Cameroon

Malaria burden

Cameroon is among the 15 highest burden malaria countries and has 3% of all global malaria cases in 2018; this represents the 3rd highest number of malaria cases in Central Africa (12.7% of cases).  Suspected malaria cases caused 30 % of all medical consultations, and 21 % of visits to health facilities resulted in a diagnosis of laboratory-confirmed malaria.3 National statistics from 2015 note that In health facilities, 19 % of deaths were attributed to malaria, and 48 % of all hospital admissions were due to the suspicion of severe malaria. 

Between 2015 and 2018, progress was made towards malaria control. Case numbers fell by 3% from 254 to 245 per 1000 of the population at risk.3 Mortality rates also fell by 16% between from 2015 to 2018 from 0.53 to 0.44 per 1000 of the population at risk.3 Less than 30% of children who reported having fever were tested for malaria.3

Malaria in young children

In 2015, over 60 % of the malaria-related deaths in children under five years of age were recorded in the far north (26% of malaria-related deaths) and northern regions of Cameroon (27% of malaria-related deaths) which also have a disproportionately higher number of malaria cases and deaths.4

Severe malaria

The 2017 National Malaria Control Program (NMCP) annual report indicates that about 2.1 million cases of malaria were confirmed by diagnostic test.4 Of these, 49% were noted to be severe malaria. The government is targeting several health facilities with advanced facilities. These will be used as training and reference centres for the management of severe malaria.4

Diagnosis and treatment are free for children under five with severe and uncomplicated malaria. Treatment with artemether-lumefantrine (AL) is however not free, except in the north and far north where it is the first-line treatment.4

Severe malaria case management in pregnancy4

The 2014-2018 National Strategic Malaria Control Plan advises that all cases of malaria in pregnancy be treated as severe malaria, although this is not recommended by WHO. In the first trimester of pregnancy, intravenous quinine is to be used for the first 24 hours; this is subsequently followed by oral quinine for up to seven days. From the second trimester, the first-line treatment is injectable artesunate; recommended second-line treatments are injectable quinine or intramuscular artemether. This treatment is not free, but subsidized. This presents a hurdle for many pregnant women needing to access malaria interventions.

In 2017, 62% of pregnant women received at least two doses of Intermittent Preventative Treatment of malaria in Pregnancy (IPTp) and 40% received at least three doses of IPTp.3 The low coverage of IPTp (and the general lack of inclusion of this intervention in antenatal care (ANC) services) was reportedly due to the following:4

  • frequent stock outs at the health facility level due to procurement delays and issues with inventory management; 
  • noncompliance by health workers; 
  • poor management of antenatal care services at health facilities,
  • delayed start of antenatal care services by pregnant women (some as late as seven months), 
  • and financial barriers, even though sulfadoxine pyrimethamine (the intervention used for IPTp) is supposed to be provided free of charge.

Cameroon’s health sector is divided into the following administrative regions:4

  • 10 semi-autonomous administrative regions each headed by a governor 
  • Each region is further divided into 58 divisions, each headed by a divisional officer, 
  • Each division is also split into sub-divisions; each sub-division local council and headed by a mayor.

Cameroon’s National Strategic Plan has included Seasonal Malaria Chemoprevention (SMC) as a key component especially for children in the northern parts of the country.4

In 2017, four cycles of SPAQ (sulfadoxine pyrimethamine plus amodiaquine), the intervention used for SMC, were administered to 1.5 million children aged 3-59 months old (94.5% of children in that age group).4 About 3.5 million children were administered with SMC in 2018. 

Preliminary data from the first two SMC cycles (2017) in the northern region suggested that SMC contributed to preventing malaria in over 95% of children aged 3-59 months.4

In view of the SMC programmes in the northern part of the country, the first-line ACT for that part of the country was switched to artemether-lumefantrine (AL) rather than artesunate-amodiaquine (ASAQ) to mitigate against potential drug resistance to amodiaquine. The other eight regions will maintain ASAQ as the first-line treatment.4

Vulnerable populations such as displaced persons, nomads, orphans, prisoners and refugees continue to have limited access to anti-malarial services. Additionally, data is of poor quality and there is limited integration of private-sector care providers.4

Health financing

The country’s health financing mechanism includes several instruments:6

  • Government-subsidized services, the Social Assistance Scheme (Régime d’Assistance Social), 
  • Social security, 
  • Community Based Health Insurance, 
  • Private health insurance, 
  • and household out-of-pocket payments

The government laid out plans for universal health coverage in 2018. Malaria treatment is expected to be covered under this system.5
 

Inpatient and mortality rates

Photo: World Malaria Report 2018 Cameroon country profile

Malaria geographical distribution

Photo: World Malaria Report 2018 Cameroon country profile

Sources of health financing

Photo: World Malaria Report 2018 Cameroon country profile

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong Injectable artesunate
Alternative Injectable quinine
Alternative Injectable artemether
Recommendation Pre-Referral
Strong IV artesunate (first-dose)
Alternative IM artesunate
Alternative IM quinine
Alternative IM artemether
First trimester pregnancy
Recommendation Treatment
Strong IV Quinine