What Is Cameroon Doing About Malaria?

Cameroon has a National Malaria Control Program which is represented in each region with a Regional Malaria Control Unit. This unit is responsible for the collection of malaria related data and making sure that all health facilities in the region have supplies of rapid diagnostic tests, prophylaxis for pregnant women, seasonal malaria prophylaxis (in certain regions), bed nets for pregnant women, and malaria treatments.

The goals of the program over the next few years focus on the prevention and management of malaria. In every region they want to do the following: increase to 80% the use of Long Lasting Insecticidal Nets in the entire population (especially pregnant women and children under five years old), protect at least 80% of pregnant women through the use of Intermittent Preventative Treatment (a prophylaxis used during pregnancy), test at least 80% of suspected cases of malaria in health centers with either rapid diagnostic tests or microscopy, treat 100% of confirmed cases of malaria in health centers. So, the National Malaria Control Program is promoting things like Long Lasting Insecticidal Nets, malaria prophylaxis for pregnant women, and early test-seeking and proper treatment.

There are national policies that Cameroon has put in place in order to help control the spread of malaria, such as pregnant women receive a free mosquito net at their antenatal consultation, rapid diagnostic tests and treatment are free for children under five years old, and malaria prophylaxis is given to pregnant women at their consultations.

Though there is still a long way to go, Cameroon has started taking some positive steps toward eradicating malaria in Cameroon.

Prevention of Malaria

There are several things that people can do to protect themselves from malaria. Since the mosquito that transmits malaria only bites at night, the best tool for malaria prevention is a mosquito net. The mosquito net is hung over a bed so that mosquitoes cannot get to the person sleeping underneath it at night when the mosquitoes are biting and the person is less able to wave them away. Some mosquito nets are treated with insecticide which means that when a mosquito touches the net it will, soon after, die. The use of mosquito nets is important for everyone, since everyone can get malaria, but it is especially important for at risk populations, like children under five years old, pregnant women, and people living with HIV/AIDs. Mosquito nets can help eradicate malaria because the mosquitoes that carry malaria become infected only when they bite someone who has malaria. This means that if there were no infected people to bite and any infected mosquitoes could not get to uninfected people because of mosquito nets then the malaria parasite would die along with the infected mosquitoes since the parasite requires the human body and the mosquito body to complete its life cycle. This makes it very important for everyone to sleep under a mosquito net every night in malarial regions.

Other things that people can do are to try to only go out at night when necessary, wear covering clothing if they do go out at night, use mosquito repellent, use insecticide for the house, clear away any standing water (mosquito breeding grounds) that is near the house, cut back tall grass and bushes that are close to the house, repair tears in mosquito nets immediately, and get treated immediately when they think that they might have malaria so that there is less time that they could potentially spread the disease to more mosquitoes.

Diagnosis and Treatment of Malaria in Cameroon

There are simple and severe cases of malaria. Simple malaria is defined as having a positive malaria test and a fever of 39.5˚C or less with any of the following: chills, headache, body aches, joint pain, back pain, loss of appetite, nausea, vomiting, or diarrhea. Severe malaria, on the other hand, comes with a positive malaria test and a fever of 39.5˚C or more with at least one of the following: severe anemia, convulsions, shallow and rapid breathing, severe dehydration, delirium, hypoglycemia, jaundice, acute renal failure, shock, and death.

In Cameroon, both simple and severe malaria are diagnosed with either a rapid diagnostic test or with microscopy. The rapid diagnostic test (RDT) is done with a finger prick and shows whether or not the patient has malaria but not the severity. Microscopy is done by drawing blood and shows not only whether or not the patient has malaria but also whether the infection is simple or severe. Rapid diagnostic tests are used most often in Cameroon because the results come back quickly and don't require lab equipment or technicians.

Simple malaria is typically treated with Artemisinin Combined Therapies (ACT), which are made up of two anti-malarial drugs coupled together. Treatment of simple malaria is a three-day course of treatment of which the dosage depends on the age and weight of the patient. Severe malaria is treated intravenously (injection) with fast acting drugs to quickly reduce the malaria parasites in the patient.

"Fun Fact: Chloroquine started out as a great anti-malarial drug. In fact, it worked so well that doctors started treating every case of fever with it, without verifying if each fever was, in fact, a case of malaria. This, combined with people not completing their course of treatment, resulted in the parasite developing a total resistance to Chloroquine, and as such, it can no longer be used to treat malaria in the majority of the world."

• U.S. Peace Corps Cameroon Malaria Handbook, 2014 edition

Most At-Risk Populations of Malaria

There are four populations that are more at risk of catching and/or dying from malaria. These populations are children under five years old, pregnant women, people living with HIV/AIDS, and non-immune foreigners.

Children under five years old are at-risk because they have not yet developed any immunity or resistance to the disease and are not as able to survive the symptoms. Each year in Cameroon, often more than half of the deaths caused by malaria are in children under five years old. Often seen in young children, severe malaria can cause anemia when the parasite feeds off  of the red blood cells and destroys them resulting in a dangerous lack of oxygen reaching the organs. When this happens it can lead to coma and death.

Pregnant women are at-risk because diagnosis of malaria during pregnancy can be difficult and they can also become severely anemic. Diagnosis can be difficult because the parasite will not always show up in a blood smear but will rather show up in a sample of the placenta. Women are at highest risk of complications caused by malaria during their first pregnancies, immunity is built up with each successive pregnancy.

People living with HIV/AIDS are at-risk because their immune systems are already compromised. Their compromised immune systems put them at higher risk of complications from malaria.

The final at-risk population is non-immune foreigners because they have not built up any immunity to the disease. Malaria can cause blood clots and mini-strokes, which can lead to coma and death, in people experiencing one of their first cases of malaria. The parasite avoids the spleen, which can filter out infected red blood cells, by attaching itself to the sides of the blood vessel walls, usually in the brain, and obstructs the flow of blood. When this happens it is called cerebral malaria.

These populations are at-risk because they are more likely to get severe malaria or to have untreated simple malaria develop into severe malaria. Severe malaria is often the cause of many of the complications that these populations may experience.

Malaria in Cameroon

Malaria Day picture from the internet.

So, I am writing this little series of posts on malaria because April is World Malaria Month and the 25th of April is World Malaria Day! I hope to be able to post one to two posts a week this month (Most of the information will be from Peace Corps training and handbooks.)

Peace Corps Initiative: Stomp Out Malaria.

In Cameroon there are 1,700,000 documented cases of malaria every year. A survey done in 2011 showed that, in Cameroon, malaria is the cause of 40-45% of hospital consultations, 30% of hospitalizations (52% of child hospitalizations), 24% of deaths in hospitals, 40% of health expenditures, and 26% of reported work absences. About 71% of Cameroon has a high transmission rate, one case per one thousand people, and the rest of the country has a transmission rate of zero to one case per one thousand people (WHO). This means that malaria is transmitted in every part of Cameroon. According to a study done by Malaria No More in 2013, despite measures being taken by Cameroon to prevent malaria, only 36% of households own an insecticidal net and only 21% of children sleep under these nets.

 

Map of Cameroon showing the ten regions.

Malaria is found in all ten regions of Cameroon and it is possible for anyone to get malaria. It is thought by some people in Cameroon that it is not possible to get malaria during the dry season, if they live at higher altitudes, or if they live in urban areas. Although it is true that there are fewer mosquitoes in dry season and in urban areas due to there being less standing water in which mosquitoes can breed and there are fewer mosquitoes at high altitudes due to the cooler temperatures, it is still possible to get malaria. This is because there are still people traveling into or through the area who have malaria and some mosquitoes around to transmit the disease. There is a spike in cases of malaria not long after the start of the rainy season due to the increased amount of standing water and, therefore, the increased amount of breeding grounds for mosquitoes. Malaria survives dry season because the mosquitoes don’t require much water to breed and there are people who have malaria who do not get treated because they don't show symptoms or they weren't treated properly. In the Grand North (Adamawa, North, and Extreme North regions), malaria is almost seasonal because of the large difference in the amount of precipitation between the rainy season and the dry season. In the much more humid Grand South however, the change in precipitation does not bring as large a difference in the number of cases of malaria between the rainy and dry seasons.

Almost the entire country of Cameroon is in the "most intense transmission" category which means 75 confirmed cases per 1,000 people. Malaria is everywhere in Cameroon at all times. In one of my later posts I will talk about what Cameroon is doing to fight against the spread of malaria.

What is Malaria?

What is Malaria?

Malaria is found mainly in countries near the equator, including Cameroon. I always try to take the proper steps to avoid malaria whenever I can. For example, I sleep under a mosquito net and take my malaria prophylaxis everyday. So far I have not had malaria here in Cameroon: I had one presumed case but the test result was negative.

Map showing distribution of malaria transmission.

Malaria is a disease that is caused by a parasite of the Plasmodium genus and is transmitted by the female Anopheles mosquito. The life cycle of malaria, or  rather the Plasmodium parasite, starts when an infected mosquito bites a person who does not have malaria and infects them with the parasite. The parasite first develops in the liver and then moves to the blood. After that the person starts to show the symptoms of malaria and passes on the parasite when bitten by an uninfected mosquito. And the cycle repeats.

This image shows the life cycle of the Plasmodium parasite in detail, including the developmental stages of the parasite inside each of its hosts.

This image shows the cycle in a much simpler way, infected mosquito bites uninfected person and infects them then an uninfected mosquito bites the infected person and becomes infected.

This makes malaria a community disease. When one person has malaria and they do not treat it properly or they do not take precautions to protect themselves from other mosquitoes it becomes possible for them to pass malaria on to other people through the mosquitoes that bite them.

The female Anopheles mosquito bites at night which makes sleeping under a mosquito net every night the best way to prevent malaria. Since malaria is a community disease, getting treatment right away is the best thing to do if you do get malaria. Although, a person should get tested for malaria before they treat for malaria because the parasite could develop resistance to the drugs that are used to treat malaria. That is what happened with Chloroquine, a drug that used to be used to treat malaria. Chloroquine can no longer be used in many places because it was used to treat almost any fever without testing for malaria and the parasite developed resistance to it.

According to WHO, mortality from malaria has fallen by 42% globally since 2000 however, malaria is still responsible for over 600,000 deaths each year around the world. Most of the deaths caused by malaria, about 90%, happen in sub-Saharan Africa and about 85% of those deaths occur in children under five years old. Children under five years old, pregnant women, people living with HIV/AIDS, and non-immune foreigners are the groups that are most at risk of dying of malaria. "The Millennium Development Goal 6 specifically targets the reduction of HIV/AIDS, malaria, and other diseases. It is estimated that since 2000, 1.1 million deaths from malaria have been averted due to measures taken to reduce the disease. Countries which have adopted malaria control programs had a reduction in child malaria mortality." (Peace Corps Cameroon Malaria Handbook, 2014 Edition). Cameroon now has a National Malaria Control Program and is working to eradicate malaria in Cameroon.

Monica in Cameroon!

Monica arriving in Cameroon!

Monica finally came to visit me in Cameroon! Her plane was going to arrive Monday night so I traveled to Yaoundé on Sunday November 23rd, 2014 in order to get things arranged before she arrived. I stayed at the Peace Corps transit house in Yaounde and on Monday morning I arranged for a cab to take me to the airport
later and I booked hotel room for us. That evening I went with the cab to the airport, which is about an hour outside of Yaounde, to pick up Monica. Her plane was supposed to arrive at 8:30pm, so I made sure to get there by 8pm, and the plane was late. She finally arrived at 9:30pm. Monica was officially in Africa! We took the cab back to town and were stopped by some police and asked to show our ID. This has never happened to me in the middle of town before but it was an interesting introduction to Cameroon for Monica. Then the cab dropped us off at our hotel. I chose that hotel because it was a mid-level hotel, not too fancy but not the basic type of hotel in Cameroon either. I wanted to give Monica a smooth transition into Cameroon.

The next day we went to Amour Mezam bus company and took a bus from Yaounde to Bamenda. We took the VIP bus where each passenger gets their own assigned seat rather than crowding onto a  bench seat; I wasn't sure if Monica was ready for that. The seats in these buses though are typically smaller than they are in America so it is not really like having your own seat anyway. I had prepared Monica for this before getting to the bus station but I was surprised when we stepped onto the bus and the seats were the size you would expect to see in America. Monica was not surprised and thought that I had been pulling her leg. There were

Me and Charles!

some other volunteers on the bus and they backed me up about the typical size of the seats. The seven hour trip went well even though it was pretty hot seeing as it was getting to be dry season.

When we arrived in Bamenda we dropped our things at my house and then went out for dinner. The next day we had to wait around my house for my landlord and a technician. There was an issue with my house that I had been trying to get fixed since late September. Monica and I waited around for not only that day but the next three days; the first day they didn't show and then it took them the next two days to finish the work. This was not what I wanted to do while Monica was visiting but it couldn't be helped. We spent the rest of our time, about ten days, traveling and seeing tourist attractions.

Thanksgiving dinner.

The Thursday after Monica arrived in Cameroon was Thanksgiving. We bought potatoes and green beans in the market and canned corn and creamed corn in the supermarket so that we could make mashed potatoes, garlic green beans, and creamed corn for dinner. I also got a piece of chicken, since turkey is not really
available, to go with my dinner. Along with those things we had jellied cranberry sauce that I bought from an "American" store three weeks earlier. "American" stores are stores that sell goods that are imported from the United States and Europe. I was very excited when I found that cranberry sauce and I was surprised at how traditional Monica and I were able to make our Thanksgiving dinner.

Black sand beach at Limbe.

Monica and I went to Limbe for the weekend. Limbe is one of the two major beach towns in Cameroon, the other is Kribi in the South region. Limbe is in the South West region , sits at the foot of Little Mount Cameroon, and is known for its black sand beaches. Monica was once again lucky with the bus; it too had the American style seats. After the bus arrived in Limbe, Monica and I got a cab into town and tried to find a hotel that had been suggested to us by another volunteer. It turned out that the cab driver did not know where the hotel was or how to get there. So, Monica and I got out and started walking to see if we could find the hotel or someone who could tell us how to get there. We found a hotel that was under construction, and yet open and not open at the same time, and the staff there knew where the hotel was and helped us get a cab there.

Monica and me in our room at the hotel.

Finally we arrived at the hotel and got checked in. I'm not sure why but all of the staff at the hotel spoke French rather than English even though the hotel is in an Anglophone region. Anyway, Monica and I got settled in our room and turned the air conditioning on. To me it was just a little warm but Monica thought it was wretchedly hot. I guess I'm used to it, although Limbe is very humid. We decided to go swimming. The Limbe beach is on the Atlantic Ocean and so it took a little while for Monica and I to work up the courage to go in the water. We were being silly and considering what could be in the water. We were nervous because the water was a little murky with the black sand and silt. Finally we went in, swam, and had a lot of fun with no problems.

We swam for about an hour and a half and then decided to go back to the hotel and get cleaned up for dinner. When we got back to the room we realized that the air conditioning wasn't working. So, after we showered we went to the front desk and asked for a new room. I left Monica at the hotel restaurant and went with a member of the staff to chose a new room. Once we'd found one where all of the equipment in the room was working, I went back and joined Monica. For dinner Monica had some sort of vegetable soup and I had fish and vegetables. We both thought that dinner was good and I was glad because there are very few vegetarian options for Monica in Cameroon and I had heard that Limbe has great seafood and was glad that it was true. After that we went to our room and watched a movie while we relaxed in the air conditioning.

Fisherman's village in Limbe.

The next morning we went and had breakfast in the restaurant and then went back to the room to shower and get ready to leave. Half way through our showers the shower head broke randomly in two. So, I went to the desk and asked for a bucket of heated water so that we could finish our showers. We waited over an hour for the water and I had to inquire about it several times but it finally got to us and we were able to finish showering. After that we went and got a cab back to town.

Oil rig in the bay at Limbe.

We had to wait for the bus and it was almost lunch time so we went to find something to eat. The first place that we tried had food that was way too expensive for us so we tried a different place. The second place was just opening and the owner was there. He allowed us to make special orders so that we could get what we wanted at a price that we could afford.  I got fish again and Monica got a vegetable sauté. It was pretty good and the owner was nice. He also told us about the Limbe botanical gardens which were just around the corner. Since we still had time to kill Monica and I decided to go.

Botanical gardens in Limbe.

As we paid our entrance fees to the gardens, the woman selling the tickets asked if we were twins. When I said that we were she jumped up and rushed around her desk to hug us together. Twins are said t have great powers and so it is common for people to hug or touch twins for luck. After that Monica and I went into the gardens. There were plaques around and a few of them had papers in them labeling trees or other plants but most of them were empty. There were also benches set around the park but they were always set in the most awkward places. For example, some of them were facing trees and were only about a foot from the tree and others were under branches that hung too low to allow anyone to sit down. Other than these things the garden was nice. I was rather hoping that there would be flowers but it was all trees and bushes. I thought, before coming to Cameroon, that since it was a tropical place, there would be a lot of color and many types of flowers but it is not so. It was still nice to be away from the city. Monica and I sat down on the path, since all of the benches were so awkwardly placed, and rested for a while. After resting and exploring the rest of the gardens, and hearing all about Kensington Gardens from Monica, we left the botanical gardens. We went and found a hotel with a small restaurant to sit at while we waited for our bus. We had a snack and changed into our traveling clothes. Then we took a cab to the bus station.

The trip  is about eight or nine hours and the bus driver had a dvd menu on the monitors for the entire trip; a twenty second loop f outrageously loud music playing the entire time. I was very grateful when the trip was finally over. Monica and I took the next day to rest and see Bamenda. I showed Monica around a little and took her to some of my favorite restaurants. It was nice to be able to rest after that trip!

Tea being produced at the Ndawara Tea Plantation.

The next day we traveled up to the Ndawara Tea Planation. This tea plantation is one that is commonly visited by volunteers and comes highly recommended. Monica and I took a taxi to the town then a moto up the hill to the tea plantation. We signed n and then we were given a tour of the factory where they dry and package the tea leaves. It was really neat to see the whole process. Monica took a lot of pictures because she thought that Jason would find the process and the machinery interesting too. After that Monica and I went to see some of the other things that were on the plantation. The plantation had what could almost be considered a small town in the middle of its many, many acres where most of the workers live. The tea plantation also keeps some exotic animal species.

Visiting the chimpanzees.

Tea packaging room, packaged tea.

So, Monica and I went to see them. They call the area a preserve but it seemed to me that the cages were too small to really call it a preserve. They had snakes, peacocks, ostriches, several types of monkeys, and chimpanzees. The handlers took some of the chimpanzees out of their cage and let them run around the grounds. Bobby, one of the chimps, even herds cows! After watching the chimpanzees for a while, Monica and I went back to the factory and met our bike driver who took us back down to the town where we could get a car back to Bamenda. When we arrived back in Bamenda, Monica and I went out for dinner at a restaurant that had a vegetarian dish that Monica liked.

View from the Ndawara Tea Plantation.

The next day Monica and I took a bus to Yaoundé so that we could get ready for our flight and I could pick up my passport from the Peace Corps office. The bus that we took had the smaller type of seats so Monica was finally able to see that I had been telling the truth. Monica and I checked into a slightly cheaper hotel than last time but it was still pretty decent. In the morning I took Monica to the Peace Corps office to meet everyone. She met my program managers, Tiki and Therese, one of my training coordinators, Gaston, the safety and security coordinator, Ruth, and many of the admin that I work with often, Nancy, Sally, and Lori. They all still ask about her whenever I see them. All of the staff and admin who are Cameroonian thought it was amazing that I have a twin sister and kept saying that we look exactly alike. After showing Monica the office we went to the Mvog Betsi Zoo, the zoo that is located right in the middle of Yaounde. It is a small zoo that has several species of birds, snakes, lizards, crocodiles, turtles, and apes and there are also lions and warthogs. The zoo is set up kind of like a garden with paths running through it that lead around to the enclosures.

Monica and me at the Mvog Betsi Zoo.

As Monica and I were walking along the paths we suddenly heard rustling in the trees above us. We looked up and saw some of the monkeys leaping out of their open-topped cages and into the over hanging trees. Monica and I moved to a different area of the zoo but wondered why no caretakers or anyone seemed to be doing anything about it. We also noticed that the crocodiles' enclosure was not locked. It was closed so that the crocodile could not get out but not closed so that people could not get in. After that we went over to see the lions; there were several female lions and one male lion. The male lion had an enclosure all to himself (and at least it was shut securely). The lion was as tall as Monica and I and we were able to get very close to him because there were only the bars separating us rather than the walls, glass, and ditches that we have in the States. It was a little scary because when the lion came over to the bars to look at us, we were literally eye to eye. This lion seemed larger than any that I have seen in the States but then again they don't let people get that close. After the zoo Monica and I went back to our hotel and worked on rearranging our packing so that all of our bags were within the weight limits for our flight.

Monica on our last day in Cameroon.

We spent the whole next day on this endeavor as well, taking breaks every now and again to explore Yaounde. Finally we got everything arranged and called a cab to take us to the airport. We left together on a flight that left Cameroon almost two weeks to the day since Monica arrived. Now I was leaving Cameroon to spend Christmas in the States with some of my family and friends.

View of Yaounde from Mount Febe, the hill on which the monastery sits.