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Background  High coverage of long-lasting insecticidal nets (LLINs) is the cornerstone of the malaria control strategy of the national malaria control program (NMCP) in Cameroon, with a target of reducing malaria transmission to less than 10% by 2035. To this end, more than 20 million LLINs have been distributed to populations countrywide since 2011. The present study evaluated entomological indices and  Anopheles  susceptibility to pyrethroids in a rural forested area of south Cameroon with high coverage of LLINs.    Methods  The study was conducted between July 2014 and May 2016 in Obout, a village located in a rural forested area in south Cameroon. Resting mosquitoes were collected using electric aspirators and were identified to species using morphological criteria and PCR tools. Mosquito feeding preferences and infection status to  Plasmodium falciparum  were determined by ELISA and using TaqMan assays. The susceptibility of wild F1 adults to pyrethroids was monitored using WHO insecticide susceptibility bioassays.    Results  During the study period, 5,993  Anopheles  mosquitoes were collected indoors both in rooms with and without nets. Two main vector species, namely  An. funestus  and  An. gambiae , were identified in the locality, with  An. funestus  being by far the most abundant (89.68%). ELISA analysis revealed high percentage of blood meal taken exclusively on human (97.65–98.95%) supporting the high antropohilic behaviour of both species.  Plasmodium falciparum  infection rate detected by ELISA was high throughout the study period and varied between 3.28–14.04% (mean: 10.40%) in  An. funestus , and between 5.55–22.22% (mean: 13.87%) in  An. gambiae . This trend was confirmed by TaqMan assays, with  P. falciparum  infection prevalence of 23.33% in  An. funestus . Significant decrease of mortality associated with high frequency of  kdr  mutation was observed in  An. gambiae  (deltamethrin: 36.6–56.45%; permethrin: 6–18.65%) indicating high level of resistance to pyrethroids. For  An. funestus , resistance was marked for deltamethrin (mortality: 70.54–76.24%) than for permethrin (94.12–94.74%).    Conclusions  Our study showed that despite LLINs, the population of Obout remains exposed to bites of highly infected  An. funestus  and  An. gambiae  mosquitoes, highlighting the challenges to controlling malaria in forested areas, especially in the presence of insecticide resistance.

parasites and vectors

Elevated Plasmodium infection rates and high pyrethroid resistance in major malaria vectors in a forested area of Cameroon highlight challenges of malaria control