Effects of Contrasting Areas of Land Occupation and Housing Types on Malaria Incidence and Severity in Children under Five Years in Bolifamba, Buea

Purpose: Studies relating vector breeding sites, biting cycle and vector competence to malaria incidence in the most vulnerable population of endemic areas of the Mount Cameroon region are lacking. The purpose of this study was to compare the incidence and severity of malaria in children under 5 years in contrasting areas of land occupation in Bolifamba. 
Methodology: A cohort study design was used. In phase 1, Bolifamba South West Region was stratified in to three zones namely; zone I (Non-swampy/moderately populated), zone II (permanently swampy/highly populated) and zone III (temporally swampy/sparsely populated). Parents filled informed consent forms. A structured questionnaire was used to enroll 752 children under five years. In phase 2, entomological survey, DNA extraction and PCR for molecular form of parasite and infection were employed. Data was analyzed using the SPSS version 20. Malaria incidence was determined using Poisson regression. Kruskal-wallis test was used to compare malaria incidence and EIR. A Stratified sampling technique was used. A sample size of 752 was determine using a confidence level of 95%, ± 3% margin of error, 50% degree of variability, 95% response rate. 
Findings: The incidence of malaria in children under five years in Bolifamba was 11.2%. Malaria incidence per zone was: zone I (13.7%), zone II (14.7%) and zone III (5.2%). One thousand and seventy mosquitoes were collected. Anopheles gambiae complex (588) was the only malaria vector found in all Zones. P. falciparum and P. malariae were found in the three zones. The EIR; zone I (2.4), zone II (4.8) and zone III (3.6). 
Conclusion: Malaria incidence in children under five in contrasting areas differs and plank houses increase malaria incidence. The peak biting period was 1- 2am. Contrasting areas of the same town or village have different parous, infective and entomological inoculation rates. 
Recommendations: Mass distribution of insecticide treated bed nets to children under five years in Bolifamba by the government. Encourage the population to build block houses with ceilings. Monthly community clean up campaigns organized by each quarter head to drain stagnant water around houses in Bolifamba. Provision of better malaria control measures in order to eradicate malaria in Bolifamba.