YAOUNDE, Cameroon — It’s a Monday morning at the Yaounde central hospital, and one of the busiest days of the week for the doctors and nurses who work here. Hundreds of sick people wait for their turn in one of the consultation rooms. For many, their fate is known in advance. One in four will be diagnosed with malaria.
 
Malaria is a leading cause of hospital visits – and death - in the country. Victims are mostly children and pregnant women.  Everyone in Cameroon is considered at risk. Last year, the disease inflicted more than 1.8 million people.
 
Sunny and humid, most of Cameroon is a breeding ground for anopheles mosquitoes that transmit the malaria parasite.  The country’s 20 million people are now on the frontline of the war on malaria in Africa.
 
Dr. Esther Tallah is the manager of the Cameroon Coalition against Malaria and a major player in the struggle against the disease. She says the war is being won by expanding effective prevention and treatment.       
 
"Once you invest in the right things that we know work for malaria prevention and control, you see results immediately," she said,
 
"The world has shown and repeatedly proven that when [people] adopt the habit of sleeping under mosquito nets and that you achieve universal coverage you see a drop in the incidence of malaria.
 
"If the country decides that they want to do indoor residual spraying, and they do it effectively," she continued, "you see a drop in the incidence of malaria. In some cases, countries decide to combine indoor residual spraying and sleeping under long-lasting insecticidal mosquito nets."
 
The government and NGOs like Tallah’s coalition distributed more than eight million long-lasting insecticidal nets nationwide.
 
The government has also scaled up affordable treatment using a combination of anti-malaria drugs including artemisinin.  Together, they attack the reproductive cycle of the malaria parasite, thereby curing and reducing transmission at the same time.
 
As part of the push to end malaria, patients pay less than $1 (U.S.) for several days’ treatment. Pregnant women and children under that age of five are treated for free.
 
Health officials say universal protection and effective treatments are paying off. Doctors across the country are seeing fewer and fewer patients each year.
 
Cases reported by hospitals dropped to 28 percent in April 2012 from 30 percent in April 2011. The National Malaria Control Committee’s reports show a steady fall since the end of 2008, when the sickness rate was around 44.5 percent.
 
But the gains remain fragile.
 
In most of Cameroon, poor drainage leaves standing water in which mosquitoes breed. Health workers say many people have nets but are not using them. The mosquitoes are also developing resistance to insecticides.  
 
Talla says such problems are being tackled.
 
"The national anti-malaria commission has conducted studies, and we have a map of resistance to insecticides by the anopheles mosquitoes that transmit malaria," she said. "There is a plan to follow up on that and put in place a system that ensures that that is taken into account."

She said  that even where there's resistance, the nets are still effective, "though the people who produce the nets are conscious of resistance and are coming out with a third-generation nets that combine two products."
 
Cameroon hopes to reduce malaria infections in the country by 50 percent in a few years. For the first time, campaigners are already talking about ending the scourge.
 
But to eradicate malaria in Cameroon, Tallah says the public must play its part. Early treatment, correct use of long-lasting insecticidal mosquito nets and hygienic living can greatly reduce new infections.