[Malaria vector control in Cameroon: past, present, future. Reflections]

Abstract

During the fifties, large scale malaria vector control projects based upon house spraying were implemented in Southern and Northern parts of Cameroon in line of malaria eradication concept. In the South, the pilot zone of Yaounde gathered about 150,000 inhabitants, in the forest area. First operations started in 1953 but the programme became actually operational in 1956. It was divided in two parts: the western part was treated with DDT, while the eastern one was treated with dieldrin. At the same time, the whole forested area was also treated with dieldrin until 1960. Yaounde itself was not treated because it was free of anopheles and malaria. House spraying in the pilot area of Yaounde was a complete success and plasmodic index dropped below 1%. The same success was observed in most of the southern treated areas. Unfortunatly dieldrin resistance of An. gambiae hampered this programme which stopped in 1960. The northem pilot project dealt with some 250,000 inhabitants around Maroua, in a savanna area. To avoid dieldrin resistance observed in 1956, DDT was selected and house spraying started in 1959. From a strictly operational point of view, the campaign was considered as a success. But after two years, it was noticed that plasmodic index remained still around the same value of 35% and the programme stopped. It was thus stated that according to available techniques it was not possible to reach the ultimate goal of eradication even when chemoprophylaxis (chloroquin + pyrimethamin) was added. The comparison between south (= success) and north (= failure) was very interesting as it underlined the big differences between epidemiological faces, an unaccepted concept at that time. Now ecological and epidemiological diversity is the well acknowledged. It also underlined the need of diversity of strategies according to the epidemiology of the disease and the ecology of its vector Vector control was then stopped for a while. In the eighties, Primary Health Care was promoted and malaria control shifted from vector to parasite control, vector control remaining as a prevention method. But chemioresistance of Plasmodium falciparum appeared and. quickly spread, at different levels, across the country. A new emphasis was therefore given to vector control thank to the newly developed technique of insecticide impregnated mosquito nets. Two kinds of studies were undertaken: - what people were actually doing in term of mosquito control at family level, the main reason and the costs as well as current use of mosquito nets - the efficacy of pyrethroid treated mosquito nets (IMN) in different areas of southern forested area against different malaria vectors: An. gambiae, An. nili, An. moucheti. It thus clearly appeared that IMN were very successful in sharply reducing malaria transmission aAd morbidity. But its promotion is limited by the current poor use of mosquito nets in Yaoundé (1 mosquito net for 27 "beds") while in Douala, where IMN are largely used against the bite of the huge population of Culex. quinquefasciatus, the implementation of the first riational centre for impregnation of mosquito net was a great success, as long as it was headed by a motivated and skill manager Impregnated mosquito nets appear thus as a tool of great efficacy but their sustainability is still matter of concern and promotional campaigns must be developed involving private and public, political and scientific spheres as well as the general population who should be encouraged to become partners and even actors of vector and malaria control at their household level.