Systemic barriers to early diagnosis of neglected tropical diseases in rural Gabon: insights from a qualitative study in Makokou.

Dear Editor, We wish to share key findings from a qualitative study conducted in 2024 in Ogooué-Ivindo Province (northeastern Gabon), a region highly endemic for several neglected tropical diseases (NTDs),1,2,3 particularly Buruli ulcer and lymphatic filariasis.4 Despite the WHO’s global commitment5,6 to eliminate NTDs by 2030, early diagnosis remains a major challenge in rural Central Africa. In Makokou, we conducted semistructured interviews with 32 key stakeholders: 15 patients, 10 frontline health workers and seven traditional healers, supplemented by participant observations. Inductive thematic analysis7 revealed four interconnected barriers to early diagnosis: (i) geographic isolation and a lack of medical transport; (ii) structural weaknesses in the health system (shortages of equipment,8,9,10 trained personnel and NTD-specific training); (iii) sociocultural factors, including initial reliance on traditional medicine11,12 and disease-related stigma; and (iv) critical knowledge gaps among both patients and health professionals, leading to frequent misdiagnosis. These findings demonstrate that diagnostic delays are not merely due to ‘ignorance’, but stem from a system of structural neglect. They call for a multisectoral response: integrating NTDs into health worker training curricula, strengthening logistical support for rural health posts, implementing community awareness campaigns13 in local languages (Fang, Kota) and establishing formal collaboration with traditional healers who are already trusted community gatekeepers.