title: Physical integrity and residual bio-efficacy of used LLINs in three cities of the South-West region of Cameroon 4 years after the first national mass-distribution campaign.
abstract: Long-lasting insecticidal nets (LLINs) are effective tools at reducing malaria transmission. In Cameroon, following the first national mass distribution campaign in 2011, there has been no follow up on the efficacy of LLINs distributed. The aim of this report is to assess the physical integrity and insecticidal potency of LLINs distributed in three cities with contrasting socio economic status (SES) and to evaluate the use and care for bed nets owned by individuals.
  
  
  
  The study was conducted in Limbe, Tiko and Buea three localities in the Fako division of the South West Region of Cameroon. Tiko had the highest SES based on the type of building materials used, followed respectively by Limbe and Buea. The use and care for bed nets was assessed using a questionnaire, the physical state of bed nets evaluated following WHOPES recommendation for determining size of holes and the residual insecticidal activity of retrieved bed nets determined through a cone bioassay using susceptible strains of mosquitoes.
  
  
  
  Of the 241 households visited in Limbe (n = 81), Tiko (n = 80) and Buea (n = 80), 186 (77.2%) had LLINs, with no significant variations from the selected study locations. However, bed net coverage was not meeting World Health Organization standards (p < 0.0001). Six different brands of LLINs were recorded, and the majority were those provided by the NMCP through the 2011 national mass campaign or antenatal care programme. Based on the calculation of the Proportionate Hole Index (PHI) as indicator of physical integrity of nets, the proportion of nets classified as serviceable (versus too torn) differed statistically according to locations (p value = 0.04), with 63.8% in Tiko, 50% in Limbe and 47% in Buea. Of the 20 nets tested for their efficacy against susceptible strains of mosquito, 42.6% (3 nets) were optimally effective in Tiko, 57.4% (4), 16.7% (1) and 14.3% (1) were minimally effective in Tiko, Buea and Limbe respectively. Finally; 85.7% (6) and 83.3% (5) were not effective in Limbe and Buea.
  
  
  
  These findings pinpoint the need for more frequent replacement of LLINs especially for people with low SES and also the need for the promotion of good practices on the maintenance and washing of nets.
authors.affiliation: Microbiology and Parasitology Department, University of Buea, P.O. Box 63, Buea, Cameroon.|Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B.P. 288, Yaoundé, Cameroun.
authors.forename: Stravensky T
authors.initials: ST
authors.lastname: Boussougou-Sambe
authors.affiliation: Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B.P. 288, Yaoundé, Cameroun.
authors.forename: Parfait
authors.initials: P
authors.lastname: Awono-Ambene
authors.affiliation: Laboratory for Biodiversity and Conservation Biology, University of Buea, P.O. Box 63, Buea, Cameroon.|Department of Zoology and Animal Physiology, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Geraud C T
authors.initials: GC
authors.lastname: Tasse
authors.affiliation: Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B.P. 288, Yaoundé, Cameroun.|Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 2701, Douala, Cameroon.
authors.forename: Josiane
authors.initials: J
authors.lastname: Etang
authors.affiliation: Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B.P. 288, Yaoundé, Cameroun.|Department of Biology and Animal Physiology, University of Douala, P.O. Box 2701, Douala, Cameroon.
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Binyang
authors.affiliation: Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B.P. 288, Yaoundé, Cameroun.|Department of Biology and Animal Physiology, University of Yaoundé I, P.O. Box 3851, Yaoundé, Cameroon.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Nouage
authors.affiliation: National Malaria Control Programme, South West Regional Delegation of Public Health, P.O. Box 281, Buea, Cameroon.
authors.forename: Gaston
authors.initials: G
authors.lastname: Wamba
authors.affiliation: Microbiology and Parasitology Department, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Peter
authors.initials: P
authors.lastname: Enyong
authors.affiliation: Laboratory for Biodiversity and Conservation Biology, University of Buea, P.O. Box 63, Buea, Cameroon. efokam@yahoo.com.|Department of Zoology and Animal Physiology, University of Buea, P.O. Box 63, Buea, Cameroon. efokam@yahoo.com.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Fokam
mesh_terms: D000328:Adult; D000818:Animals; D001681:Biological Assay; D002163:Cameroon; D002947:Cities; D003430:Cross-Sectional Studies; D009033:Culicidae / Q000187:drug effects* / Q000502:physiology; D005191:Family Characteristics; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007306:Insecticides / Q000494:pharmacology*; D008283:Maintenance; D009032:Mosquito Control / Q000379:methods*; D011795:Surveys and Questionnaires
chemical_list: D007306:Insecticides