More than 90% of deaths due to malaria occur in sub-Saharan Africa where it kills a child below five years every 30 seconds. In Cameroon, malaria accounts for 40-45% of medical consultations, 57% of hospitalization and 40% of mortality among children below 5 years. The aim of this study was to determine the prevalence of malaria, assess the malaria awareness level, the treatment seeking behaviours, and its implications on the prevalence of malaria in the Dumbu community. Questionnaires were administered to inhabitants of Dumbu. The respondents’ consents were sought and those who could not read, write or understand English language were communicated to in the local ‘kemezung’ dialect. Blood samples were collected by finger pricking using sterile lancets and blood films prepared on well labeled glass slides. The dry blood films were stained using 10% Giemsa staining solution for 10 mins. Data was collected were later analyzed using SPSS. Out of the 385 persons screened, malaria was recorded in 107 persons (27.8%). Those in the age group 11-25 years old were the most infected with malaria prevalence of 32.3% (41/127) while those in the age group ≥50 years recorded the least prevalence [19.3% (11/57)] and the difference was not significant (χ2 =3.716, p=0.294). Yaounde quarter recorded the highest prevalence 32.7% (35/107) and the male were more infected than females. On awareness level, they have heard of malaria and knew its causal agent to be an infected mosquito, 48.3% considered fever as the sign of the infection. Sixty-nine-point 8 percent (69.8%) of the population rushes to the Health centre for treatment while 5.6% prefers herbal treatment. Malaria is still a health challenge in this area and people infected should be advised to seek treatment, whenever they have malaria from a health facility to ensure that the treatment given is appropriate.
Research Article
Prevalence, awareness, treatment-seeking behaviours and its implications in the control of malaria in Dumbu community, Donga-Mantung Division
https://doi.org/10.21203/rs.3.rs-3946829/v1
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Malaria
Prevalence
Awareness
Anaemia
Haemoglobin
Treatment
Dumbu
Malaria still remains a major public health concern of most endemic areas of the world (WHO, 2022). In 2020, it was responsible for about 241 million clinical cases of sickness and 627,000 deaths worldwide. About 95% of cases and 96% deaths were reported in the sub-Saharan Africa (WHO, 2022). Five species of the malaria parasite infect humans, namely Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi (Mbanefo et al., 2020; WHO, 2022). Plasmodium falciparum, the deadliest species, accounts for 99.7% of infections in Sub-Saharan Africa (Mbanefo et al., 2020). The disease is still highly endemic in Cameroon. Cameroon is among the 15 highest burden malaria countries, with 2.9% of global malaria cases and 2.4% of malaria deaths in 2020 (WHO, 2021). The Government of Cameroon has made the fight against malaria a priority with a highlight in the country’s health sector strategy and the adoption of strategies to curb the spread of the disease.
Human behaviour with regards to their perception on etiology, treatment and prevention of malaria fosters the spread of the disease within a community. People seek medical advice depending on the individual perception of ill health, fever is still not perceived as a serious symptom (Govere et al., 2010). Many community-based studies have proved that knowledge about malaria among general population is still poor and there is no promptness in treatment seeking behaviour among fever cases. People still confuse over symptoms of malaria and its preventive measures. Correct assessment of community attitudes, knowledge and behaviour can assist the reformulation of the malaria control strategy and can form the basis of appropriate health education messages (Govere et al., 2010). Proper health education of village mothers has proved to reduce under five malaria morbidity and mortality significantly in Cameroon (Nkuo-Akenji et al., 2005).
The clinical manifestation of Plasmodium infection varies from asymptomatic to severe and fatal malaria in endemic areas. On the other hand, asymptomatic infections can be associated with high levels of gametocytes, and likely serve as an important parasite reservoir, and it has a significant contribution by maintaining parasite for the transmission (Makanga, 2012). Vector control has been a vital component of malaria prevention and control, relying mainly on the use of long-lasting insecticidal nets (LLINs). Since the year 2000, Cameroon has benefited from the support of various international partners to implement malaria control interventions (PNLP, 2012). Over 20 million LLINs have so far been freely distributed to the population through several campaigns (Minsante, 2018), with the support of partners (e.g. the Global Fund). Although the coverage rate of the population is still below the target of the Ministry of Public Health (> 80% of the households having one net for two persons), it is estimated that between the years 2000 and 2015, the scale-up of treated bed nets across the country resulted in a significant decrease in the prevalence of malaria reported cases from 41–24.3%, and 54% decrease in malaria related mortality from about 13,000 to 6000 per year (Minsante, 2018). Some studies have suggested that poor environmental sanitation and housing conditions, as well as lack of appropriate control measures might be significant risk factors for malaria parasite burden (Kimbi et al., 2012a). Environmental factors such as the presence of bushes and stagnant water around homes, rainfall, low altitude and high temperatures favor the breeding of malaria vectors, as well as parasite reproduction within them (Ngadjeu et al., 2020), while increased urbanization tends to reduce the rate of breeding. The key to addressing the challenge of reducing malaria parasite prevalence is an integrated approach that combines preventative measures, such as Insecticide Treated bed Nets (ITNs), Indoor Residual Spraying (IRS), improved access to effective anti-malarial drugs (Kokwaro, 2009) as well as proper environmental management.
Self-treatment, which is widely practiced, is another important reason for the increased prevalence of malaria especially in the developing countries. It is considered an alternative way for those who are unable to afford the cost of health services and they are more likely to start with self-treatment at home as this practice yields them to minimize expenditure and suffering in the remote areas where transportation and availability of health services pose a major problem (Hlongwana et al., 2009).
Most inhabitants of Dumbu community (found in Donga Matung Division, North West, Cameroon) are living in ignorance of the risk factors. They have farm lands, refuge dumping sites, poor water drainage systems, long standing drums of water and they can’t tell when infected except when told at the health unit. Furthermore, they rely on traditional concoctions for treatment with the notion that it is cheap and accessible. The Dumbu community and its neighbouring villages are greatly affected by the on-going socio-political crisis rocking the region and as a result, movements are limited, increase cost of transportation. All these have pushed most of the inhabitants to depend on other methods of treatment, also making access to treatment more difficult.
Many of the inhabitants of Dumbu community have little or no knowledge on the cause of malaria which is a prime factor in the control of its vector. Despite government’s interventions to eliminate the mosquito vector via the distribution of bed nets and reduced cost of treatment, some inhabitants have abused the use of it, thereby exposing themselves. Information gotten from this study will be valuable to the Ministry of Public Health authorities to plan proper and effective malaria preventive strategies in this vulnerable population and create awareness of the deleterious effects of the parasite.
This study had as objectives to determine the prevalence of malaria in Dumbu community, to determine the anaemic status of the inhabitants of Dumbu, to assess the malaria awareness level amongst Dumbu inhabitants and to assess the treatment-seeking behaviours and its implications on the prevalence of malaria in Dumbu community.
Study area
The study area lies 149km from Bamenda, North West Region Cameroon (Nkwi, 1982) (Fig. 1). Dumbu is a small village under Misaje Sub-Division in Donga Mantung Division with an estimated population of about 1,900 inhabitants. It is surrounded by Misaje village to the North, Sabongida to the South, Mayo-Kila to the East and the Dumbu-Ranch and Kweh village to the West. Dumbu is mainly a farming area and most inhabitants are farmers. There are a lot of man-made forests (many eucalyptus trees planted). The climate is made up of two distinct seasons-a long rainy season from March to September and a short dry season from October to February. Sweet potatoes and corn are their main cash crops with corn being used for the production of corn beer locally called “sha”. This village has a Government primary school and a Baptist primary school located on the Misaje road alongside the Baptist, Catholic and Presbyterian churches, a Health center towards the ranch, and a Government technical college towards Sabongida.
Study population
The study population comprised of the eligible inhabitants of both sexes that are based in the village.
Ethical and administrative considerations
An Ethical clearance was obtained from the Institutional Review Board of the Faculty of Health Sciences, of The University of Bamenda, followed by an approval for data collection from the Fon of Dumbu, Chief of Dumbu Integrated Health Centre, the Lord Mayor and the Head of Centre of the Dumbu Integrated Health Centre. The aim and objectives of the study were explained to participants in the language they understand best (English, pidgin English or Kemezung dialect). The participants were informed that the process of finger-prick blood collection will pain but the pain will last for a few minutes and equally the results of tests done will be kept confidential. The potential benefits of this study were explained to the participants and these included: knowing their malaria status and seeking medical attention early enough; they were sensitized and any questions which they asked were answered.
Inclusion criteria
Included in this study were participants who were resident in Dumbu and accepted to be part of the study and signed the informed consent form to participate in the study.
Exclusion criteria
Excluded were those who refused to sign or give their informed consent, those who accepted and later withdrew from the study, those who were critically sick and those on malaria treatment or recently recovered.
Estimation of sample size
Where n = sample size,
Z = statistic for a level of confidence,
P = expected prevalence or proportion
d = precision
and Z = 1.96 at 95% confidence interval
P = 0.455
d = 0.05 at 5% precision. (www.surveysystem.com/sample-size-formula.htm)
Administration of questionnaires
A total of 385 questionnaires were administered. Those who could not read or write were read the questions and helped out in answering. Local inhabitants were employed to help translate the questions on the questionnaires where they were understanding and language problems. The questionnaire included aspects on socio-demographics (e.g. age, sex, level of education, etc.) malaria awareness (transmission of malaria, where you heard about malaria?, how the disease can be prevented?, etc) and treatment seeking behaviours (e.g. where do you go to when feeling sick?, what form of medication do you prefer and why?, do you have a mosquito net and how often do you use it?). Each questionnaire was assigned a number which corresponded to the respondents’ slide number for blood collection and Hb values.
Blood collection, preparation and staining of smears
Using sterile disposable lancets, finger pricks were performed. Thick and thin blood films were prepared using the method described by Cheesbrough (2005). The code number of each individual was written on the slide and the blood films were allowed to air dry protected from dust and flies. In the laboratory, the thin films were fixed with 100% methanol for one minute and both thick and thin blood films were stained with 5% Giemsa stain solution for 30 minutes (Cheesbrough, 2005).
Detection and estimation of parasitaemia of Plasmodium species
The slides were read under x100 (oil immersion) objective of the microscope for the detection of malaria parasites by an experienced microscopist. A second experienced microscopist, blinded to the first reading, read all thick smears and any discrepancies (positive vs. negative; results that did not match each other; >25% difference in parasite density) were resolved by a third microscopist. Parasite densities were determined from thick blood smears by counting the number of asexual parasites or sexual parasites per 200 WBCs and converted to number of parasites/µl blood assuming a standard WBC count of 8,000/µl. A smear was considered negative if no parasites were seen after a review of 100 high-powered fields. The parasite load was estimated using the formula shown below as:
The parasite loads were classified as shown below:
-
Less than 1000 parasites/microliter of blood was considered low;
-
1000–4000 parasites/microliter of blood was considered Moderate parasitaemia;
-
Greater than 4000 parasites/microliter blood were considered high parasitaemia. (WHO, 2010).
Determination of haemoglobin level
After blood was collected to prepare thick and thin blood filmms for malaria, another drop of blood was put on a haemoglobinometer (Mission Hb. SN: 195A0012B09) to measure participants’ haemoglobin level and the value was read after 15 minutes and recorded. A dry swab was then used to wipe off the blood and the used cotton was discarded in a waste bin (Cheesbrough, 2005).
Data analysis
Data obtained were entered into Microsoft excel spread sheet and analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Proportions were compared using the Chi-square test. Means ± standard deviations were calculated and compared using the independent sample t-test. Odds Ratios (OR) were calculated to determine the important factors that were associated with malaria parasite prevalence. Pearson’s correlation coefficient was used to evaluate relationship between variables. Significant levels were measured at 95% confidence level, with significant differences recorded at P < 0.05.
Demographic characteristics of the study population
A total of 385 participants with 178 (46.2%) males and 207 (53.8%) females took part in the study. Most of the participants 127 (33.0%) were in the age group 11–25 years while the least 57 (14.8%) were in the age group ≥ 50 years old. Yaounde quarter recoded the highest number of participants, 107 (27.8%) while the least number of participants resided in Hausa quarter, 36(9.4%). (Table 1). Among the participants, 59.1% (231), ended education at the secondary level. Most of the participants were students (46.8%). The mean (± SD) age of the population was 25 (± 20) years Table 1.
| Parameter | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Sex | Males | 178 | 46.2 |
| Females | 207 | 53.8 | |
| Location | Three corners quarter | 73 | 19.0 |
| Barack quarter | 48 | 12.4 | |
| Central quarter | 58 | 15.0 | |
| Hausa quarter | 36 | 9.4 | |
| Upper central quarter | 63 | 16.4 | |
| Yaoundé quarter | 107 | 27.8 | |
| Age groups | < 10 | 113 | 29.3 |
| 11–25 | 127 | 33.0 | |
| 26–49 | 88 | 22.9 | |
| ≥ 50 | 57 | 14.8 | |
| Anaemic status | Non-anaemic | 295 | 76.6 |
| Anaemic | 90 | 23.4 | |
| Anaemic category | Mild | 72 | 80.0 |
| Moderate | 10 | 11.1 | |
| Severe | 8 | 8.9 | |
| MP-status | Negative | 278 | 72.2 |
| Positive | 107 | 27.8 | |
| MP category | Low | 60 | 56.0 |
| Moderate | 28 | 26.2 | |
| Severe | 19 | 17.8 |
Prevalence of malaria in the study population with respect to demographic characteristics
From the study, we had an overall prevalence of 27.8% (107/385), with males 30.9% (55/178) were more infected than the females 25.1% (52/207) although the difference was not significant (χ2 = 1.592, p = 0.207). Males were more likely than females to be infected with malaria, although this was insignificant (OR = 1.3 (0.8/52-2.084), p = 0.208).
With respect to age groups, those in the age group 11–25 years old were the most infected with malaria recording a prevalence of 32.3% (41/127) while those in the age group ≥ 50 years recorded the least prevalence 19.3% (11/57) and the difference was not significant (χ2 = 3.716, p = 0.294). When compared to the age group ≥ 50 years old, those of the age group 26–49 years old had a higher risk of being infected with the malaria parasite (Table 2).
Based on locations, the inhabitants of the Hausa quarter recorded the least malaria prevalence 17.8% (13/73) while the highest with 32.7% (35/107) was recorded in the Yaoundé quarter, although this difference was of no significance (χ2 = 5.485, p = 0.360) as shown on Table 2.
| Parameter | Category | Number examined | Prevalence % (number positive) | Binary logistic regression OR (95% C.I. for OR) | p - value | |
|---|---|---|---|---|---|---|
| Sex | Males | 178 | 30.9 (55) | 1.3 (0.8/52-2.084) | 0.207 | |
| Females | 207 | 25.1 (52) | Reference | - | ||
| Significance | χ2 = 1.592, p = 0.207 | |||||
| Age group | < 10 | 113 | 25.7 (29) | 1.4 (0.661–3.155) | 0.357 | |
| 11–25 | 127 | 32.3(41) | 1.8 (0.787–3.909) | 0.170 | ||
| 26–49 | 88 | 29.5 (26) | 2.0 (0.936–4.245) | 0.074 | ||
| ≥ 50 | 57 | 19.3 (11) | Reference | - | ||
| Significance | χ2 = 3.716, p = 0.294 | |||||
| Location | Three corners quarter | 73 | 17.8(13) | 0.4(0.216–0.918) | 0.028 | |
| Barack quarter | 48 | 31.3(15) | 0.9(0.450–1.944) | 0.857 | ||
| Central quarter | 58 | 25.9(15) | 0.7(0.352–1.464) | 0.362 | ||
| Hausa quarter | 36 | 27.8(10) | 0.8(0.344–1.821) | 0.582 | ||
| Upper central quarter | 63 | 30.2(19) | 0.9(0.453–1.741) | 0.730 | ||
| Yaoundé quarter | 107 | 32.7(35) | Reference | - | ||
| Significance | χ2 = 5.485, p = 0.360 | |||||
| *No. =Number, OR = Odds Ratio, CI = Confidence Interval | ||||||
Prevalence of malaria with respect to anaemia
With respect to the clinical findings, the anaemic population 67.8% (61/90) were more prevalent for malaria parasite when compared to the non-anaemic population 15.6% (46/295) although the difference was greatly significant (χ2 = 93.579, p = 0.001) as shown on Table 3.
Malaria parasite was more prevalent among those with mild anaemia70.8% (51/72) when compared to those with moderate anaemia 50.0% (5/10) although the difference was not significant (χ2 = 1.857, p = 0.395). Those with mild anaemia were 1.5 (OR) times more likely to get infected with the malaria parasite when compared to those who were moderately anaemic although the difference was not significant (p = 0.627) as shown in Table 3.
| Parameter | Category | Number examined | Prevalence % (number positive) | Binary logistic regression OR (95% C.I. for OR) | p – value |
|---|---|---|---|---|---|
| Anaemic status | Non-anaemic | 295 | 15.6(46) | 0.1(0. 051-0.151) | 0.001 |
| Anaemic | 90 | 67.8(61) | Reference | - | |
| Significance | χ2 = 93.579, p = 0.001 | ||||
| Anaemic category | Mild | 72 | 70.8(51) | 1.5(0.319–6.655) | 0.627 |
| Moderate | 10 | 50.0(5) | 0.6(0.090–3.986) | 0.597 | |
| Severe | 8 | 62.5(5) | Reference | - | |
| Significance | χ2 = 1.857, p = 0.395 | ||||
| *No. =Number, OR = Odds Ratio, CI = Confidence Interval | |||||
Treatment seeking behaviours among the study population
From the study, 93.2% (359/385) of the respondents in our study preferred the standard medication while 6.8% (26/385) preferred the herbal form of treatment and this difference was not significant (χ2 = 0.123, 0.726) (Table 4). From the 93.2% (359/385), 50.7% (181/359) preferred the standard medication because it is very effective (Table 5).
| Parameter | Category | Number of respondents | Prevalence % (number positive) | Binary logistic regression OR (95% C.I. for OR) | p - value |
|---|---|---|---|---|---|
| Forms of treatment | Standard (modern) | 359 | 27.6 (99) | 0.9(0.361–2.034) | 0.726 |
| Traditional (herbal) | 26 | 30.8 (8) | Reference | - | |
| Significance | χ2 = 0.123, p = 0.726 | - | |||
| Category | Number of respondents | Reasons for treatment choice | |||||
|---|---|---|---|---|---|---|---|
| Less costly | Easily available | Effective | Less side effects | More advanced | All five reasons | ||
| Standard | 359 | 00 | 00 | 168 | 66 | 95 | 30 |
| Percentage (%) | 00 | 00 | 46.8 | 18.4 | 26.5 | 8.4 | |
| Traditional | 26 | 08 | 09 | 06 | 02 | 00 | 1 |
| Percentage (%) | 30.8 | 34.6 | 23.1 | 7.7 | 00 | 3.8 | |
| Total | 385 | 08 | 09 | 174 | 68 | 95 | 31 |
This study investigated the prevalence of malaria, awareness level and treatment seeking behaviours in the crisis-hit community of Dumbu. The overall prevalence of malaria was low when compared to values of similar studies carried out in the Mount Cameroon region (Kimbi et al., 2005, Achidi et al., 2008). This observation might probably reflect the improvement in malaria control strategies, especially among the vulnerable groups in Cameroon by the government, consisting of the free distribution of long-lasting insecticide treated bed nets, as well as free treatment of malaria among children less than five years of age (Kimbi et al., 2012b). This agrees with a report from Kenya (Okiro et al., 2007), which showed that malaria morbidity and mortality is on a decline, as a result of scale up anti-malarial activities.
With respect to age groups, 11–25 recorded the highest. This may be due to the fact that these participants are all youths and occupy themselves with late nights keeping, early morning activities like farming and fishing. These periods are when the malaria vector activity is greatest, as such exposing themselves to the vector bites. Also, the high prevalence in this age group maybe due to the fact that they have little or no memory of the malaria parasites in their immune system. This was not the case with the greater than 50 years age group where the least percentage was recorded. This can be because they are an elderly set of participants, having little or no exposure time to the vector as they confine themselves in their homes before the peak of the vector activity. Also, they have been exposed to the parasite before and therefore their immune system generates a response to combat the parasitic attacks, hence justifying the low prevalence (Carter et al., 2002). The observed difference in prevalence with respect to age is consistent with the view that the speed of acquired anti-disease immunity depends on the frequency of parasite exposure from birth. Such variation in background immunity may also explain the differences in the age of presentation of severe malaria as reported previously (Bassat et al., 2008) or other undefined variables.
With respect to location, the Yaounde quarter recoded the highest prevalence of malaria. This quarter has a slow-moving stream that serves as a breeding site for the malaria vector. Stagnant water around residences was associated with significantly higher malaria parasite prevalence, when compared to those who did not have stagnant water around their home. This suggests that the presence of stagnant water around homes constitutes a risk factor that needs to be taken into consideration, when planning control measures against malaria, as malaria vectors need water for the survival of the immature stages. Furthermore, they live in mostly thatched and cracked wall houses as opposed to the prevalence recorded with the Fulani in the Hausa quarter. The finding seems to suggest that Semi-Bantu are more susceptible compared to the natural Dumbu people. Several studies have demonstrated differences in susceptibility to malaria, with the Fulani of West Africa having a lower incidence of malaria than other sympatric groups (Greenwood et al., 1987) and the Fulani in Burkina Faso being less parasitized than the sympatric Mossi and Rimaibé groups (Modiano et al., 1996). This is also true for the Malian Fulani and their sympatric neighbours, the Dogon (Dolo et al., 2005). Various markers confirm that the Fulani are genetically distinct from other African tribes (Israelsson et al., 2008). Such genetic differences may be less apparent in the Littoral and South West regions due to extensive ethnic mixing. However, previous results have also shown that this relative resistance to malaria in the Fulani, as compared to other sympatric tribes, appears to be pathogen related and not due to a general hyper-reactive immune system (Bolad et al., 2005).
Our finding on the awareness level of the cause of malaria was surprisingly great with 98.2% (378/385) knowing the correct cause of malaria to be resulting from mosquito bites. This is opposed to the findings of a study among 1,197 health service users in northern Cameroon, where only 1% identified mosquitoes as a source of malaria transmission (Einterz, 2003). This may have to do with the increased government efforts (Tsounkeu, 2009).
In this study, most respondents knew at least one sign or symptom of malaria compared to a study by Einterz and Bates (1997), in northern Cameroon where majority of participants incorrectly claimed they had fever. The general malaria high prevalence in Cameroon (50 to 70%) may be a contributing factor for this high knowledge. This discrepancy may also be linked to illiteracy, as many persons in the northern part of the country are less scholarised (Tsounkeu, 2009), but the inhabitants do take health related issues very seriously. Symptoms like headache, fever were well known by the population of Dumbu. Even though most respondents knew at least a symptom or sign of malaria, these were often considered as disease entities on their own which very often may lead to treatment of one symptom for long periods at home allowing the malaria to degenerate into complications. Malaria is well known among the natives of Cameroon, although the common symptoms and signs may not necessarily be compounded together to one disease entity (Lantum, 1971) as malaria.
It was discovered that 93.2% (359/385) of the respondents in our study preferred the standard medication, while 6.8% (26/385) preferred the herbal form of treatment. From the 93.2% (359/385), 50.7% (181/359) preferred the standard medication because it is very effective. Considering that many of the participants used the standard treatment methods, it indicates a good step for public health campaign. Although not presented in the results section, when these participants were asked why they preferred the herbal form of treatment, they complained about the distance of the health facilities and difficult economic situation. Remember that participants in this area have been living with the on-going socio-political crisis for more than 5 years which has crippled many people economically. Due to the on-going anglophone crisis in which the Dumbu has been affected, the prices of basic commodities as well as drugs have greatly increased, many persons have been displaced to neighbouring villages. This probably justifies why 6.8% (26/385) of the study population prefers herbal treatments as many and better herbalists are found in the neighbouring villages. From this 6.8% (26/385), 34.6% (9/26) preferred the herbal form because it is readily available.
The implications of using non-standardised traditional medicines over the conventional ones, are that improper use puts consumers at risk for potentially serious side effects as a result of allergies, drug interactions, contamination of the products with pesticides, heavy metals and other substances, or trauma inflicted by inexperienced or poorly trained practitioners. Therefore, the government of Cameroon should do all to ensure that its citizens have access to appropriate malaria treatment.
One important limitation of this study was that the time at which persons sought medical treatment was not assessed.
From this study, it can be concluded that an overall prevalence of 27.8% (107/385) with the male having a high prevalence rate of 30.8% was recorded. The percentage of persons anaemic stood at 67.8% (61/90) while those non-anaemic were 15.6% (46/295). Malaria was more prevalent in persons with mild anaemia-70.8% (51/72).
A great majority of the population 98.2% (378/385) knew the cause of malaria and at least one sign. As concerns their preferred method of treatment, 93.2% (359/385) preferred the standard form of medication. In all, it was demonstrated that the on-going anglophone crisis had little or no impact on the prevalence of malaria. However, the government of Cameroon is encouraged to work through the medical personnel found in the region to encourage the inhabitants of Dumbu to always seek standardised medical treatment when sick, reduce the prices of drugs and build many more and accessible health facilities.
Competing Interests
The authors declare that they have no competing interests.
Author Contribution
EEJE, ECB and KAS conceived and designed the study. All authors participated in the field work. EEJE and ECB analysed the data. EEJE and AP wrote the first draft of the manuscript. KAS read the first draft and made important contributions. All authors read and approved the final manuscript for submission.
Acknowledgements
We would like to thank the administrative authorities in Dumbu who received us and gave us the go-ahead to collect samples in their community. We want to acknowledge parents who willingly accepted that their children participated in the study. Finally, we would like to thank the laboratory staff of the medical facilities who assisted in the collection and analysis of the samples.
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No competing interests reported.