Variation in malariometric and red cell indices in children in the Mount Cameroon area following enhanced malaria control measures: evidence from a repeated cross-sectional study.

BACKGROUND: Following enhanced malaria control measures, such as nationwide free distribution of insecticide-treated bed nets (ITN) by the government of Cameroon, its impact on malariometric and red cell indices in children ≤14 years in Muea, in the Mount Cameroon area was evaluated. METHODS: Two cross-sectional studies were conducted during the malaria transmission season (March-July) in 2006 (baseline) and 2013 (follow-up), respectively. The investigative methods included the use of a questionnaire to assess ITN use and coverage, clinical evaluation and laboratory investigations. Blood sample collected from each child was used for the preparation of blood films for detection of malaria parasites and density as well as full blood count determination using standard procedures and also an automated haematology analyzer. RESULTS: The majority of children (81.5%) possessed an ITN in 2013. The proportion of effective users of ITN increased significantly from 20.9% (CI = 17.3-25%) in 2006 to 35.2% (CI = 31-39.7%) in 2013. The highest relative risk reduction in prevalence during the follow-up study was observed in malaria anaemia (79%, CI = 58.0-69.1% [69.1 to 14.5%]), followed by gametocytaemia (71.6%, CI = 58.9-80.3% [25.6 to 7.3%]), anaemia (64%, CI = 58.0-69.1% [80.1 to 28.9%]), and malaria parasitaemia (57.2%, CI = 51.4-62.3% [85.4 to 36.6%]). In the baseline survey, the prevalence of splenomegaly was significantly highest (χ2 = 18.3, P <0.001) in the youngest group of children while in the follow-up study, it was highest in the oldest (χ2 = 6.03, P = 0.049). The overall prevalence of mild, moderate and severe anaemia in the study population at baseline (59.6, 14.9, 6.3%) decreased significantly (P <0.001) to 24.4, 2.7 and 1.3%, respectively during the follow-up with the highest relative risk reduction in prevalence occurring in moderate anaemia (82.1%, CI = 67.3-90.2% [14.9 to 2.7%]). Microcytic anaemia also decreased significantly (P <0.001) from 56 to 7.7% during the follow-up survey. CONCLUSION: Following interventions, anaemia (moderate to severe) was a more sensitive measure to changes in malaria exposure and children between 11-14 years of age experienced a significant increase in malaria-related morbidity.

Knowledge and perceptions towards malaria prevention among vulnerable groups in the Buea Health District, Cameroon.

BACKGROUND: Malaria is a public health problem especially in vulnerable groups such as pregnant women and children under five years in Cameroon including the Buea Health District (BHD). Misconceptions concerning it exist. This study assessed the level of knowledge and perceptions towards malaria control among pregnant women and mothers/caretakers of under-fives in the BHD. METHODS: A community-based cross-sectional study was conducted in the BHD in August, 2011 in five health areas. A questionnaire was used to collect data on demographic variables, knowledge and perceptions towards malaria control from 443 respondents aged 15-73 years. RESULTS: Of the 443 respondents interviewed, 99% had heard about malaria. Awareness of malaria was similar in rural (98.04%) and urban (98.97%) areas. The health facility was the most popular source of information (74%). The radio, television, tracts/posters and the community relay agents (CRAs) all informed significantly higher proportions of respondents in the urban than rural communities (P < 0.05). Overall, 92% of respondents had the right perception of malaria and 88% knew at least one correct sign/symptom of malaria. The most recognised sign of malaria was fever. When all aspects of malaria were considered, majority (88%) of respondents had good levels of knowledge on malaria. The level of good knowledge in respondents with ≥ secondary school education (91%) was significantly higher (P = 0.01) than in those with ≤ primary school level (83%). Overall, 99% had heard about insecticide treated nets (ITNs); 99% perceived ITNs as a good means to prevent malaria; most respondents (57%) used ITNs mainly for protection against mosquito bites while 48% used them for protection against malaria. CONCLUSION: Respondents with no formal education had a poor level of knowledge on malaria. Hence, new strategies for sensitization messages involving their active participation need to be developed.

Malaria and haematologic parameters of pupils at different altitudes along the slope of Mount Cameroon: a cross-sectional study.

BACKGROUND: Haematologic abnormalities are features in Plasmodium falciparum infection, and anaemia is an inevitable outcome. This study examines the influence of malaria status and altitude on haematologic parameters in school-aged pupils. METHODS: A cross-sectional study was conducted among 728 school pupils aged between four and 15 years at three different altitudinal ranges along the slope of the Mount Cameroon region. The investigative methods included the use of questionnaire, clinical evaluation and laboratory investigations. Blood sample collected from each child was used for the preparation of blood films for detection of malaria parasites and assessment of malaria parasite density as well as full blood count determination using an automated haematology analyzer. RESULTS: The prevalence of malaria in the study population was 33.8% and 64.2% (158/246) of these were asymptomatic (AM). Pupils in lowlands had a significantly (P <0.05) prevalence (95% confidence interval, CI) of malaria (60.6%, CI = 54.6-65.9%) than those in middle belt (29.1%, CI = 23.9-34.8%) and highlands (7.7%, CI = 6.1-9.8%), while those in middle belt had significantly higher geometric mean parasite density (475) than those in lowlands (233) and highlands (388). The prevalence of malaria was significantly higher in children that presented with fever (40.4%, CI = 33.8-47.2%) when compared with afebrile subjects (31%, CI = 27-35.2%). Pupils with AM had a higher prevalence of leucopaenia (43.7%, CI = 35.8-51.8%), microcytosis (27.2%, CI = 20.5-34.9%), hypochromasia (27.8%, CI = 21-35.5%) and thrombocytopaenia (14.9%, CI = 8.9-22.8%) when compared with those with clinical malaria (CM). All mean haematological parameters were comparable in pupils with CM and AM, except for the mean white blood cell (WBC) counts. Pupils with AM had significantly lower (P = 0.02) mean WBC counts (5.1 ± 2.5 × 109/L) than those with CM (5.9 ± 2.3 × 109/L). Age, altitude and malaria parasitaemia was of significant influence on several haematological parameters. CONCLUSION: Altitude influenced the distribution and density of malaria parasites and was of confounding influence on the haematologic profiles. These results highlight the insidious effects of AM on the haematologic components.