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High malaria prevalence in an area with high coverage level of insecticide treated nets in Cameroon

Cyrille NDO1,2,3, Dominique MIEGUIM NGNINPOGNI3,4, Charles-Felix BILONG BILONG4 

1. Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon 

2. Liverpool School of Tropical Medicine, UK 

3. Malaria Research Laboratory, OCEAC, Cameroon 

4. Faculty of Sciences, University of Yaoundé 1, Cameroon 

Massive scaling up insecticide treated bednets (ITNs) coverage has contributed to a significant decline of malaria morbidity and mortality during the last decades. In Cameroon, more than 12 million of free ITNs have been distributed to populations countrywide since 2011. The present study was undertaken with the aim to assess malaria prevalence in relation of ITNs ownership/use in Okola, a locality situated within the equatorial forest of Cameroon. Malaria prevalence was assessed among 269 people aged between 1 and 84 years in March 2017, by microscopic examination of thick blood smears. In addition a structured questionnaire was administrated to a sample of 113 peoples to assess the ownership/use and protective efficacy of ITNs. 

In general high malaria prevalence was detected in the surveyed population despite high ownership and use of ITNs (85%). A total of 86 out of 269 people were tested positive for malaria, corresponding to an overall prevalence of 31.97%. In the most vulnerable group constituted of children under 5 years, malaria prevalence was very high (62.72%) and significantly differed from the rest (24.77%) (P<0.05). By contrast prevalence didn't significantly differ between people with and without ITNs, good or torn ITNs, old or new ITNs (P>0.05). 

Our results suggest that ITNs didn't provide consistent protection against malaria in people living in Okola. Several factors including early night or outdoor transmission, misuse of ITNs and insecticide resistance in Anopheles vectors need to be addressed in order to elucidate this transmission pattern. Moreover, the very high prevalence detected in children under 5 years is alarming and call for an urgent reframing of malaria control strategies in this area.