Abstract
BackgroundIn the wake of a decline in global malaria, it is imperative to describe the epidemiology of malaria in a country to inform control policies. The purpose of this study was to describe the epidemiological and clinical profile of paediatric malaria in five epidemiological strata of malaria in Cameroon including: the Sudano-sahelian (SS) strata, the High inland plateau (HIP) strata, the South Cameroonian Equatorial forest (SCEF) strata, the High western plateau (HWP) strata, and the Coastal (C) strata.MethodsThis study involved 1609 febrile children (≤15 years) recruited using reference hospitals in the five epidemiological strata. Baseline characteristics were determined; blood glucose level was measured by a glucometer, malaria parasitaemia was assessed by Giemsa microscopy, and complete blood count was performed using an automated hematology analyser. Severe malaria was assessed and categorized based on WHO criteria.ResultsAn overall prevalence of 15.0% (95% CI: 13.3–16.9) for malaria was observed in this study. Malaria prevalence was significantly higher in children between 60 and 119 months (p < 0.001) and in Limbe (C strata) (p < 0.001). The overall rate of severe malaria (SM) attack in this study was 29.3%; SM was significantly higher in children below 60 months (p < 0.046). Although not significant, the rate of SM was highest in Maroua (SS strata) and lowest in Limbe in the C strata. The main clinical phenotypes of SM were hyperparasitaemia, severe malaria anaemia and impaired consciousness. The majority (73.2%) of SM cases were in group 1 of the WHO classification of severe malaria (i.e. the most severe form). The malaria case-fatality rate was 5.8%; this was higher in Ngaoundere (HIP strata) (p = 0.034).ConclusionIn this study, malaria prevalence decreased steadily northward, from the C strata in the South to the SS strata in the North of Cameroon, meanwhile the mortality rate associated with malaria increased in the same direction. On the contrary, the rate of severe malaria attack was similar across the different epidemiological strata. Immunoepidemiological studies will be required to shed more light on the observed trends.
Highlights
In the wake of a decline in global malaria, it is imperative to describe the epidemiology of malaria in a country to inform control policies
Distribution of malaria in the study population Among the 1609 participants, 242 were positive for malaria parasites giving an overall prevalence of 15.0%
The prevalence of malaria was highest in Limbe (C strata) 27.4% (87/318; 95% CI: 22.5–32.6) followed by Yaounde (SCEF strata) 18.2% (62/341; 95% CI: 14.2–22.7), Bamenda (HWP strata) 14.5% (46/318; 95% CI: 10.8–18.8), Ngaoundere (HIP strata) 8.8% (28/317; 95% CI: 6.0–12.5), and lowest in Maroua (SS strata) 6.0% (19/315; 95% CI: 3.7–9.3)
Summary
In the wake of a decline in global malaria, it is imperative to describe the epidemiology of malaria in a country to inform control policies. A vast majority of cases and deaths occurred in children in SSA [1]. A declining trend has been observed in the global incidence of malaria in recent years; compared to the year 2000 (where global incidence stood at 262 million cases and 839,000 deaths), the incidence and number of deaths due to malaria have decreased by 18% and 48% respectively [1]. A similar trend has been observed in paediatric malaria where the incidence decreased from 33% in 2000 to 16% in 2015 [1]. Malaria incidence is decreasing, there has hardly been a reduction in the role of malaria as a major cause of death in children in SSA, claiming the life of a child every 2 min [1]
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