By Boris Esono Nwenfor
Every year, around 6 million cases of malaria are recorded and in the health facilities, about 4000 deaths are recorded, most of which occur in children below the age of 5.
Dr Dorothy Achu, Permanent Secretary, National Malaria Control Program Ministry of Public Health in Cameroon, however, says there is some good news as the mortality rate related to malaria, which is endemic in the country is reducing by the numbers.
In an interview with the World Health Organization, WHO, said: “Around 30% of all outpatient visits to health care facilities are for malaria, making it a disease of importance in our country. On the positive side, we have witnessed a drop in the proportion of deaths attributed to malaria, from 18% in 2019 to 13.5% today, according to national surveillance reports.”
The reduction according to Dr Dorothy Achu is down to the intensification of the malaria prevention efforts, including rolling out two mass long-lasting insecticide-treated bed net (LLINs) distribution campaigns in the past 6 years to ensure that every household has nets.
“We are improving case management via a network of community health workers who help detect cases early, and either provide treatment or refer patients to health facilities. We’ve found that this approach helps us identify and treat cases early enough to prevent deaths.”
“We’re improving the quality of diagnosis, and in the process, we noticed that many of the deaths being recorded as malaria deaths were not caused by malaria,” Dr Dorothy Achu added.
How important is disease surveillance to your malaria prevention, treatment and control efforts?
While it’s still a work in progress, we’ve successfully worked with health facilities across the country to ensure that they can report data more regularly through our national health information system platform, giving us wider visibility on the trends in morbidity and mortality. What we are focusing on now is data quality: we want to ensure that data is not just collected but that it’s also corrected. We do that by organizing quarterly data validation meetings at district, regional and central levels.
Another fundamental thing we are working on is improving the quality of diagnosis. Historically, that has been an issue in Cameroon, and we’ve been worried that reported incidence and mortality rates don’t reflect reality. Microscopy (a key malaria detection tool) has been an issue because many technicians are not properly trained, which leads to mistakes in the way they prepare and read the slides. We also have had issues with the quality of microscopes themselves, and of the reagents that are used to stain the blood sample to help with the visualization of malaria parasites.
Due to lack of supervision, lots of errors go unidentified and make their way into surveillance reports. We’re therefore working to put in place a quality assurance system that will help to validate microscopy results being reported by health facilities. We do this via training and refresher courses, but also by putting in place laboratory mentors that help validate results.
Finally, we are in the process of putting in place sentinel surveillance, identifying specific health districts and facilities that will be able to consistently provide high-quality diagnosis, care and reporting, allowing us to register actual trends in malaria burden and mortality. At the moment, we’ve selected the sites, developed a training module for staff, and are now planning to roll out training and start to collect data.
What does your programme hope to achieve over the next 12 months?
We’re committed to finding ways for everyone in the country to have better access to malaria prevention and care. Concerning case management, we are scaling up the mentoring of healthcare workers to improve the diagnosis and management of malaria cases, especially severe cases, in a bid to further reduce mortality.
More broadly, we’re also working to integrate malaria services into the proposed universal health coverage package in Cameroon. At the moment, many of those services, including diagnosis or treatment, are paid for out-of-pocket, making them unaffordable for a large part of the population.
To achieve all this, the Minister of Public Health, Dr Manaouda Malachie, has launched a 12-month national advocacy campaign championed by the First Lady, Mrs Chantal Biya, to engage community leaders and other sectors to get more involved in control measures and to help mobilize more domestic resources to address the identified gaps.