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Demographic and Clinical Characteristics Associated With Severity, Clinical Outcomes, and Mortality of COVID-19 Infection in Gabon

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1 Credit CME
Key Points

Question  What were the epidemiologic and clinical aspects of patients with COVID-19 infection in the Armed Forces Hospital in Libreville, Gabon, from March to June 2020?

Findings  In this cross-sectional study of 837 patients with COVID-19 in Gabon, 63% had no symptoms. Severity of disease and mortality were associated with advanced age and advanced stage of lung damage.

Meaning  Findings from this observational study provide preliminary data for use in future epidemiologic studies of COVID-19 in Gabon.


Importance  Since the emergence of COVID-19 in central China, sub-Saharan African countries, with the exception of South Africa, have been relatively spared during the COVID-19 pandemic. Consequently, few descriptive studies from this region are available.

Objective  To describe the clinical characteristics and outcomes of patients with COVID-19 infection in Gabon, from March to June 2020.

Design, Setting, and Participants  A single-center, cross-sectional study of 837 patients with COVID-19 was conducted from March to June 2020 in the Armed Forces Hospital in Libreville, Gabon.

Main Outcomes and Measures  Demographic and clinical characteristics and imaging findings of hospitalized patients with COVID-19.

Results  Of the 837 patients enrolled, 572 (68.3%) were men, and 264 (31.5%) were women (male to female ratio, 2:1); the median (interquartile range [IQR]) age was 35 (30-45) years (mean [SD] age, 38.0 [12.2] years. The mortality rate associated with COVID-19 was low (1.4%). Of these 837 patients, 524 (62.6%) were categorized as having no symptoms, 282 (33.7%) as having mild symptoms, and 31 (3.7%) as having severe symptoms. Patients with severe symptoms were older (mean [SD] age, 46.1 [14.7] years) than patients with mild symptoms (mean [SD] age, 41.3 [12.5] years) and those with no symptoms (mean [SD] age, 35.7 [11.3] years) (Kruskal-Wallis χ22 = 53.5; P < .001). History of diabetes was the principal risk factor associated with both severe symptoms in 5 of 31 patients (16.1%) and mild symptoms in 11 of 282 (3.9%) compared with no symptoms in 5 of 524 (0.9%) (Pearson χ22 = 30.9; P < .001). Patients with severe symptoms and a fatal outcome were older (mean [SD] age, 53.4 [15.1] years) than survivors (mean [SD] age, 41.5 [12.9] years) (t20.83 = 2.2; P = .03).

Conclusions and Relevance  In this single-center, cross-sectional study in Libreville, Gabon, the mortality rate associated with COVID-19 infection from March to June 2020 was low, and patients who died of COVID-19 infection were younger on average than reported elsewhere, possibly reflecting a smaller elderly population in Gabon.

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Article Information

Accepted for Publication: June 29, 2021.

Published: September 14, 2021. doi:10.1001/jamanetworkopen.2021.24190

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Iroungou BA et al. JAMA Network Open.

Corresponding Author: Berthe Amélie Iroungou, PhD, Unité Mixte de Recherche Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, PO Box 20404 HIAOBO, Libreville, Gabon (

Author Contributions: Dr Iroungou had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Iroungou, Mangouka, Bivigou-Mboumba, Nzigou Boucka, Aghokeng, Tchoua, Pineau, Nzenze.

Acquisition, analysis, or interpretation of data: Iroungou, Mangouka, Bivigou-Mboumba, Moussavou-Boundzanga, Obame-Nkoghe, Nzigou Boucka, Mouinga-Ondeme, Nzenze.

Drafting of the manuscript: Iroungou, Mangouka, Bivigou-Mboumba, Nzigou Boucka, Mouinga-Ondeme, Pineau.

Critical revision of the manuscript for important intellectual content: Iroungou, Mangouka, Bivigou-Mboumba, Moussavou-Boundzanga, Obame-Nkoghe, Aghokeng, Tchoua, Nzenze.

Statistical analysis: Mangouka, Moussavou-Boundzanga, Obame-Nkoghe, Nzigou Boucka, Aghokeng, Pineau.

Obtained funding: Iroungou, Tchoua, Nzenze.

Administrative, technical, or material support: Iroungou, Bivigou-Mboumba, Nzenze.

Supervision: Iroungou, Bivigou-Mboumba.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by the Gabonese government (Prof Tchoua and Prof Nzenze).

Role of the Funder/Sponsor: The Gabonese government had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We are grateful to all patients involved in this study. We also acknowledge Remi Charlebois, MS (GSSHealth), for attentive review of the manuscript. He was not paid for this contribution.

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