survey was designed as a cross-sectional study in a rural community in Central African Gabon and inhabitants of the entire community were invited to participate. Overall prevalence assessed by real-time PCR and sequencing was 19.6% (95% CI 16-23.2%, n=91) in 465 stool samples provided by the study participants. Younger age groups showed a significantly higher prevalence of T. whipplei colonization ranging from 40.0% (95% CI 27.8-52.2) among the 0-4 year olds to 36.4% (95% CI 26.1-46.6) among children aged 5-10 years. Prevalence decreased in older age groups (p<0.001) from 12.6% (95% CI 5.8-19.4%; 11-20 years) to 9.7% (95% CI 5.7-13.6) among those older than 20. Risk factor analysis revealed young age, male sex, and number of people sharing a bed as factors associated with an increased risk for T. whipplei carriage. These results demonstrate that T. whipplei carriage is highly prevalent in this part of Africa. The high prevalence in early life and the analysis of risk factors suggest that transmission may peak during childhood facilitated through close person-to-person contacts.

Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon.

Deaths resulting from unsafe induced abortions represent a major component of maternal mortality in countries with restrictive abortion laws. Delays in obtaining care for maternal complications constitute a known determinant of a woman's risk of death. However, data on the role of delays in providing care at health care facilities are sparse. The association between the cause of maternal death (abortion versus post-partum haemorrhage or eclampsia) and the time interval between admission to hospital and the initiation of treatment were evaluated among women who died at the Maternité du Centre Hospitalier de Libreville, Gabon, between 1 January 2005 and 31 December 2007. The women's characteristics and the time between diagnosis of the condition that led to death and the initiation of treatment were compared for each cause of death. After controlling for selected variables, the mean time between admission and treatment was 1.2 hours (95% CI: 0.0-5.6) in the case of women who died from post-partum haemorrhage or eclampsia and 23.7 hours (95% CI: 21.1-26.3) in the case of women who died of abortion-related complications. In conclusion, delay in initiating care was far greater in cases of women with complications of unsafe abortion compared to other pregnancy-related complications. Such delays may constitute an important determinant of the risk of death in women with abortion-related complications.

Socio-economic status is inversely related to bed net use in Gabon.

BACKGROUND: Insecticide-treated bed nets (ITNs) range among the most effective measures of malaria prophylaxis, yet their implementation level in sub-Saharan Africa is still low. The goal of this study was to investigate the influence of socio-economic factors on the use of bed nets by mothers in Gabon. METHODS: A cross-sectional study was conducted completing pre-tested, interviewer-administered questionnaires exploring socioeconomic proxy measures with 397 mothers or guardians of young children. Respondents were grouped according to their socio-economic situation, using scores. The condition of the bed nets was evaluated during a home visit. RESULTS: Socio-economic factors of wellbeing were negatively associated with bed net use, such as living in a stone house (OR 0.26, 95% CI 0.14-0.48), running water in the house (OR 0.44, 95% CI 0.21-0.92), shower/flush toilet in the house (OR 0.39/0.34, 95% CI 0.21-0.75/0.16-0.73), ownership of a freezer (OR 0.50, 95% CI 0.26-0.96) and belonging to the highest group in the economic score (OR 0.32, 95% CI 0.15-0.67). In contrast, similar factors were positively associated with a good maintenance condition of the bed nets: higher monthly income (OR 5.64, 95% CI 2.41-13.19) and belonging to the highest group in the economic score (OR 2.55, 95% CI 1.19 - 5.45). CONCLUSION: Among the poorest families in Lambaréné the coverage with untreated nets (UTNs) is the highest, but the condition of these UTNs is the worst. To achieve a broad implementation of ITNs in Lambaréné, there is an urgent need for educational programmes as well as need-tailored marketing strategies for ITNs.

[Maternal mortality in Libreville, Gabon: assessment and challenges]. / Mortalité maternelle à Libreville (Gabon): état des lieux et défis à relever en 2006.

OBJECTIVE: To analyze the course over time of the rates and causes of maternal mortality in Libreville, Gabon. MATERIAL AND METHODS: This prospective descriptive study covers the 6-year period from January 1, 2001, to December 31, 2006. It was performed at the Libreville Hospital Center (LCH) maternity ward, the leading obstetrical care facility in the country. A maternal mortality registry began recording deaths on January 1, 2001. All maternal deaths are listed there, and a department meeting focusing on the death is organized after each. In this study, we analysed the epidemiologic characteristics, circumstances and cause of each death. RESULTS: In all, 136 women died. Their mean age was 25 +/- 5 years with a range of 16 to 41 years. Mean parity was 4 +/- 3, and ranged from 1 to 7. Most of the women were not employed (86%), but had at least some secondary schooling (88%). There were 126 cases (93%) of intrapartum deaths. They occurred more often at night (72% versus 28% during the day) and during the week (77% versus 23% on weekends). The maternal mortality rate was cut in half between 2000 and 2006 (p<0.005), dropping from 444 to 248 per 100 000 live births. Hemorrhages and eclampsia were the two principal causes of mortality. CONCLUSION: Faster access to care and improvement in the quality of emergency obstetrical care are essential conditions for reducing maternal mortality.

[Clinical and laboratory findings in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon (2002-2005)]. / Bilan clinico-biologique des patients infectés par le VIH à la Fondation Jeanne Ebori de Libreville (2002-2005).

The purpose of this study was to evaluate management of HIV-infected/AIDS patients within the framework of the ACCESS program at Center N 3 over a 4-year period. This retrospective single-center study included HIV-positive patients treated at the Jeanne Ebori Foundation in Libreville, Gabon between January 2002 and December 2005. The active file included 749 patients, i.e., 436 undergoing antiretroviral therapy and 313 with intention to treat. The population consisted mainly of city dwellers. Mean patient age was 38.8 years with a female predominance (sex ratio, 0.8). The highest incidence of infection was observed in the 20- to 30-year age group. Socioeconomic position was low in 63.2 % of patients. Clinical suspicion (67%) was the main reason for testing. In order of frequency, symptoms defined according to the WHO criteria were classified as stage B (33.5 %) and stage C (27.1%). Opportunistic infections were observed in 95% of cases: fungal: 57%, bacterial: 30.7%, and viral: 7.3%. Tritherapy, i.e., 2INTI + 1INNTI (72.9%) and 2INTI+1 IP (17.1%), was used in most cases. Treatment led to clinical improvement with a gradual, steady, and sustained increase in CD4 lymphocyte count. Adverse events were noted including gastrointestinal reactions (16%), neurological manifestations (12%), and general symptoms (12%). Concurrent disturbances in lipid levels and liver function were noted. Overall outcome was positive with a decrease in mortality from 39.2% (M0-M6) to 2.7% (M30-M36). The findings of this study show that improvement in socioeconomic conditions and availability of adequate diagnostic and therapeutic resources at management centers to obtain long-term control of HIV infection are still current issues.

Impact of increasing consultation fees on malaria in Africa.

To evaluate the impact of the increase in consultation fees on malaria incidence in children presenting in the outpatient clinic of a privately funded hospital, we measured the impact of two fee increases on the number of pediatric outpatients. A 74% reduction in outpatients and a 78% reduction in malaria cases occurred in a course of four years. No differences were observed in an adjacent public hospital that does not charge consultation fees. This surprisingly strong effect may be the basis for increase in malaria morbidity and mortality, since in the time course of 4 years, an estimated 3000 children did not receive adequate malaria treatment in this region. Furthermore, it may drive parasite resistance, due to inadequate auto-medication.

Catastrophic ape decline in western equatorial Africa.

Because rapidly expanding human populations have devastated gorilla (Gorilla gorilla) and common chimpanzee (Pan troglodytes) habitats in East and West Africa, the relatively intact forests of western equatorial Africa have been viewed as the last stronghold of African apes. Gabon and the Republic of Congo alone are thought to hold roughly 80% of the world's gorillas and most of the common chimpanzees. Here we present survey results conservatively indicating that ape populations in Gabon declined by more than half between 1983 and 2000. The primary cause of the decline in ape numbers during this period was commercial hunting, facilitated by the rapid expansion of mechanized logging. Furthermore, Ebola haemorrhagic fever is currently spreading through ape populations in Gabon and Congo and now rivals hunting as a threat to apes. Gorillas and common chimpanzees should be elevated immediately to 'critically endangered' status. Without aggressive investments in law enforcement, protected area management and Ebola prevention, the next decade will see our closest relatives pushed to the brink of extinction.