[Behavior and attitudes towards smoking among student midwives in Libreville]. / Comportements et attitudes des élèves sages-femmes de Libreville vis-à-vis du tabagisme.

BACKGROUND: The midwife, in taking on a public health role, is one of the most important resources for the prevention of smoking and in helping smoking cessation among women of childbearing age thanks to their numerous contacts with pregnant women. With this in mind, we conducted a study among student midwives to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention. METHOD: This was a descriptive cross-sectional study conducted from 15 January to 15 February 2018 using a self-administered questionnaire and included the student midwives of the University of Health Science at Libreville (Gabon). RESULTS: A total of 188 student midwives completed the questionnaires (70.7% of students of the 1st year, 15.0% of students of the 2nd year and 14.3% of students of the 3rd year). Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking in pregnancy and its role in the development of complications for the mother and foetus. Overall, 17.1% of student midwives think that smoking is responsible for the occurrence of ectopic pregnancies, 20.3% believe it is responsible for retro-placental haematoma, 17.6% for premature rupture of the membranes. The prevalence of smoking was 11.1% and was most frequent in 2nd year students (25.0%) and 3rd year students (14.8%) (P<0.023). The mean age of beginning smoking was 19.0±4.4 years. The main initiating factors were peer influence (28.6%), pleasure (19.0%) and stress (14.3%). Nicotine dependence was weak to moderate among 48.8% of smokers and absent in 52.2%. CONCLUSION: Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking to complications of pregnancy. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

[Susceptibility status of Anopheles gambiae s.s. and An. coluzzii to Organophosphates and Carbamates in the Agricultural Exploitation Zones of oil Palm at Mouila, Gabon]. / Susceptibilité d'Anopheles gambiae s.s. et An. coluzzii aux organophosphorés et aux carbamates en zones d'exploitation industrielle de palmiers à huile à Mouila, Gabon.

This study was conducted during the rainy season of 2017 in the agricultural areas at Mouila, with the aim to assess the determination of susceptibility of Anopheles gambiae complex to insecticides and the detection of Ace 1R mutation. Mosquito larvae were collected by using the dipping method and nursed to adult stage. The susceptibility of adult Anopheles gambiae s.l. populations to organophosphates and carbamates was assessed using the standard WHO susceptibility test protocol. The tested mosquitoes species were identified by PCR. These tested mosquitoes were used to search for the Ace 1R mutation. The insecticides used were pirimiphos-methyl 0.25% and 1.25%, fenitrothion 1%, malathion 5%, propoxur 0.1%, bendiocarb 0.1%, 0.5% and 1%. In the prospected areas, An. gambiae s.l. included An. gambiae s.s. and An. coluzzii sympatric in their larval habitats. However, An. gambiae s.s. was predominant in all studied areas (99.1%) comparatively to An. coluzzii Moreover, the susceptibility tests of Anopheles to organophosphates and carbamates revealed mortality rates of 100% regardless of the origin of the mosquitoes. PCR diagnosis of Ace 1R mutation showed that none tested mosquito (An. gambiae s.s. and An. coluzzii) from prospected areas harbored the Ace 1R gene in all prospected areas. The lack of Ace 1R mutation in An. gambiae s.l. reveals the current effectiveness of organophosphates and carbamates for the control of these mosquitoes. Bboth these classes of insecticides could be used for the anopheline populations control in the agricultural spaces at Mouila.

Cette étude a été menée en 2017 pendant la saison des pluies dans les zones d'exploitations agricoles à Mouila, afin de déterminer le statut de sensibilité des membres du complexe Anopheles gambiae aux insecticides et de rechercher la présence de la mutation Ace 1R. Les moustiques ont été collectés au stade larvaire par la méthode du « dipping ¼, puis élevés jusqu'au stade adulte. La susceptibilité des adultes d'An. gambiae s.l. aux organophosphorés et aux carbamates a été évaluée par la méthode standard de l'OMS concernant les tests de sensibilité aux insecticides. Les classes d'insecticides testées étaient les organophosphorés (pirimiphos-méthyl 0,25 % et 1,25 %, fénitrothion 1 %, malathion 5 %) et les carbamates (propoxur 0,1 %, bendiocarb 0,1 %, 0,5 % et 1 %). Les moustiques testés ont été identifiés par PCR. Les anophèles issus des tests ont été utilisés pour la recherche de la mutation Ace 1R par PCR. Dans les sites d'étude, Anopheles gambiae s.l. était composé d'An. gambiae s.s. et An. coluzzii vivant en sympatrie dans leurs habitats larvaires, avec une prédominance d'An. gambiae s.s. (99,1 %) sur An. coluzzii. Les tests de sensibilité des anophèles aux organophosphorés et aux carbamates ont révélé des taux de mortalité de 100 % quelle que soit l'origine des anophèles. La PCR diagnostique de la mutation Ace 1R a montré qu'aucun moustique issu des tests de sensibilité n'était porteur de gènes de résistance Ace 1R. L'absence de mutation Ace 1R chez An. gambiae s.l. révèle l'efficacité actuelle des carbamates et des organophosphorés dans la lutte contre ces moustiques. Ces familles d'insecticides pourraient être utilisées pour la lutte contre les anophèles dans les espaces agricoles de Mouila.

Molecular characterization of Shigella spp. from patients in Gabon 2011-2013.

BACKGROUND: Shigella spp. dysentery is widespread in developing countries; the incidence is particularly high in children between 1-2 years of age. In sub-Saharan Africa, there is a paucity of epidemiological data on Shigella spp., with possible negative consequences for recognition and correct treatment choice for this life-threatening bacterial infection. We therefore characterized Shigella spp. isolates from Gabon. METHODS: The antimicrobial resistance, virulence factors, genotypes and mobile genetic elements of Shigella isolates (29 S. flexneri; 5 S. boydii; 3 S. sonnei) from a retrospective strain collection were analyzed. RESULTS: High resistance rates were found for gentamicin and tetracycline (100%, 37/37), cotrimoxazole (92%, 34/37) and ampicillin (84%, 31/37). All isolate harbored ial and ipaH; no isolate produced Shiga toxins (stx1/2); enterotoxins (set1A/B) were only found in S. flexneri (n=19). Multilocus sequence types (MLST) clustered with global clones. A high prevalence of atypical class 1 integrons harboring blaOXA30 and aadA1 were detected in S. flexneri, while all S. sonnei carried class 2 integrons. CONCLUSIONS: There is a strong link of Gabonese Shigella spp. isolates with pandemic lineages as they cluster with major global clones and frequently carry atypical class 1 integrons which are frequently reported in Shigella spp. from Asia.

[Prevalence of illegal abortions in Libreville Hospital, Gabon]. / Prévalence des avortements clandestins au centre hospitalier de Libreville, Gabon.

The objectives of this study were to determine the prevalence of illegal abortion in Libreville and to describe abortive methods used. It is a cross sectional and descriptive survey carried out at the maternity hospital of Libreville (MHL) during one year, from 1 January 2008 to 31 December 2008. 750 abortions were performed during this period and 651 cases were illegal abortions. Prevalence was of 86.7%. The women undergoing illegal abortion were most often pupils (67.1%), with an average age of 22.4 +/- 5.3 years old and a mean parity of 1.2 +/- 1.50. The average gestational term was of 7.4 +/- 1.9 weeks. Misoprostol (63.1%) was the most frequent abortive product used. 2 maternal deaths were notified. Prevalence of illegal abortions is increasing at the MHL. Up to now, misoprostol is the most frequent abortive product used.

Medical anthropology and Ebola in Congo: cultural models and humanistic care.

Seldom have medical anthropologists been involved in efforts to control high mortality diseases such as Ebola hemorrhagic fever (EHF) This paper describes the results of two distinct but complementary interventions during the first phases of an outbreak in the Republic of Congo in 2003. The first approach emphasized understanding local peoples cultural models and political-economic explanations for the disease while the second approach focused on providing more humanitarian care of patients by identifying and incorporating local beliefs and practices into patient care and response efforts.

Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon.

BACKGROUND: HIV-infected patients (pts) in Africa are often diagnosed at very advanced stages of disease. They seek relief using traditional medicine or religious beliefs. General practitioners (GPs) are often consulted first. Once the HIV diagnosis has been made, concomitant use of alternative and allopathic medicine is also frequent. OBJECTIVE: To describe the delay between presentation of HIV-related symptoms and diagnosis, the first physician consulted, and the use of traditional medicine or religion as an alternative or complement to allopathic medicine in HIV-infected patients. METHOD: Patients followed for HIV infection at Fondation Jeanne Ebori were retrospectively interviewed to trace their therapeutic itinerary. RESULTS: 150 pts were interviewed. There were 63% females, mean age was 39 years, median CD4 count was 242 cells/microL (102-394), CDC stage A/B/C was 32%/40%/28%, and 57% had very low income. Religious affiliations were Catholic (52%), Protestant (21%), Muslim (3%), "progressive" Church (16%), and none (7%). The median time elapsed between their first symptoms and HIV diagnosis was 124 (20-292) days. The first person consulted was a traditional healer (5%), GP (61%), or private clinics (23%). Traditional healers were consulted for initiation rites in 23%, cure of disease in 90%, or sorcery in 20%. Once allopathic medicine was started, concomitant alternative therapy occurred in 25 (17%) for traditional medicine and 4 (3%) for faith healing. Resort to traditional healer (odds ratio [OR] 2.6, p = .02) and to faith healing (OR 3.1, p = .048) were risk factors for diagnosis delay. CONCLUSION: Many factors related to patients, the health system, and culture or society are detrimental to an early diagnosis of HIV infection in Gabon. Increasing awareness of the risk of HIV infection throughout the general population and hope and trust in western medicine in patients and non-HIV-specialist physicians, as well as suppression of social stigma, could shorten the delay before diagnosis. Better communication between allopathic physicians and traditional or faith healers could also improve the care of HIV-infected patients.