title: 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.
abstract: Sub-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.
  
  
  
  Major 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.
  
  
  
  Infectious 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.
  
  
  
  Despite 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.
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: R Zoleko
authors.initials: RZ
authors.lastname: Manego
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Département de Parasitologie-Mycologie, Université des Sciences de La Santé, Libreville, Gabon.
authors.forename: G
authors.initials: G
authors.lastname: Mombo-Ngoma
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Witte
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Deutsches Zentrum für Infektionsforschung (DZIF), Standort, Tübingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Held
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Deutsches Zentrum für Infektionsforschung (DZIF), Standort, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gmeiner
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Deutsches Zentrum für Infektionsforschung (DZIF), Standort, Tübingen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Gebru
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Centre de Recherches Médicales de la Ngounié, Fougamou, Gabon.
authors.forename: B
authors.initials: B
authors.lastname: Tazemda
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Mischlinger
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Groger
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Lell
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: A A
authors.initials: AA
authors.lastname: Adegnika
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: S T
authors.initials: ST
authors.lastname: Agnandji
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.
authors.forename: P G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Deutsches Zentrum für Infektionsforschung (DZIF), Standort, Tübingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Mordmüller
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon. michael.ramharter@meduniwien.ac.at.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany. michael.ramharter@meduniwien.ac.at.|Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria. michael.ramharter@meduniwien.ac.at.
authors.forename: M
authors.identifier: 0000-0002-9259-1885
authors.initials: M
authors.lastname: Ramharter
authors.affiliation: Centre de Recherches Médicales de Lambaréné , Lambaréné, Gabon.|Institut für Tropenmedizin, University of Tübingen, 72074, Tübingen, Germany.|Centre de Recherches Médicales de la Ngounié, Fougamou, Gabon.
authors.forename: P B
authors.initials: PB
authors.lastname: Matsiegui
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005681:Gabon / Q000453:epidemiology; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D000068097:Maternal Health / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology; D037841:Pregnant People; D011295:Prenatal Care / Q000706:statistics & numerical data; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Filariasis; Gabon; Malaria; Maternal health; Pregnancy; Tsamba-Magotsi; Urinary schistosomiasis