Background: Malaria is a major public health problem in Cameroon. The study of the genetic diversity within parasite population is essential for understanding the mechanism underlying malaria pathology and to determine parasite clones profile in an infection, for proper malaria control strategies. The objective of this study was to perform a molecular characterization of highly polymorphic genetic markers of Plasmodium falciparum, and to determine allelic distribution with their influencing factors valuable to investigate malaria transmission dynamics in Cameroon. Methods: A total of 350 P. falciparum clinical isolates were characterized by genotyping block 2 of msp-1, block 3 of msp-2, and region II of glurp gene using nested PCR and DNA sequencing between 2012 and 2013. Results: A total of 5 different genotypes with fragment sizes ranging from 597 to 817 bp were recorded for GLURP. Overall, 16 MSP-1 genotypes, including K1, MAD20 and RO33 were identified, ranging from 153 to 335 bp. A peculiarity about this study is the RO33 monomorphic pattern revealed among the Pfmsp-1 allelic type. Again, this study identified 27 different Pfmsp-2 genotypes, ranging from 140 to 568 bp in size, including 15 belonging to the 3D7-type and 12 to the FC27 allelic families. The analysis of the MSP-1 and MSP-2 peptides indicates that the region of the alignment corresponding K1 polymorphism had the highest similarity in the MSP1and MSP2 clade followed by MAD20 with 93% to 100% homology. Therefore, population structure of P. falciparum isolates is identical to that of other areas in Africa, suggesting that vaccine developed with K1 and MAD20 of Pfmsp1 allelic variant could be protective for Africa children but these findings requires further genetic and immunological investigations. The multiplicity of infection (MOI) was significantly higher (P < 0.05) for Pfmsp-2 loci (3.82), as compare with Pfmsp-1 (2.51) and heterozygotes ranged from 0.55 for Pfmsp-1 to 0.96 for Pfmsp-2. Conclusion: High genetic diversity and allelic frequencies in P. falciparum isolates indicate a persisting high level of transmission. This study advocate for an intensification of the malaria control strategies in Cameroon.

Background: Management of malaria requires prompt diagnosis of malaria by microscopy, Rapid Diagnostic Tests (RDTs), or other available tools. The objective of this study was to determine the best approach on malaria diagnosis in detection of malaria parasite in the Northwest region, of Cameroon among different population groups. Materials and method: The cross sectional study was conducted on 60 febrile patients who were directed to the laboratory department for blood screening at the Bamenda Regional Hospital after showing signs and symptoms of malaria infection. Blood sample were collected aseptically and dispensed into an EDTA container where RDTs and microscopic examination were performed to assess the presence of malaria parasites. Results from the rapid diagnostic kits were analyzed and compared to those obtained by general microscopy. Results : Of the 60 samples enrolled 37 (61.7%) were found to be positive with blood films examination while in rapid diagnostic test 27 (45%) were positive. Based on frequency of infection by age 20-35 years had 13 (35.1%) as the most vulnerable group, followed by 0 -5 year with 11 (29.7%), 6-19 had 6 (16.2%) while age group of 36-59 had 5 (16.0%) and lastly the age group of 60 and above had least value of 2 (5.4%). The prevalence of malaria obtained through microscopy (62%) was significantly higher than in RDT (45%). Considering microscopy as the gold standard, RDT exhibited high specificity (100%) and sensitivity (73%) with positive predictive and negative predictive values of 100% and 70%, respectively. The sensitivity of RDT increased significantly with increase in P. falciparum parasitaemia which was the plasmodium specie detected in all positive cases. Conclusion: The study, therefore, highlights that the routine microscopy test demonstrated a superior sensitivity compared to RDT method of malaria diagnosis, however, RDT could be a useful tool in individuals suspected to show high degree of disease spectrum for quick intervention in order to avert danger associated with delayed diagnosis.

Background: Artemisinin-based Combination Therapies (ACTs), have been reported to be effective against multidrug-resistant Plasmodium falciparum. There are controversies in the choice of the type of ACTs to be used at hospitals settings and health centres. This is mostly determined by the cost and less side effects reported for each drug leading to an over prescription and consumption of some ACTs compared to others and consequently to drug resistance. This situation highlight the importance for constant monitoring of ACTs efficacy to provide a guideline to the National Malaria Control Program (NMCP) in readjusting treatment policy when these ACTs are no longer effective and safe in the management of uncomplicated malaria. ACTs including Malacur® (DHAP), artequin® (ASMQ) and cofantrine® (AL) , have been reported to be effective against multidrug-resistant Plasmodium falciparum malaria in many countries including Cameroon and the efficacy may have another profile as the consumption increases in the treatment of any fever cases as malaria observed in meso to high malaria endemic countries. Methods: This open-label, randomized clinical trial was conducted from October 2012 to March 2013 at the Cameroon Development Corporation (CDC) health facilities in Cameroon. Patients who had P. falciparum mono-infection were randomized to receive Malacur® (DHAP), artequin® (ASMQ) and cofantrine® (AL) in the treatment of malaria in a high malaria transmission area. Out-patients from the clinics and hospital of the Cameroon Development Corporation having amongst other criteria, a pre-treatment parasite density of ≥2000 μL-1 of blood were enrolled for the study following the WHO protocol. Informed Consent was obtained from the parents/guardians of the participants and the drugs were given on days 0, 1 and 2. Each patient was followed up to day 42. Blood slides and filter paper samples for Polymerase Chain Reaction (PCR) were collected on days D0, D1, D2, D3, D14, D21, D28, and D42 post treatment.Findings: Results showed that of the one thousand five hundred and fifty five (1555) patients screened, two hundred and sixteen (216) meet the enrolment criteria, but 207 completed the trial. Baseline characteristics were similar in all three treatment groups. All of these participants were included in the per- protocol (PP) analysis. The overall crude adequate clinical and parasitological response (ACPR) were 84% (95%IC; 83.3- 84.7), 86.9% (95% IC; 86.1-87.7%), 92.1% (95% IC; 91.9-92.3%) in AL, ASMQ, and DHAP arms respectively. The PCR-corrected cure rates were generally higher than crude cure rates. The AL, ASMQ and DHAP PCR-corrected percentage cure rates were 95.6% (95% IC; 95.3-96.0%), 97.1% (IC95%; 96.8-97.4%) and 99.3% (IC95%; 99.1-99.6%) respectively with a significantly higher cure rate(p < 0.01) recorded for DHAP comparable to ASMQ and AL. The success rates, PCR-corrected for AL on D1, D2, D3, D7, D14, D28 and D42 were 88.90%, 99.97, 99.99, 100, 100, 97.10 and 94.20%, respectively. The success rates for the ASMQ group were 99.60, 99.93, 99.96, 100, 100, 97.10% and 97.10 %, respectively. The success rates for the DHAP group were 99.86, 99.98, 100, 100, 100, 100, 98.60 and 100% respectively. Parasite clearance time was shorter in the DHAP group 28.7± 9.64 hours as compare with AL, 34.33±18.40 hours (CI 95% 3.25-8.08；P=0.0001) and ASMQ 39.7± 21.4 hours (CI 95% 7.34-14.66）P=0.0001). The mean fever clearance times were 12.57, 11.25 and 11.02 hours, for AL, ASMQ and DHAP respectively. The DHAP and ASMQ exhibited marked antigametocyte activity, with a gametocyte clearance time of 48 and 51.0 hours respectively. The adverse reaction common to the three groups of treatment were cough, weakness, abdominal pain, loss of appetite. There were no major adverse reactions in the DHAP group. However, mild but higher frequency of abdominal pain, loss of appetite, vomiting and pruritus was observed in the AL group while mild hallucination and dizziness occurred only in the ASMQ group. It was equally observed that AL, ASMQ and DHAP have an impact in the improvement of Haematocrit rate. Conclusion: This finding provide evidence that DHAP is the most efficacious, safe and well tolerated ACT compared to ASMQ and AL. Its use is therefore recommended as alternative treatment of malaria in Cameroon and in meso to high malaria endemic countries in general.Trial registration This study is a randomized controlled trial approved by Cameroon National Ethics Committee and retrospectively registered with controlled-trials.com on the 28/11/2016 at the website: https://clinicaltrials.gov/ct2/show/NCT02974348 with the registration number NCT02974348.