Browsing by Subject "Gabon"

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    Factors associated with retention to care in an HIV clinic in Gabon, Central Africa
    (Public Library of Science, 2015) Janssen, Saskia; Wieten, Rosanne Willemijn; Stolp, Sebastiaan; Cremers, Anne Lia; Rossatanga, Elie Gide; Klipstein-Grobusch, Kerstin; Belard, Sabine; Grobusch, Martin Peter
    BACKGROUND: Retention to HIV care is vital for patients' survival, to prevent onward transmission and emergence of drug resistance. Travelling to receive care might influence adherence. Data on the functioning of and retention to HIV care in the Central African region are limited. METHODS: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon. Adult patients who presented to this clinic between January 2010 and January 2012 were included. Outcomes were retention in care (defined as documented show-up for clinical visits, regardless of delay) or LTFU (defined as a patient not retained in care; on ART or ART naïve, not returning to care during the study period with a patient delay for scheduled visits of more than 6 months), and mortality. Cox regression analysis was used to assess factors associated with respective outcomes. Qualitative data on reasons for LTFU were obtained from focus-group discussions. RESULTS: Of 223 patients included, 67.3% were female. The mean age was 40.5 (standard deviation 11.4) years and the median CD4 count 275 (interquartile range 100.5-449.5) cells/μL. In total, 34.1% were lost to follow up and 8.1% died. Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data. CONCLUSIONS: Retention to HIV care in a primary clinic in Gabon is relatively poor and interventions to address this should be prioritized in the HIV program. Early initiation of ART might improve retention in care.
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    Knowledge and perception on antimicrobial resistance and antibiotics prescribing attitude among physicians and nurses in Lambaréné region, Gabon: a call for setting-up an antimicrobial stewardship program
    (2022-03-03) Adegbite, Bayode R; Edoa, Jean R; Schaumburg, Frieder; Alabi, Abraham S; Adegnika, Ayola A; Grobusch, Martin P
    Background Africa is challenged by the emergence of antimicrobial resistance (AMR). In order to improve patient management and to optimise approaches to curb the spread of antimicrobial resistance, we examined knowledge and perceptions of AMR and antibiotics prescription practices of HCW (healthcare workers) in Lambaréné, Gabon. Methods We conducted a self-administered, questionnaire-based survey in HCW at the regional referral hospital, a medical research centre, and peripheral health care facilities. The proportions of correct responses to questions were determined and compared between physicians and nurses using Fisher’s Exact test. Results A total of 47 HCW took part in the survey. Of those, 64% (30/47) recognised antibiotic resistance as a major public health issue in Gabon, but only 14/47 (30%) recognised it as a problem in their health facility. Of note, 37/47 (79%) recognised excessive use of antibiotics without microbiological confirmation in case of infection, and buying antibiotics without a prescription, as possible cause of antimicrobial resistance. Some HCW (28%; 13/47) reported having prescribed antibiotics because the patients asked for them; and a total of 15/47 (32%) responded that antibiotics could help patients recover faster when added to malaria treatment. Compared to nurses, most of the physicians recognised that excessive use of antibiotics without microbiological confirmation of infection could contribute to AMR spread (18/19 (95%) vs 19/28 (68%); p = 0.028). Conclusion Most HCW recognised AMR as public health issue. However, a quarter of the participants did not know about the causes fostering the emergence of antimicrobial resistance. There is a need to perform regular HCW training in antimicrobial prescription, and to set up an antimicrobial stewardship program.
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    Tuberculosis infection control measures in healthcare facilities in Moyen-Ogooué Province, Gabon
    (2021-11-05) Vigenschow, Anja; Adegbite, Bayodé R.; Edoa, Jean-Ronald; Alabi, Abraham; Adegnika, Akim A; Grobusch, Martin P; Massinga-Loembe, Marguerite
    Background Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. Methods A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. Results Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. Conclusions In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation.