Prevalence of Malaria and Plasmodium Species Composition in the Western Highlands of the North West Region, Cameroon

Abstract

Background: Malaria persists as a major public health challenge in Cameroon, particularly in rural highland agro-ecological zones affected by unique environmental conditions and the ongoing Anglophone socio-political crisis since 2016 Aim: To determine the epidemiology and Plasmodium species prevalence in the western highlands of the Northwest Region of Cameroon. Study Design: The study was a community-based study with a cross-sectional study design. Place and Duration of Study: Ndop (Ngoketunjia division) and Nkambe (Donga Mantung division) from April 2024 to March 2025. Methods: A community-based cross-sectional survey was conducted between April 2024 and March 2025, enrolling 966 participants. Socio-demographic and behavioural data were collected using structured questionnaires. Venous blood samples were analysed by microscopy and real-time PCR to determine parasite prevalence, density, and species distribution. Statistical analyses included Chi-square, Mann–Whitney U, Kruskal–Wallis, and logistic regression, with significance set at p ≤ 0.05. Results: Malaria prevalence among participants was 31.9% (308/966), with the 11-20 years age group most affected (36.1%). University graduates recorded the highest prevalence (37.2%), followed by civil servants (36.1%) and retired individuals (34.5%). Use and ownership of LLINs showed no statistically significant association with parasite density. Non‑users had a higher geometric mean parasitaemia density (379.11 parasites/µL; p=0.676). Participants living in favourable vector breeding environments recorded an even higher mean density (417.12 parasites/µL; p=0.118). Age‑specific analysis revealed the highest mild parasitaemia in the 11–20 years age group (32.4%; p=0.382). Moderate parasitaemia was most common in the 6–10 years age group (6.5%; p=0.356). None of these associations reached statistical significance. Plasmodium falciparum was the predominant species among positive cases (66.9%). Plasmodium malariae had the lowest prevalence (12.3%). Conclusion: Malaria remains highly prevalent in Cameroon’s western highlands, with geographic variation and behavioral risk factors sustaining transmission. Strengthened vector control, improved LLIN usage, and targeted interventions for high-risk groups are essential.