title: The effect of Insecticide Treated Nets (ITNs) on Plasmodium falciparum infection in rural and semi-urban communities in the south west region of Cameroon.
abstract: Insecticide Treated Nets (ITNs) have been shown to reduce morbidity and mortality, but coverage and proper utilization continues to be moderate in many parts of sub-Saharan Africa. The gains made through a nationwide free distribution were explored as well as the effect on malaria prevalence in semi-urban and rural communities in south western Cameroon. A cross sectional survey was conducted between August and December 2013. Information on net possession, status and use were collected using a structured questionnaire while malaria parasitaemia was determined on Giemsa-stained blood smears by light microscopy. ITN ownership increased from 41.9% to 68.1% following the free distribution campaign, with 58.3% (466/799) reportedly sleeping under the net. ITN ownership was lower in rural settings (adjusted OR = 1.93, 95%CI = 1.36-2.74, p<0.001) and at lower altitude (adjusted OR = 1.79, 95%CI = 1.22-2.62, p = 0.003) compared to semi-urban settings and intermediate altitude respectively. Conversely, ITN usage was higher in semi-urban settings (p = 0.002) and at intermediate altitude (p = 0.002) compared with rural localities and low altitude. Malaria parasitaemia prevalence was higher in rural (adjusted OR = 1.63, 95%CI = 1.07-2.49) compared to semi-urban settings and in those below 15 years compared to those 15 years and above. Overall, participants who did not sleep under ITN were more susceptible to malaria parasitaemia (adjusted OR = 1.70, 95%CI = 1.14-2.54, p = 0.009). Despite the free distribution campaign, ITN ownership and usage, though improved, is still low. As children who reside in rural settings have greater disease burden (parasitemia) than children in semi-urban settings, the potential gains on both reducing inequities in ITN possession as well as disease burden might be substantial if equitable distribution strategies are adopted.
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
authors.forename: Tobias O
authors.initials: TO
authors.lastname: Apinjoh
authors.affiliation: Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Anchang-Kimbi
authors.affiliation: Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
authors.forename: Regina N
authors.initials: RN
authors.lastname: Mugri
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon; Department of Medical Laboratory Science, University of Buea, Buea, Cameroon.
authors.forename: Delphine A
authors.initials: DA
authors.lastname: Tangoh
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon; Department of Medical Laboratory Science, University of Buea, Buea, Cameroon.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Nyingchu
authors.affiliation: Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
authors.forename: Hanesh F
authors.initials: HF
authors.lastname: Chi
authors.affiliation: Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
authors.forename: Rolland B
authors.initials: RB
authors.lastname: Tata
authors.affiliation: Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
authors.forename: Charles
authors.initials: C
authors.lastname: Njumkeng
authors.affiliation: Department of Animal Biology and Physiology, University of Yaounde I, Yaounde, Cameroon.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Njua-Yafi
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Achidi
mesh_terms: D000293:Adolescent; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D009032:Mosquito Control; D016017:Odds Ratio; D018512:Parasitemia / Q000469:parasitology; D010963:Plasmodium falciparum; D012307:Risk Factors; D012424:Rural Population; D013383:Suburban Population; D055815:Young Adult