The comparative efficacies of malartin, with and without amodiaquine, in the treatment of Plasmodium falciparum malaria in the Buea district of Cameroon.

The in-vivo efficacies of the artesunate malartin, alone and in combination with amodiaquine, have been assessed against uncomplicated cases of Plasmodium falciparum malaria attending two treatment centres in Cameroon (the WHO/University of Buea malaria health post in Bolifamba and the University of Buea's health centre in Molyko). The 213 participants were treated for 3 days (malartin-amodiaquine) or 5 days (malartin alone) and then followed-up on days 3, 7 and 14. Only 86 of the patients given malartin alone and 80 of those given malartin-amodiaquine completed follow-up. Most patients given malartin alone showed an adequate clinical and parasitological response (91.9%), the rest showing late parasitological failure (7.0%) or early treatment failure (1.2%). The corresponding values for the malartin-amodiaquine combination were slightly better, at 93.8%, 5.0% and 1.2%, respectively. No late clinical failures were recorded in either treatment arm. In both treatment arms, the prevalence of anaemia in the treated adults (aged>15 years) and children decreased significantly during follow-up (P<0.05). Both regimens were well tolerated and neither gave rise to any serious adverse effects. The most common side-effects were dizziness and fatigue in those given malartin alone and fatigue, itching and nausea in those given malartin-amodiaquine. Three days of treatment with the malartin-amodiaquine combination appears to be slightly more effective and a slightly better choice than 5 days of treatment with malartin alone.

Environmental Factors Affecting Malaria Parasite Prevalence in Rural Bolifamba; South-West Cameroon

The impact of some environmental factors on malaria parasite prevalence was investigated in rural Bolifamba; Cameroon. The study population comprised 1454 subjects aged 0 - 65 years. Malaria parasite prevalence was higher in the rainy (50.1) than in the dry season (44.2) with a significant difference (P=0.001) in mean parasite density between seasons. Individuals 15 years old; had significantly higher malaria parasite prevalence (55.5) than those 15 years (37.4). Malaria parasite prevalence (P=0.001) and parasite density (P=0.03) were higher in the individuals of wooden plank houses than those of cement brick houses. Inhabitants of houses surrounded by bushes or garbage heaps and swamps or stagnant water showed higher malaria parasite prevalence and densities compared with those from cleaner surroundings. Anopheles gambiae (63.8) and A. funestus (32.8) were associated with perennial transmission of malaria. Our data indicates that poor environmental sanitation and housing conditions may be significant risk factors for malaria parasite burden in Bolifamba

The epidemiology of malaria in Bolifamba, a rural community on the eastern slopes of Mount Cameroon: seasonal variation in the parasitological indices of transmission.

The prevalences of malarial parasitaemia, fever, splenomegaly and anaemia and the levels of parasitaemia were investigated, through part of one wet season (in 2001) and the following dry season (in 2002), in 2157 subjects in the village of Bolifamba, in south-western Cameroon. Overall, 55.9% of the villagers checked in the wet season but only 49.5% of those examined in the dry season were found smear-positive for malaria (P<0.0001). Rainfall was found to be significantly associated with the mean level of parasitaemia (P=0.001). The prevalences of fever (40.3% v. 19.6%), splenomegaly (37.4% v. 4.0%) and marked splenomegaly (i.e. a Hackett's score of 2 or higher; 25.8% v. 2.4%) were all significantly higher in the wet season than in the dry (P<0.0001 for each). No seasonal difference was observed, however, in the prevalence of anaemia. Parasitaemia, fever, splenomegaly and anaemia were all significantly more common in the young children investigated (i.e. those aged < 5 years) than in the older subjects. When the data were subjected to a multiple logistic regression, age-group, anaemia, fever, and month of examination were all found to be significantly associated with the presence of malarial parasitaemia. The results of this large-scale study, the first of its kind in the Buea district of Cameroon, indicate the intense transmission of malarial parasites in rural Bolifamba, with young children at greatest risk. The data collected provide a useful 'base line' for an ongoing study to assess the immune status of the residents of Bolifamba.

Evaluating a malaria intervention strategy using knowledge, practices and coverage surveys in rural Bolifamba, southwest Cameroon.

We evaluated the impact of a malaria intervention in Bolifamba in rural Cameroon. The intervention consisted of educating the community on management of malaria and provision of a dispensary for early diagnosis and treatment. In July 2001, prior to the intervention, a questionnaire was used to obtain information on knowledge of and practices toward childhood malaria of 185 mothers of children aged 0-5 years. The same questionnaire was administered to 120 of the 185 mothers, one-year post-intervention. Clinical and laboratory investigations were carried out on children whose mothers were interviewed. A comparison of pre- and post-intervention data indicated significant changes in (i) the use of appropriate malaria treatment (from 50% to 81.7%); (ii) recognition of splenomegaly as a feature of malaria (from 18.4% to 80.8%); (iii) prevalence of splenomegaly (from 26.5% to 13.3%); (iv) prevalence of fever (from 27.8% to 13.3%); (v) parasite prevalence (from 60.5% to 44.2%) and (vi) severe malaria anaemia (from 2.6% to 0.0%). These findings revealed that proper education of villagers, particularly mothers, on malaria and the presence of health facilities, where treatment is readily available at affordable cost, close to villages, are important strategies that would reduce malaria morbidity and mortality significantly.