A Cross-sectional Study on the Influence of Altitude and Urbanisation on Co-infection of Malaria and Soil-transmitted Helminths in Fako Division, South West Cameroon

Aims: Malaria and soil-transmitted helminth (STH) infections are parasitic diseases afflicting populations that are impoverished and malnourished. The aim of this study was to assess the influence of altitude and urbanisation on Co-infection of malaria and soil-transmitted helminths in Fako Division, South West Cameroon.
Study Design/Place and Duration of Study: It was a cross-sectional survey carried out from 2012 to 2014 involving 1138 children aged 4 – 15 years in Fako Division.
Methodology: Structured questionnaire was administered to obtain demographic and socio-economic data. Blood samples were collected by pricking the finger. Malaria parasite prevalence, density and species were determined from Giemsa-stained thick and thin blood smears respectively. Quantitative estimation of helminth eggs was done by Kato-Katz thick smear technique. Based on height above sea level (a.s.l.), the study sites were classified as Lowland (<200 m.a.s.l), Lower middle belt (>200 but ≤ 400 m.a.s.l), Upper middle belt (>400 but ≤600 m.a.s.l.) and Highland (>600 m.a.s.l). The study communities were also classified into rural, semi-urban and urban areas.
Results: The overall prevalence was 38.1% (433) for malaria, 2.5% (29) for STHs and 0.9% (10) for malaria-STH co-infection. The prevalence of malaria was significantly highest (χ2 = 84.6, P <0.001) in urban areas (52.2%, 263) than in the semi-urban (29.4%, 152) and rural areas (15.4%, 18). Malaria prevalence was significantly highest (χ2 = 123.4, P <0.001) at the lowest altitude (60.5%, 182) and decreased as altitude increased to a minimum of 15.4% (18) at highland (>600 m.a.s.l). Only two species of soil-transmitted helminths [Ascaris lumbricoides (1.9%) and Trichuris trichiura (0.6%)] were found. The prevalence of STH was significantly higher (χ2= 33.8, P <0.0001) in rural (13.6%, 16) than urban (0.39%, 2) areas. The prevalence of STH was significantly highest (χ2 = 33.8, P <0.0001) at high altitude (13.6%, 16) than the upper middle-belt (2.0%, 8), lower middle-belt (1.2%, 4) and lowlands (0.7%, 2). The prevalence of co-infection varied significantly (χ2 = 72.2, P <0.0001) with level of urbanisation with the highest level of co-infection occurring in the rural areas (2.6%, 3) and the lowest level in the urban areas (0.2%, 1).
Conclusion: Malaria control measures need to be intensified especially in the lowland and urban areas. Deworming campaigns are yielding positive results in Fako Division.