Malaria case management over 15 years (2006 -2021) in Jakiri North-West Region Cameroon

Ndong Henry Ndang ^1* Njodzela Christian Mengnjo ^2* Palmer Netongo Masumbe ^3,4 Olajoju Temidayo Soniran ^5* Chuo Ennestine Chu ^6* Eugene Chiabi ^7* Alfred Amambua-Ngwa ^8* Ndong Ignatius Cheng ^6,8,9*

• ¹ Faculty of Engineering and Technology, University of Buea, Buea, Cameroon
• ² Catholic University of Cameroon, Bamenda, Northwest Region, Cameroon
• ³ Navajo Technical University, Crownpoint, New Mexico, United States
• ⁴ The Biotechnology Centre, University of Yaounde 1, Yaounde, Cameroon
• ⁵ Akanu Ibiam Federal Polytechnic, Unwana, Nigeria
• ⁶ Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
• ⁷ Cameroon Baptist Convention Health Services, Bamenda, Cameroon
• ⁸ MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, University of London, Fajara, Banjul, Gambia
• ⁹ University of Cape Coast, Cape Coast, Central Region, Ghana

Background: Malaria remains a serious health challenge; thus, the need for continual improvements in treatment regimens and the adoption of new treatment guidelines to enhance case management is vital. We report trends in malaria case management over a 1615 -years period at the Jakiri Health Centre in Cameroon, an area that has been plagued with civil unrest since 2016.Methods: Data were collected retrospectively from consultation, laboratory, antenatal care (ANC) and prescription registers, and double entered into Excel. Analysis was conducted using SPSS statistics and Microsoft Excel.Results: A total of 3,800 febrile patients visited the outpatient department (OPD), and patients received 8,324 prescriptions were received by patients. Of these prescriptions, 11.6% (964/8324) were anti-malarials, 3.5% ( 291/8324) were ferrous sulfate (FS), 40.8% (3,396/8324) were antibiotics (AB), and 44.1% (3,673/8324) were analgesics. The antimalarials prescribed were artemisinin-based combination therapies (ACTs) 83.2% (802/964) and quinine (Q) 16.8% (162/964). No ACTs were prescribed between 2006 and 2011. The 5 to <15 years age group received the highest most proportion of ACTs (42.3%) (189/447), followed by the 1 to <5 years age group (31.8% (127/399)). Males were more likely to be prescribed ACTs than females were (OR= 1.336, 95% CI 1.141-1.564; p<0.0001). Between 2006 and 2013, the number of quinine prescriptions increased from 17.2% (21/122) in 2006 to a peak of 26.1% (30/115) in 2009. Antibioticprescription rates were high across all age groups. The prescription of antimalarials to malaria-negative patients was relatively low over time. ACTs were prescribed to all participants attending the ANC who were confirmed malaria-positive. 97.7% of SP was prescribed as intermittent preventive treatment in pregnancy (IPTp) with highest prescription rates observed among women in their third trimester 96.2% (76/79).This study demonstrated that recommended malaria treatment guidelines have been adopted by the Jakiri Health Centre, which has transitioned from quinine as a first-line treatment to ACTs. ACTs were not used in the facility until 2012. Though antimalaria prescription was largely appropriate, antibiotics and analgesics were highly over 3 prescribed. There is great need for continuous monitoring and as well as refresher training for health workers to enforce adherence to the guidelines.