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Resurging Malaria Catches Cameroon Napping

November 12, 2013 - 08:34 -- Bart G.J. Knols
The article below was contributed by journalist Ntaryike Divine Jr. (Douala, Cameroon). 
In 2008, the government of Cameroon engaged a policy-swing designed to irreversibly roll back malaria.  The strategy entailed providing free treatment for simple malaria for under-fives and pregnant women, a countrywide gratis distribution of treated bednets, as well as increased consciousness campaigns.
Initially, the Ministry of Health appeared to be winning the war against the bloodthirsty mosquitoes that have hemmed Cameroon among malaria endemic territories over the years.  In fact, earlier this year, officials were upbeat about sustaining the victory.    
“If we make a comparison between the current situation and what we saw in 2008, we note that malaria-related morbidity has dropped.  Related mortality among under-fives has decreased from 144 to 122 per hundredthousand thanks to actions taken by the Ministry and we’re lobbying for another campaign to distribute free bednets in 2014,” boasted Dr Etienne Fondjo, permanent secretary of the Program to Fight against Malaria.

However, current casualty figures now mock those gains.  Between January and September alone, malaria killed 1,000 of 182,000 infected persons in the Far North Region bordering Lake Chad.  Officials blame reluctance and misuse of treated bednets, recurrent floods favouring mosquito breeding, out-of-hospital therapy, shabby environments and outdoor sleeping for the soaring deaths and infections.
“Effectively in our country which is malaria-endemic, we have peak periods when malaria breaks out.  We have between 400,000 and 450,000 cases of severe malaria infections annually for mortality rates of between 20 and 25 percent.  So we easily reach a hundred thousand deaths yearly, but bad habits, especially in the Far North, have it that people have fever but don’t quickly seek treatment and others reach hospitals in critical conditions,” says Health Minister Andre Mama Fouda.
Over the last three months, the few operating healthcare delivery facilities across the region have been overflowing with patients, mostly women and children.  In Maroua, the regional capital, it is commonplace to find patients agonizing on mats on bare ground with drips hanging from tree branches! And weeks after the situation hit the news headlines, the government reaction only came in early November.
“It’s not a new problem,” Fouda remarked, dismissing claims linking the resurgence to drug resistance.  “The issue of resistance is not a major concern now because prescribed treatment is showing positive results.  The phenomenon would be countrywide if it was a case of resistance.”  Meanwhile add-on figures indicate soaring infections elsewhere across the country with 178,000 registered cases in the Center Region, idem for the coastal Littoral Region and 117,000 in the West Region.
Malaria specialists now argue that distributing insecticidal long-lasting nets gratis is not entirely the antidote.  “They’ve talked about the intensive use of treated nets. But I think we should add active case detection to that.  So we have to upgrade diagnosis,” cautions Dr Leopold Lehmann, a malaria researcher.  
He says simple tactics including involving high-risk communities in identifying and destroying mosquito breeding grounds as well as stepping up communications including in local patois can be crucial in curbing contagion within a context wherein many use the freely shared over eight million treated bednets in 2011 for fishing and termite hunting or for sewing wedding gowns.