Introduction

1Epidemic outbreak in the cities of developing countries is recurrent and the some local populations are familiar to such unfortunate situation (Esposito S. et al; 2020). The inhabitants are usually at the mercy of disease infection and contamination as their respective communities lack adequate hygiene and sanitary equipment to prevent the spread of diseases. This is opposed to the developed countries which have advanced protective mechanisms against the spread of diseases in time and in space (WHO 2018, Meva’a Abomo et al; 2015). The African continent in particular has for long been experiencing series of epidemics ravaging the four corners of the continent. During the colonial era, Africa was named the white man grave on the bases of disease infection persistently taking away humans lives. At present, malaria fever is considered as a staple infection in the lives of more than 90% of each born and bred African, especially those residing in the tropical zones where there exist huge dense tropical rain forests with average temperature ranges from 20°C to 25°C, favouring the reproduction of mosquitoes.

2The continent has also been witnessing the occurrence of dreadful disease infections like the Ebola, HIV/AIDS, Hepatitis and now the corona virus infection. The Covid-19 infection in Africa unlike in the developed and economically advanced countries has not had the same appreciations and effects. Though the pandemic is unbiased, the developed and the economically advanced countries like China, Thailand, Japan, South Korea, Singapore, Vietnam, Taiwan, Nepal, and the United States which registered the first cases of Covid-19 carried out community reconfiguration of the sanitary system as a means to curb the effects of the virus; whereas in Africa and precisely in Cameroon, it was more of an idle debate. In the North West Region of Cameroon, no single case of Covid-19 or 2019-nCoV was confirmed from the beginning of the outbreak till the month of April where the first case was confirmed on Monday 20, 2020 (RDPH 2020). Before a single case was confirmed and even after confirmation, the local stakeholders namely the State, the local populations, the civil society and the international community have undertaken measures to lessen the spread of the infection. Paradoxically, the Covid-19 situation in the area today is on the rise, with increasing number of infected person and increase death toll which are sustained by laxity and negligence to implement barrier measures established by the World Health Organization. Now therefore, this paper aims to give a response to the problem of increasing number of infected persons and deaths despite the many barrier measures prescribed by WHO and enforced by the government of Cameroon.

1. Methodology

1.1. Location of the Study Area

3Cameroon is located at the coast of Guinea and the country comprises of ten Regions. The study area is located in the North West portion of the country and bordered to the north by the Federal Republic of Nigeria, to the south by the West Region, to the east by the Adamawa Region and to the west by the South West Region. With a surface area of 17 300 km², the Region is situated on an average altitude of 1 550 m above sea level and has mountain chains of more than 3 000 m of altitude (NIS 2014). Figure 1 represents the study area with the various administrative demarcations.

1.2. Data Collection

4The Leibniz’s hypothetical deductive methodology was used to realise this study and it was basically on validating hypothesis from observation. The general method of the study has been the geographical method of investigation which comprises of four stages, namely observation, description, analysis and interpretation of facts of Covid-19 in different communities in the North West Region of Cameroon. Added to this, were the trans-disciplinary approach of research and eco-health approach which analyses the relation between humans and environment.

5Primary data for the study were collected on the field while secondary data were collected from pre-existing scientific works in libraries, archives and the internet. The data were collected from the months of December 2019 (outbreak of the pandemic in China) to August 2020 (evaluation of the current situation in the North West Region of Cameroon). Qualitative data were collected through observation (in-situ observation and participating observation), and interview (direct and indirect interview) with the local stakeholders; while quantitative data were collected through survey (simple random survey and stratified survey). The qualitative data were analyzed with the help of MACTOR software while quantitative data were treated with the help of SPSS and Excel 2007.

2. Results and Discussion

2.1. Contextual situation of the area enhancing the spread of Covid-19

2.1.1 Migratory Movements of People and Goods

6Human beings are naturally mobile from the time of the early man who moved from place to place, practicing hunting and gathering (Rodriguez-Morales AJ, 2020). Biologists consider movement as one of the characteristics of living things among others like breathing, hearing, sensing and feeling. To the economists, movement can either be sustained by push factors or pull factors in different communities; the pull factors are those which attract a person to enter a given community. The local populations of North West Region are attracted to the towns of Yaoundé and Douala by employment opportunities, educational purposes, better living conditions, availability of social facilities and the desire to live in a peaceful environment. The push factors on the other hand comprise of repelling/driving aspects which project an individual from his/her area of residence to a different destination. Examples of such are unemployment, civil unrest (socio-political crisis of the North West and South West Regions), family pressure, superstition and any form of threat to human existence (Ganafei S., 2016).

7Migratory movement in the North West Region of Cameroon is more active with greater flux within the perimeters of the Region in the form of urban to urban, urban to rural, rural to urban and rural to rural than inter regional migration. The movement toward other Regions like the Centre, Littoral and the West became intensified as of 2017 (a year after the outbreak of the socio-political crisis hitting the Region), where many residents relocated to these Regions for safety. The mastery of the situation in the late 2019 and the registering of the first cases of Covid-19 in Yaoundé and in Douala in February 2020 led to a backward movement to the North West Region by some displaced population. The return to the North West Region by this population is partly supported by the fear to be infected by the Covid-19 at the time the first cases were reported in Douala and in Yaoundé, and also due to the fact that others wanted to return to their normal activities to end a living rather than residing in the camps of the internally displaced population (IDP) or residing with a relatives and friends. During this time, no restrictions were placed on the movement of persons and goods, barrier measures were not enforced and the populations do not care much about being infected by the virus; this free movement of persons and goods to-and-fros from the North West Region stands as the pathway of the virus into the Region. Beside, some of the populations moving into the North West Region from Yaoundé and Douala have been in direct and indirect contact with their love ones who returned from Europe on the 28^th of February 2020, in a flight suspected of having Covid-19 patients. These populations were not quarantined before and after entering the North West Region. Furthermore, interurban and urban to rural movements in the North West Region of Cameroon is currently practiced with the overloading system of transport cars and motorcycles. It is common place to see 3-4 persons on a motorcycle parading the streets and villages in the study area. Such overloading system which violates the WHO recommendation of one meter distance from each other is a contributing factor to the spread of Covid-19 in the North West Region of Cameroon (Wei X, Li X, Cui J. 2020).

8The movement of goods has equally contributed to the spread of the virus in the Region since the country continued importing goods from China and other countries till the month of February 2020 despite the reports of cases of Covid-19 in those countries. Though the Cameroon government later closed the national borders on March 24, 2020, this was however implemented at official entry/exit points; whereas, clandestine movements of goods and individuals continued along the areas of Baworo, Akwaya, Ejagam and Idenao. These areas are the main clandestine supply zones which permitted the infiltration of goods into the North West Region despite government restrictions on imports. Clandestine or informal circulations are often carried out within horrible contexts just to avoid official control and the actors involved do not care much on their health and that of others; they rather pay attention to escaping from the sight of decentralized territorial authorities in the area. Moreover, majority of those who move clandestinely do not undergo any medical check-up or screening before departure and so, their arrival at destination exposes the local population to disease infection especially if they had had previous contact with infected persons. Now therefore, clandestine movement of persons and goods from different geographical areas into the North West Region of Cameroon stands as a factor to the spread of Covid-19 (Shrikrushna Subhash Unhale et al; 2020).

2.1.2. Socio-Cultural System as Factor of the Spread of Covid-19

9The two English speaking Regions of Cameroon namely the North West and South West Regions have a particular cultural system inherited from the British during the colonial period of 1884. The English speaking Regions also known as the “Anglophone Regions” inherited a cultural system which enables them to live in well structured communities whereby, cultural values like respect, tradition and loyalty are highly promoted. The tradition considers the greeting of an elderly person through the shaking of hands as sign of blessing to the younger generation, same as the imposition of hands on the younger ones by the elderly as sign of prosperity. In some traditional manifestations, the partakers drink from the same cup, eat from the same plate, break and eat cola nut together. Example here is traditional wedding were the bride’s uncle is the master of the scene as shown in figure 2.

10Just as tradition demands, the bride’s uncle ‘A’ serves the palm wine and give to the bride ‘B’ to drink as a sign of marriage acceptance; she would later give to the bridegroom ‘C’ to do same. This first movement of the cup from A-B-C is denoted by the orange line on figure 2. After he must have drunk, the latter ‘C’ would return the cup of palm wine to his bride ‘B’ who would also handover to her uncle ‘A’ to drink from the same cup and seal the marriage. This second movement in an inverse manner from C-B-A is denoted by the red line on the figure 2. This represents a typical example among others whereby the corona virus can easily spread and infect many persons on the base of tradition. The first movement denoted by the orange line represents low probability of being infected by the virus if and only if ‘A ‘and ‘B’ are not carriers. The second movement denoted by the red line represents high probability of being infected by the virus if ‘C’ happens to be a carrier. The same principle is applied to the sharing of cola nut, but the probability of spread is higher at this stage especially if the person sharing the cola nut is already infected by the virus or one of the partaker upstream is infected. Such traditional practices which require the sharing of the same substance among groups of persons are recurrent in the Region and some villages like the Esimbi, Batibo, Bali, etc; do carryout such practices during traditional ceremonies.

11Furthermore, the ignorance and negligence of some locals favour the spread of Covid-19 in different communities of the North West Region of Cameroon (Zhang L, Shen FM, Chen F, Lin Z. 2020). As earlier seen, shaking of hands and embracing are common practices in the Region, so, any attempt by a diligent youth to avoiding hand shake from an elderly person is considered as a sacrilege by the people of Esimbi, Bafut, Bali, Batibo, Esu and many others (Li F. 2016).

2.1.3. Socio-Political Crisis as Factor of the Spread of Covid-19 in the North West Region

12The socio-political crisis affecting the North West and South West Regions of Cameroon since November 2016 now portrays more negative effects on the health of the population in both Regions. Before the crisis, medical personnel moved from one health district to another without fear of being kidnapped or molested by whosoever, but the coming of the crisis imposed a turn around and a complete change of medical strategy of intervention. The crisis so far has led to the closure of hundreds of hospitals, clinics, pharmacies and drug stores in the Region, medical personnel have fled from the Region for safety while others merely visit their post of work occasionally when the neighbourhoods are apparently calm or when tensions are lessen. The crisis has created more traumas in the communities, especially to those who have been either a direct victim or an indirect victim of kidnap and payment of ransom, harass, looting, sexually abuse and menace of death from unknown armed men (Spanjaard H, Khabib O. 2007, Ejuande E. W. 2017).

13Many health centres which could have been active actors in the fight against Covid-19 are no more operating or are partially operating due to the persistence of the crisis. Medical personnel in the North West Region of Cameroon find it difficult to consecrate efforts in the fight against the corona virus ravaging the community, they consecrate more of their time and efforts to protect themselves from sudden and sporadic attacks on the field while little efforts is reserved to the fight against the virus itself. More than twenty medical personnel have lost their lives as a result of the crisis and the situation is more controversial since the government military accused the amba boys (a set of armed men fighting for the liberation of the former British Cameroon –Ambazonia) of being responsible for the deaths and the amba boys do likewise. In such a circumstance of the fear of the unknown, medical personnel in the Region are unable to carry on their duty properly and the patients in the hospitals are not receiving adequate treatment. The fear has equally restricted the movement of medical personnel from one health district to the other and even when they successfully arrive in a medical centre to perform their duty, they do with lots of fear in mind because of frequent gunshots in the area, between the military and the amba boys. The fear of the unknown has led to the neglect of patients and in some cases, patients with different cases of illnesses like tuberculosis, malaria fever, typhoid fever and many others are grouped together for security purposes rather than laying emphasis on the health risk of contracting or being infected by a disease (Chen J. 2020).

14The imposition of ghost town (lockdown) every Monday by the secessionists (people who desire separation between the former British Cameroon and the French Cameroon) is a factor contributing to the spread of the virus in the area. During the regular ghost town scheduled on Monday of the week, everything, be it businesses or movement of persons and goods come to a standstill; any person or business activity which dares to go operational automatically becomes the target of the secessionists. Moreover, the ghost town imposed by the secessionists often extends to 03, 05 and 07 days depending on their predefined agenda, in such a context the medical personnel are unable to intervene promptly in suspected cases of Covid-19 or in other cases which need medical assistance (Benvenuto D, et al; 2020).

15It is therefore visible at this juncture that the ongoing socio-political crisis in the North West Region is a factor of the spread of Covid-19 in the area since more efforts are being converged toward self and family protection against the crisis rather than on the virus itself.

2.2. Community Reconfiguration of the Sanitary System

16The entire sanitary system in the North West Region of Cameroon has undergone major reconfiguration process from the onset of the pandemic in the area. The reconfiguration process of the sanitary system is carried out by each of the stakeholder and in various communities according to their social composition (Hemida M.G. 2019).

2.2.1. The State and the Decentralized Territorial Authorities

17Before the outbreak of the pandemic in the North West Region of Cameroon, the sanitary system had no major changes since most of the illnesses such as malaria, Chlamydia, dysentery, HIV/AIDS, rheumatism and many others were more of routine illnesses in the area. The government could manage these diseases called common place illnesses. The local hospitals like the Bamenda general hospital, the St. Elizabeth Catholic general hospital Shisong, Mbingo Baptist hospitals, Wum District Hospital, PMI Nkwen and the Banso Baptist Hospital, had a trained team and infrastructure to contain patients suffering from these common place illnesses, though the management system and infrastructures were not sufficient to provide appropriate health care to the local populations in dire need.

18The outbreak of the pandemic in Cameroon and in the North West Region in particular greatly imposed the urgent need of revising the sanitary system which was being neglected by the government and other stakeholders. It is on this base that the president of the republic of Cameroon H.E Paul Biya outlined strategic measures to fight against the pandemic on March 17, 2020; the initiative led to the publishing of texts, sensitization, training of medical personnel and the provision of sanitary equipment to the general public. The measures were a total of seven and some of them were: systematic wearing of facemask, local production of drugs, screening test, hydro alcoholic gel, creation of specialized Covid-19 centres, intensification of testing campaign, intensification of sensitization campaign, carry out essential activities and lay sanction on defaulters. They were not exhaustive since other measures were envisaged according to the evolution of the virus. The government later outlines a couple of protective and prevention measures against the virus which were to be implemented by the population of the North West Region of Cameroon as well as in all other Regions within the national territory. These measures are being reinforced by various decentralized authorities in their respective area of competences. Beginning from the Governor, the Senior Divisional Officers, Regional Delegations of Public Health, Education, Social Welfare, Sport and Physical Education, Fishery and Animal Husbandry and many others do pass out circular letters on the need to respect and fully implement the barriers measures. Moreover, in their various outings, these stakeholders sensitize the population through television programs (CRTV, Equinox, STV, and Canal 2), radio programs (CRTV Bamenda, Radio hot cocoa, and Gospel radio station), group sensitization and door-to-door sensitization. On June 07, 2020, some 5750 persons were sensitized and from the 06^th of March to the 06^th of June 2020, some 286 809 persons were already sensitized (RDPH 2020).

19The government equally calls on each inhabitant put on facemask and practice regular hand wash during the day. School authorities on their part were to ensure that each student has a facemask worn properly to prevent infection or the spread of the virus in school premises.

20Furthermore, the Cameroon government engaged in the training of medical personnel (special team of Covid-19) who would intervene in any suspected case of Covid-19 in the country. The trained medical personnel were to give further training to their colleagues at the Regional, Divisional and Sub-divisional levels. In the North West Region of Cameroon, all the 19 health districts have trained medical personnel who are ready to intervene in any suspected case of Covid-19 and the government has also earmarked appropriate hospitals or Covid-19 centres to receive patients and provide medical care. The creation of Covid-19 centres like the pandemic incident centre was as a result of increasing number of cases from 01 on April 20, 2020 to 684 on July 27^th 2020 (RDPH 2020). The creation of such centres is accompanied by the provision of basic necessary sanitary equipment. The Regional Delegate of Public Health (Covid-19 pandemic Incident Management for the North West Region) calls on the population to respect all barrier measures and do well to contact health personnel for assistance. The table 1 represents Health Districts and contacts of health personnel in the Region.

Table 1: Health Districts and emergency contact of health personnel in the North West Region

Health District	Contact	Health District	Contact
Ako	677775529	Ndop	679911853
Bafut	677802159	Ndu	654492203
Bali	677319374	Njikwa	677101901
Bamenda	679167140	Nkambe	650077258
Batibo	677364809	Nwa	674334230
Benakuma	675318490	Oku	675516307
Funding	677866226	Tubah	677412062
Kumbo East	675919418	Santa	678801756
Kumbo West	674283400	Wum	676375983
Mbengwi	674022962	Regional Delegation of Public Health	233361503/ 650335693/ 1510

Source: Regional Delegation of Public Health NW Region

21The central government put in place a general telephone number 1510 to receive calls from all corners of the national territory but the strategy could not satisfy the majority of the population suffering from the corona virus. The Regional Delegation of Public Health for the North West Region came out with a new strategy of one-Health-District one-emergency-contact as presented in table 1. This strategy has permitted the rapid intervention of health personnel in any suspected case of Covid-19 in various communities.

22The government efforts have not only been limited to the aforementioned, but extend to the provision of material equipment like buckets, soap, facemasks, hand sanitizers, hand gloves and many others to the local population and to the medical personnel. The material gifts destined to the local population are limited to soap, buckets, facemasks and hand sanitizers. This initiative has equally been sustained by the government national solidarity campaign launched to the general public, many individuals, companies and business organizations contributed to this government initiative. The table 2 represents selected number of donors in the plan.

Table 2: Selected donors of the Government solidarity campaign in the fight against Covid-19

Donors	Description/value
Jean de Dieu Momo	500 000 FCFA
Elections Cameroon	5 000 000 FCFA
MTN	10 000 000 FCFA
Express Union SA	25 000 000 FCFA
Contribution from Senate	100 000 000 FCFA
Groupe Baba Danpoulo	100 000 000 FCFA
Dangoté	15 000 surgical masks, 1000 protective lenses, 4000 litres of alcoholic gel and many others

Source: MINSANTE 2020

23The national solidarity campaign saw the donation of more liquid cash than material goods from the general public as presented on the table 2 with selected donors. The financial contributions yielded a total of one billion, six hundred and eighty seven million, four hundred and ninety-nine thousand, seven hundred and twenty seven (1 687 499 727 FCFA) francs CFA (MINSANTE 2020).

24The president of the republic of Cameroon H.E Paul Biya gave material gifts to be distributed in the entire territory and the minister of territorial administration Paul Atanga Nji handed the portion destined for the North West Region to the governor of the North West Region Adolphe Lélé Lafrique, who then dispatches to the Divisional and Sub-divisional Officers in their respective jurisdictions and to the beneficiaries (the local populations). Also, the government initially launched confinement strategy against the virus and it was relieved in the month of June, to permit students return to school and business activities to take on. Presently, the local authorities in the North West Region of Cameroon ensure that anybody suspected of being infected by the virus stays in Covid-19 centres for two weeks under observation before confirming whether it is positive or negative. The president of the republic further passed out decree № 2020/193 of 15 April 2020 to commute and remit sentences of prisoners as a measure to reduce overcrowding in prisons within the national territory.

25Since the fight is a global one, all the various chieftaincies, councils and urban councils work hand-in-glove with the central government to see that the pandemic comes to an end in the North West Region of Cameroon. All the government efforts so far are being concretized by the local decentralized authorities. Beside the initiative from the central government, individual chieftaincy, council and Regional Delegation takes personal initiative of sensitizing, providing material gifts to their respective population to help combat the common enemy. They implement the government barrier measures at the regional level by ensuring that all gatherings should not exceed 50 persons and the local councils have set wash points in public places like the local markets and council areas.

26Lastly, the government has put in place a special team of medical personnel in charge of burial. Once a Covid-19 patient dies, the medical team quickly intervenes to convey the corps directly to the grave. In cases where the bereaved family attempts to mount resistance, the medical team immediate calls for the attention of the police and gendarms who would intervene and permit the dead body to be transported to the grave; this is to prevent the love ones to be infected by the virus.

27Beside the carrots measures given to the population to fight against the virus, the government equally sets out coercive measures on defaulters which took effect on the April 13, 2020. The security forces combined (police, gendarms and the military) usually charge a penalty of 6000 FCFA to defaulters who do not move around with facemask.

2.2.2. The Local Population

28Historically, the indigenous populations of the North West Region are conservators of tradition and have high respect of traditional values; they also have a trans-generational cultural life and believe. Disease infection in the area is most often handled traditionally, except in special cases which require modern treatment methods. Cases of malaria fever, typhoid fever, injuries and fractures and a host of other infections/diseases are often treated traditionally. Since the first cases of Covid-19 were announced in Cameroon, the population of the North West Region engaged in a multiple defensive strategy to counterattack the pandemic. It is believe in the area that all existing treatment of malaria can help prevent people from the corona virus, so, the populations do constantly consume Artemisia, chloroquine and a combination of herbs and truck of trees. It is noted from field observations that more than 80% of the local populations prefer traditional method of treatment to modern treatment in the area (Lu H. 2020).

29The pandemic situation in the area is like a revival of the basic principles of hygiene and sanitation which were taught and forgotten or neglected by the population but now, it has revived the sense of hygiene in the community. Though the populations are more conscious to practice personal hygiene, this is on the bases of facts and figures from medical personnel on the number of persons who have died of the virus. They are now engaged in constant hand washing exercise. Bucket of water or other reservoirs and soap are placed at the entrance of some homes to permit everyone entry the house to wash their hands; drinking spots and eateries do likewise. In the absence of running water and soap to wash the hands, the population uses hand sterilizer at home and out of the home. The local populations also collaborate with the government to respect barrier measures by putting on facemask; about 95% of the facemasks are locally made and the cost varies from 100 FCFA to 500 FCFA.

30The pandemic has inspired the local populations to implement what they consider as preventive method against the virus. Since the populations in the Region prefer traditional treatment method to modern treatment, they consume more of natural herbs and locally made drugs. Some individuals have resorted to drinking of warm water mixed with lime and fever grass (Cymbopogon or lemongrass) every mornings and evenings to protect themselves from the virus. Others do take chloroquine 200 mg, Artemisia 40g, Azithromycin 500mg, Paracetamol 500 mg etc; all these products are to combat against the symptoms of the virus which are; fever, headache, common cool, sweat, cough, difficulty to breathe, etc.

2.2.3. The Civil Society and the International Community

31The role of the civil society and the international community are perceptible in multiple dimensions. The civil society comprises of local groups and associations, Non-governmental Organization (NGO’s) and the elites of the area. On the other hand, the active actors under the banner of the international community are the Chinese government, the United Nations agencies like WHO, UNHCR, UNICEF and the doctors without borders known in French as médecins sans frontières (MSF).

32One of the major efforts of the civil society has been the sensitization of the population, especially members of various social groups and associations. The success of sensitization method through socio-cultural groups and associations in the North West Region of Cameroon is due to the fact that close to 98% of the population belongs to social groups called “family meeting, njangi, association of former students, etc,” Most of these social groups and associations meet on a weekly base to discuss the affairs of their union, some of the associations do meet and discuss on their activities in the presence of the members while others do meet online through social media (WhatsApp groups, Google cloud meeting, instagram, facebook, etc). During such gatherings, the message of barrier measures is been preached to the members who later inform their respective family members. Local churches in the area constantly repeat the message of barrier measures to their members each time they meet. In some local churches like the Full Gospel church Benabinge, the leaders have printed the barrier measures and past on the notice board. The local churches just like the other social groups and associations have provided water and soap and/or hand sanitizer at the entrance of their place of gathering to permit members to wash hands before accessing the hall.

33Some companies have contributed both in kind and/or in cash to the government national solidarity campaign to the fight against Covid-19. Example is the OLAM Cameroun S.A, Cameroon Petroleum Company and Groupe Nobru which contributed 50 million FCFA, 30 million FCFA and 20 million FCFA respectively.

34The international community on its part has engaged in the provision of material equipment to the local populations and to the medical personnel. The Chinese government provided 5 000 mask KN95, 22 000 surgical masks, 2 000 protective eye lenses, 48 test kits etc; Addax Petroleum provided 225 000 protective masks, 75 000 medical gloves, 50 000 boxes of 14 tablets of 100mg hydroxychloroquine, etc. The WHO as well provided vehicles of the type 4X4 as a means to fight the virus. These material gifts were distributed to the ten Regions of Cameroon and the North West Region in particular benefited from these gifts. The international community through WHO and UNICEF also help to carry out screening campaign. In the Matazem and Widikum areas, more than 105 000 and 6 800 persons were screened respectively by the 05^th of May 2020 (RDPH 2020). After screening, all positive cases presented no symptoms or mild symptoms were quarantined at Azam Hotel in Bamenda.

2.3. Repercussions of Covid-19 in the North West Region of Cameroon

35The pandemic situation of corona virus just like the lake Nyos gas disaster of the 21^st August 1986 is among the worse situation the North West Region has known and the local population is suffering from the aftermath of the explosion, coupled with the present pandemic situation. The repercussions of the pandemic situation in the Region touch a multiple of sectors with varying magnitude of loses in properties, finances and in human lives (Chen Z.; Zhang W.; Lu Y et al; 2020).

36On the social plan, the pandemic situation has been deteriorating from the onset with many new cases of persons infected by the virus and others dying on a daily base (Munster V.J. 2020). The pandemic situation in the Region is represented in the table 3.

Table 3: Reported cases of Covid-19 in the North West Region of Cameroon

№	Health District	Cumulative number of positive cases	Number of recoveries	Number of deaths	Number of active cases
1	AKO	4	0	0	4
2	BAFUT	21	12	0	9
3	BALI	11	10	0	1
4	BAMENDA	467	317	51	99
5	BATIBO	5	3	1	1
6	BENAKUMA	0	0	0	0
7	FUNDONG	84	64	9	11
8	KUMBO EAST	23	21	1	1
9	KUMBO WEST	9	1	0	8
10	MBENGWI	4	3	0	1
11	NDOP	2	1	1	0
12	NDU	0	0	0	0
13	NJIKWA	0	0	0	0
14	NKAMBE	14	1	1	12
15	OKU	0	0	0	0
16	NWA	0	0	0	0
17	SANTA	16	11	0	5
18	TUBAH	18	12	0	6
19	WUM	6	2	1	3
	Total	684	458	65	161

Source: Regional Delegation of Public Health for the North West (RDPH), July 2020

37Table 3 presents increasing number of infected persons and deaths in the North West Region of Cameroon. Bamenda represents the epicentre of the corona virus infection with a total of 467 positive cases, 99 active cases and 51 deaths as of the 27^th July 2020 (RDPH 2020). This situation can be accounted for by the strategic position of the town which is also the capital city of the Region and receives the highest number of persons entering and leaving the town. The massive demographic movement of population from other Regions into Bamenda is usually unnoticed by the administrative authorities who are taken by surprise as the number of infected persons keeps swelling due to the absence of proper medical control of those entry the town. On this base, it is evident that massive demographic movement into the town of Bamenda without corresponding medical control and care would definitely leads to increase infection in the community. The statistics presented in the table 1 and showing zero case of Covid-19 in the Benakuma, Ndu, Njikwa, Oku and Nwa Health Districts do not in any way justify that these Health Districts are free from the virus infection since about a hundred persons have been quarantined while others prefer to hide themselves.

38The WHO and the Cameroon government recommend the wearing of facemask as a means to prevent further infection in the society, but, the problem of the facemask identified in the North West Region is that the inhabitants use the same facemask for more than three days without replacement or washing. Such practice places the population at high risk of being infected by the virus or contracting other air borne diseases like tuberculosis, influenza, asthma, etc. In the health districts of Benakuma, Nwa, Oku and Bali etc, some inhabitants put on the facemask throughout the day irrespective of the social distance from others, this makes breathing difficult as some even suffocate in their masks.

39The repercussions of the pandemic are also felt in the family setup and the education milieu. The persistent negative effects of the pandemic have led to the loss of family and social ties in the community. Today, family members cannot easily group themselves to discuss family issues as it was the case before the pandemic. There is a spirit of dissociation in families and in other social gatherings since the government restricted social gatherings to a maximum of 50 persons. In the same light, the academic calendar of the Region has been distorted by the pandemic, students of the final year and those in higher levels of studies only resumed in the month of June while secondary school students in intermediate classes only went to school to collect their results. The pandemic situation made students not to complete their normal learning hours and teachers have not completed their programs for the year. Beside, the parents are economically poor, instead of permitting the children to register for holiday classes, they prefer to keep them at home, let them go hawking on the streets and villages, take them to farm, etc. Such a situation would definitely have a devastating effect on the young generation who are supposed to be leaders of tomorrow (Kern J. 2020).

40On the economic plan, the pandemic has greatly paralyzed business activities in the North West Region of Cameroon (Ayittey F.K, et al; 2020). In Cameroon, the North West Region is among the first labour providers to agro industrial plantations located in the South West Region (the CDC, Delmonté, Palm’or), in the Littoral Region (SOCAPALM, CDC, PHP) and the West Region. Only few companies are based in the Region, some of them are; the Ndawara Tea Estate, Bamenda Palm Company, Bamenda Police Co-operative Credit Union Ltd, Bio Oil Investment Ltd, etc; and they recruit insignificant number of persons compared to the total population, so, the mass of labour force migrate to other Regions in search for employment as it has always been the case. Now therefore, the coming of the corona virus has rather amplified the existing unemployment situation and many employees of the private sector have been sent home under the pretext of technical leave while others have completely loss their employment as a result of the Covid-19. Most private enterprises in the Region have laid off about one third of their employees while others which still have about half of theirs, do not pay regular salaries or complete salaries. Businessmen have loss more than half of their profit margins in the Region while other business structures have simply closed down activities. On the bases of these, the populations in the Region now have very low living standards compared to the pre-pandemic period. Moreover, the prices of some drugs consider to fight against the symptoms of Covid-19 have been on an increase at the beginning of the crisis. Before the pandemic, 40g of Artemisia was sold at 2000 FCFA but now the same quantity is sold at 3500 FCFA, lime of 3.5 centimetre in diameter was sold at 25 FCFA but now 100 FCFA.

41On the religious plan, believers are of the view that true love is best expressed without restrictions, that is, each believer is free to give a hand shake as a means to express brotherly love. Paradoxically, the Covid-19 has made the government to outline barriers measures which greatly discourage the shaking of hands. Presently, there exist controversies in the religious and cultural milieu on the issue of hand shake. Many feel despise and frustrated when they are not given a handshake or when someone refuses to accept a handshake. Such a frustration leads to the loss of social ties in the community and installation of fear in the minds of the local populations.

Conclusion

42This paper aims at analyzing the root cause of the increasing number of infected persons from Covid-19 despite the implementation of several preventive measures by different stakeholders in the North West Region of Cameroon and the various strategies of stakeholders in the 19 Health Districts to fight against the pandemic.

43The study made used of primary and secondary data for analysis and the results reveal a set of factors responsible for the spread of Covid-19 in the North West Region of Cameroon. Some of them are; uncontrollable movement of persons and goods in and out of the town, socio-cultural setting of the Region and the socio-political crisis ravaging the Region since November 2016. This prevailing situation has been at the base of community reconfiguration of the sanitary system of the Region where public and private stakeholders intervene to bring the pandemic situation under control. The reconfiguration concerns mostly the creation of pandemic centre, training of health personnel, reorganization of the hospital framework, setting up of wash point in both public and private spaces, etc. Unfortunately, stakeholders’ intervention is yet to bring significant changes to the situation, reason for which the repercussions are evaluated in terms of increase number of deaths to 65 persons, infected persons (684 persons) and those being tested positive (161 persons) as of July 27^th, 2020 (Regional Delegation for the North West Region, Cameroon), increase rate of unemployment and loss of social ties.

44In view of this, the paper proposes community participation of all stakeholders as a panacea to eradicating Covid-19 in the North West Region of Cameroon. Each local community in the 19 Health Districts and the various stakeholders should strive toward the same direction of eliminating the virus. Digital platforms should be encouraged for the sensitization of the local population and the cost should be at the reach of the users. It further recommends the full implementation of barriers measures outlined by the WHO and those of the Cameroon government. Sanitary equipment like facemask, soap, bucket, hand sanitizer, testing kits, etc, should be made available to various communities especially the epicentre of Bamenda and other Health Districts with high number of infected cases like Fundong, Kombo East and Bafut, without neglecting Health Districts like Benakuma, Ndu, Oku, Njikwa and Nwa which have not yet register infected cases of Covid-19. Local authorities must ensure that these barrier measures are fully respected and the local populations should be conscious enough for their wellbeing and those of others.