The global decrease of malaria prevalence, from intervention may abrogate naturally acquired immunity among denizens of Bolifamba. A study in Kenya showed that naturally acquired immunity to malaria is achieved by development of a threshold concentration of antibodies to malaria antigens, which occurred in an area with high endemicity (PfPR(2–10) =44 %) and was absent in an area with intermediate endemicity (PfPR(2–10) =29 %) . However, Bolifamba is still endemic for malaria with a PfPR(2–10) of 40.8 %.
The high prevalence of asymptomatic malaria corroborates findings in other malaria endemic regions  and the fact that asymptomatic malaria almost always more than doubled symptomatic malaria is consistent with the findings that in most malaria endemic areas, the majority of parasite carriers are asymptomatic . This is a major obstacle to malaria control programs, because even sub-patent malaria is transmissible. The seasonality of malaria observed in Bolifamba with peak malaria prevalence occurring in April, at the start of the rainy season has also been reported in Accra, Ghana, although in Accra, the peak malaria months July and August, immediately follow peak rainfall in June .
The prevalence of malaria was highest amongst the age groups 2–10 years old (40.8 %) and the age group greater than 10–18 years. However, the parasite load was significantly higher only in the age group 2–10 years old and this age group had the highest prevalence of symptomatic malaria (11.2 %) which was significantly different from the others (p < 0.01). This finding agrees with the fact that children aged 2–10 years are the most at risk of malaria, and may also represent the main reservoir for gametocytes .
The high prevalence of anemia and its association with malaria (p < 0.001) strongly suggest that malaria accounts for a major part of the burden of anemia in this community. Malaria parasites feed on hemoglobin and ends up destroying red blood cells, which leads to anemia. Similar findings have been reported in Tanzania  and Mozambique . The high prevalence of anemia was also significantly associated to asymptomatic malaria. The single case of splenomegaly observed amongst 32 children less than five years old, stood in sharp contrast to what was observed ten years ago and suggests that the multiple control interventions instituted have resulted in the reduction of malaria morbidity among children.
In this study malaria was not significantly associated with housing type (p = 0.09). The protection conferred by ITBNS may have reduced the exposure of wooden house dwellers resulting in a lower prevalence than what was observed in 2006 . This is presumably because mosquitoes are thought to enter wooden houses through the crevices and joints of the planks to have access to the occupants. However, their maximum biting period was between 10.00 pm-5.00 am , which coincides with sleeping time spent under ITBNs to limit transmission. The finding that malaria parasite prevalence was significantly associated with non-usage and/or irregular usage of ITBN compared to regular usage of ITBN (p < 0.05), is an indication that ITBN provide some level of protection against malaria and is a contributing factor to the drop in malaria prevalence from 50.1 % and 44.2 % in 2006  to 38.3 % and 24.4 % in the present study, during the rainy and the dry season respectively. The association of ITBN with decreased malaria prevalence is consistent with that reported elsewhere in this region  and corroborates with the finding that ITBN offers some protection against malaria vectors [22, 23]. However there was no significant difference in parasite load between regular users and non users or irregular users of ITBN (p = 0.79). This implies that although ITBN plays a role in preventing infected mosquito vector from biting inhabitants of Bolifamba, when bitten by infected mosquitos, sleeping under an ITBN has no effect on the multiplication rate of the parasite within an infected person.
Naturally acquired immunity to malaria is in three stages; protection from severe disease , immunity to clinical symptoms, and partial protection from severe disease , which depends on constant transmission. Duration of stay showed an initial increase in log of parasite load up to less than 5 years of stay (2.49) and a gradual decrease in log of parasite load beyond five years of living in Bolifamba, (p = 0.046). This may be indicative of acquired immunity. It is probable that immunity to clinical symptoms is acquired within five years of living in the locality and beyond five years of stay partial protection against parasitization is gradually developed with prolonged duration of stay. This study has identified a suitable population in which protective immunity studies involving the identification and testing of malaria vaccine candidates can be undertaken, however this finding needs to be confirmed using immunological techniques.
The very high incidence of fever in October and December corresponds to the onset of the dry season and the presence of dust in the atmosphere respectively. Other pathogens in addition to malaria may be responsible for this surge in fever episodes, but the pathogens transmitted during these months are yet to be identified.
Climatic factors tend to influence the prevalence of malaria by affecting the abundance, biting habits and development of malaria parasites inside the mosquito vector. Generally minimum and maximum temperatures drop by 1 °C after every 100 m rise in altitude. The rise in altitude from intermediate to high altitude has been associated with a drop in malaria prevalence in the Mount Cameroon region . Since minimum temperature is recorded in the night which corresponds to the biting time of the mosquito vector in this region , therefore, the decrease in temperature may lead to reduced activity and biting rate of the mosquito vector as supported by the data with an r value of 0.6 in Fig. 8. Further more, low temperatures (<15 °C) and low humidity tends to interfere with proper development of the mosquitoes in this region . Rainfall had a non-linear relationship to malaria prevalence (r = 0.563). It is known that an increase in rainfall favors the accumulation of puddles, which serve as breeding sites for mosquitoes that transmit malaria parasite. But excess rainfall tends to wash off puddles with increased surface run-offs, thereby eliminating breeding sites of mosquitoes with concomitant reduction of malaria prevalence.
The equation for the measurement of malaria endemicity, predicts that in areas where the P. falciparum parasite rate (PfPR) is 40 % or more, transmission of malaria is unlikely to be interrupted by ITBNs alone , and this is true for the study population. It is therefore recommended that an integrated approach be adopted in the control of malaria within this community. This should include, improved drainage system, indoor residual spraying and prophylactic treatment in the peak malaria months of March, April and May, coupled with the existing strategies in place.