Molecular prevalence of intestinal parasites infections in children with diarrhea in Franceville, Southeast of Gabon
Authors: Sylvie Kwedi Nolna
Franck Mounioko
Jean Bernard Lekana-Douki
Nal Kennedy Ndjangangoye
Lady Charlene Kouna
Gwladys Mirlande Lekolo
Sandrine Lydie Oyegue-Liabagui
Journal: BMC Infectious Diseases (2020)
Discipline: IMMUNOLOGY
Keywords: diarrhea; children; intestinal parasitic infections; molecular diagnostic; Franceville
Affiliations: Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université des Sciences et Techniques de Masuku, BP 876, Franceville, Gabon. ., Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre International de Recherches Médicales de Franceville (CIRMF), BP 769, Franceville, Gabon. ., Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université des Sciences et Techniques de Masuku, BP 876, Franceville, Gabon., Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre International de Recherches Médicales de Franceville (CIRMF), BP 769, Franceville, Gabon., Laboratoire d'Ecologie Vectoriel, Institut de Recherche en Ecologie Tropicale, BP 13354, Libreville, Gabon., Capacity for Leadership Excellence And Research (CLEAR, Inc.), Yaoundé, Cameroon., Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon.

Abstract:  Background: Pediatric diarrhea caused by a range of pathogens, including intestinal parasites, is one of main causes of death among children under 5 years of age. The distribution of these parasitic infections overlaps in many environmental, socioeconomic and epidemiological settings. Their distribution and prevalence varies from region to region. In the current study, we assess the prevalence of intestinal parasites among pediatric patients with syndromic diarrheal disease living in Franceville, Gabon. Methods: A cross-sectional study conducted in the Amissa Bongo Regional Hospital and Chinese-Gabonese Friendship Hospital in Franceville, between November 2016 and August 2017, enrolled a total of 100 diarrheic children between 0 and 180 months of age. Parasite detection in stool samples was performed using molecular diagnostic by PCR. Difference in means were tested by Student's t test and ANOVA while principal component analysis was used to determine the correlation between parasite distributions and age groups. Results: The overall prevalence of intestinal parasite infection was 61% (61/100). Hymenolepis sp and Cryptosporidium hominis/parvum were the most common parasites (31 and 19%, respectively), followed by Encephalitozoon intestinalis (15%), Trichuris trichiura (4%), Dientamoeba fragilis (4%), and Enterocytozoon bieneusi (2%). The polyparasitism rate was 19.7%, with 83.3% double and 16.7% triple infections. Protozoan infections (66.7%) were more prevalent than helminths infections (33.3%). Seasonal association of the circulation of intestinal parasite was statistically significant (p = 0.03). Correlations between different parasites was also observed. Conclusion: The prevalence of intestinal parasitic infections is highest in diarrheic pediatric children. The prevalence of parasitic infections indicates that protozoa and helminths are the most common parasites in the Franceville environment. This study reinforces the importance of routine examination of diarrheic stool samples for the diagnostic of intestinal parasites. Further analyses are required to better understand the local epidemiology and risk factors associated with the transmission of intestinal parasites in Franceville, Gabon. KEYSWORDS: diarrhea, children, intestinal parasitic infections, molecular diagnostic, Franceville, Gabon. 

Retracted: No

PubPeer comments:
 This paper is part of a set of 6 papers. According to the authors, all papers are related to the same protocol approved under the **number 0020 2015 SG CNE** by the National Ethics Committee of Gabon. One of the authors is mentioned in the 6 papers. Other authors are mentioned in several papers. This protocol seems to cover different objectives, different types of participants, different type of study designs. According to the protocol approval number (0020 2015 SG CNE) and its format, the protocol has been approved in 2015 by the National Ethics Committee of Gabon. But what does this protocol cover ? **Different therapeutic areas, Different objectives:** -t**Article 1**: Malaria - Aim: to investigate the causes of febrile illnesses among children -t**Article 2**: Malaria - Aim: to investigate the prevalence of mutations in Pfdhfr and Pfdhps associated with sulfadoxine-pyrimethamine resistance. -t**Article 3**: Diarrhea - Aim: To identify and characterize bacterial and parasitic pathogens responsible for childhood diarrhea, and to identify environmental risk factors associated with diarrhea in children under 5 years old -t**Article 4**: Diarrhea - Aim: to assess the prevalence of eighteen IPIs in children with diarrhea -t**Article 5**: Malaria - Aim: adhesion to treatment with Sulfadoxine-Pyrimethamine -t**Article 6**: Head lice - Aim: to investigate the phylogeny of head lice collected in Gabon and their associated bacteria **Different types of samples Different types of participant Different dates of participantsu2019 recruitment** -t**Article 1**: Blood samples Children November 26, 2015 to January 25, 2016 -t**Article 2**: Blood samples Adults and children February 02, 2016 to May 31, 2016, -t**Article 3**: Stools samples Children under 5 years old May 2016 to February 2018 -t**Article 4**: Stools samples Children November 2016 to August 2017 -t**Article 5**: Blood samples Pregnant women February 2018 to May 2018 -t**Article 6**: Head lice Women only March 26th, 2018 to April 11th, 2018 Can the authors explain how a unique protocol cover 6 different types of study design with 6 different objectives and 6 different types of recruitment? -tStudy designs are very different. -tRecruitment periods are different. -tTypes of participants are different -tTypes of sample are different, etcu2026 It seems pretty unusual that a same protocol cover -tblood samples in children to study malaria in 2015 and stool samples one year after, -tthen, head lice in women, 3 years after. Can the authors explain the scope of the protocol 0020 2015 SG CNE and the approval process by the National Ethics Committee of Gabon? How a protocol can cover so many different type of study design? **Article 1: [High Circulation of Malaria and Low Prevalence of Bacteremia in Febrile and Afebrile Children in Northeastern Gabon] ** According to the authors, this study is a retrospective study in children. The aim of the study is to investigate the causes of febrile illnesses among children. Blood sample has been collected between November 26, 2015 and January 25, 2016. These dates raises a serious concern regarding the nature of the study. Indeed, a retrospective study is defined as a study which analyses data already collected. The Ethics approval have been obtained in 2015. However data was collected until 2016. As a consequence, the study collected prospectively the data after the ethical approval. This study should be considered as a prospective study. The authors donu2019t mention the date of the ethical approval. This information should be useful to determine if the ethical approval was obtained before the recruitment of participant or after. It will be in a public interest to disclose the approved protocol by the National Ethics Committee of Gabon in order to understand how a study which have been approved before the end of the data collection has been considered as retrospective by the authors. **Article 2: [High prevalence of genotypes associated with sulfadoxine-pyrimethamine resistance in the rural area of Fougamou, Gabon] ** 204 febrile patients were included, with a mean age of 167.75u00b1138.83 months. Blood samples have been collected. The ethical approval has been obtained in 2015 and the study performed from 2016. Data are collected after the ethical approval. This study is a prospective study. The objective of this study is to investigate the prevalence of mutations in Pfdhfr and Pfdhps associated with sulfadoxine-pyrimethamine resistance in Gabonese rural areas. **Article 3: [Etiology and biodistribution of enterobacteria and parasites, and their associated environmental risk factors among children under 5 years old with diarrhea in East-Central Gabon] ** 132 children under 5 years old were enrolled. Stools samples have been collected. The ethical approval has been obtained in 2015 and the study has been performed in 2016. Data are collected after the ethical approval. This study is a prospective study. The objective of this study is to identify and characterize bacterial and parasitic pathogens responsible for childhood diarrhea, and to identify environmental risk factors associated with diarrhea in children under 5 years old living in Koula-Moutou, East-Central Gabon **Article 4: [Molecular prevalence of intestinal parasites infections in children with diarrhea in Franceville, Southeast of Gabon] ** 100 diarrheic children between 0 and 180 months of age have been recruited from November 2016 to August 2017. Stools samples have been collected. Data are collected after the ethical approval. This study is a prospective study. The objective of this study is to assess the prevalence of eighteen IPIs in children with diarrhea. **Article 5: [Evaluation of the adhesion of pregnant women to intermittent presumptive treatment with Sulfadoxine-Pyrimethamine in a rural area of Gabon] ** 607 pregnant women before their delivery have been recruited from February to May 2018. The aim of the study is the adhesion to treatment with Sulfadoxine-Pyrimethamine. The authors mention that recruitment is prospective. Blood samples and questionnaires have been collected. **Article 6: [Evaluation of the adhesion of pregnant women to intermittent presumptive treatment with Sulfadoxine-Pyrimethamine in a rural area of Gabon] ** From 26 March to 11 April 2018, 691 head lice were collected from 86 women in Franceville, Gabon. Data are collected after the ethical approval. This study is a prospective study. The aim of the study is investigate the phylogeny of head lice collected in Gabon and their associated bacteria. ,