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.  Diarrheal disease is the second most frequent cause of mortality in children younger than 5 years worldwide, causing more than half a million deaths each year. Our knowledge of the epidemiology of potentially pathogenic agents found in children suffering from diarrhea in sub-Saharan African countries is still patchy, and thereby hinders implementation of effective preventative interventions. The lack of cheap, easy-to-use diagnostic tools leads to mostly symptomatic and empirical case management. An observational study with a total of 241 participants was conducted from February 2017 to August 2018 among children younger than 5 years with diarrhea in Lambaréné, Gabon. Clinical and demographic data were recorded, and a stool sample was collected. The samples were examined using a commercial rapid immunoassay to detect Rotavirus/adenovirus, conventional bacterial culture for  Salmonella  spp., and multiplex real-time PCR for  Cryptosporidium  spp.,  Giardia lamblia ,  Cyclospora cayetanensis , enterotoxigenic  Escherichia coli  (ETEC), and enteroinvasive  Escherichia coli  (EIEC)/ Shigella . At least one infectious agent was present in 121 of 241 (50%) samples. The most frequently isolated pathogens were EIEC/ Shigella  and ETEC (54/179; 30.2% and 44/179; 24.6%, respectively), followed by  G. lamblia  (33/241; 13.7%),  Cryptosporidium  spp. (31/241; 12.9%), and Rotavirus (23/241; 9.5%). Coinfection with multiple pathogens was observed in 33% (40/121) of the positive cases with EIEC/ Shigella , ETEC, and  Cryptosporidium  spp. most frequently identified. Our results provide new insight into the possible causes of diarrheal disease in the Moyen-Ogooué region of Gabon and motivate further research on possible modes of infection and targeted preventive measures.

Prevalence of Pathogens in Young Children Presenting to Hospital with Diarrhea from Lambaréné, Gabon