The Ministry of Health has been battling increasing malaria cases over the course of the last three years. To deal with it, new strategies have been laid and a combination of interventions already been rolled out to stamp out the killer disease once and for all.

The Head of the Malaria and other Parasitic Infections Unit at the Rwanda Biomedical Center, Dr Aimable Mbituyumuremyi, talked to Nasra Bishumba about the challenges they are facing and why eradicating malaria is an achievable dream.

Below are the excerpts:

Malaria seems to be a persistent disease that according to its trend seems to have seasons of its peak. What is the status right now?

Dr Mbituyumuremyi: Malaria is back and has been increasing for the last three years. We have been receiving different cases of malaria at community, health centre and hospital levels. This is because of the season because, normally, after the rainy season, especially the months of November, December and January due to the November rains. Then it increases again in May and June due to the rainy season of April.

After the rainy season, when the temperature begins increasing, we also have malaria during that season all over the country. Malaria trends change but when we look at a 12 month period, in January 2016, we registered almost 500,000 cases and in November, we registered around 700,000 cases countrywide.

Initially, there was an issue of mosquitoes being resistant to insecticide, has that changed?

Dr Mbituyumuremyi: The issue is still there but we have changed the insecticide, we used to use Parathyroid insecticide to spray in people’s homes but after some time, we noticed some resistance so we changed to Bendiocab and two years later, we are now using Actellic and we have so far used it in Kirehe and Nyagatare districts and it’s a totally new product that we are hoping will be effective.

Based on the data that we have, resistance is not generalised countrywide. We are monitoring each district and where we find resistance, we change immediately and combine the two. For instance, in Gisagara, Bugesera and Gatsibo districts, we are still using Bendiocarb because it is still effective in these areas and not in others.

What are you doing towards stamping out the disease once and for all?

Dr Mbituyumuremyi: There are many interventions in the pipeline and some of them are already being implemented. The first one is basic hygiene, which is mostly cutting the bushes around homes and dealing with stagnant waters. If this is well implemented, it is a successful way of ridding a community of malaria.

The second one is bed net implementation and use and that’s why we are doing this countrywide, making sure that people are sleeping properly in the nets because some people don’t use them properly, others sell them, while others use them for fishing purposes.

Another one is spraying by targeting high burden districts because the cost of insecticide is very high and we cannot afford spraying the whole country.

Another intervention is home based malaria case management where we train health care providers to train community health workers who are then well equipped to diagnose and treat malaria at the community level without necessarily going to facility level. In each village we have at least three trained health workers and this is a strategy that is being successfully implemented in all the 30 districts countrywide.

In November last year, we started providing free malaria diagnosis and treatment to people, who cannot afford it. These people fall under the Ubudehe I and Ubudehe II are receiving this service at community and health centre level and this can be directly linked to the increase in cases that we have been noting since November last year. This may be related to cases that can now be registered because now people can go to health facilities unlike before when they could not afford the services.

Talking of mosquito nets, in the past, we have seen nets being distributed countrywide. We have seen the distributors doing rounds once again. Could you tell us more about that?

Dr Mbituyumuremyi: Distributing nets is one of the routine things that we do in Rwanda but based on the period or lifespan of a net. We distribute mosquito nets all over the country every two years to ensure universal coverage. This means that it’s a net for every two people. We started just last month and we have covered almost the entire country and, by the end of January, all the 30 districts will have received the nets.

We have another type of distribution that is not necessarily like the one we are doing now where through our health centres, we supply nets to pregnant women and children less than one year to make sure that those who were born after we had the nationwide net distribution drive do not miss out. This particular drive was put in place to make sure that everybody is covered.

How many nets have been distributed so far?

Dr Mbituyumuremyi: For the fiscal year 2016/2017 which begins in July each year and ends in June of the other year, we purchased about 6.2 million mosquito nets and have distributed almost all of them and are only remaining with Nyamagabe District, which takes less than five hundred thousand nets.

There was a plan to manufacture mosquito nets in Rwanda. How far has that plan gone?

Dr Mbituyumuremyi: So far, we are still purchasing mosquito nets from outside the country because we do not have the capacity to manufacture them as yet. However, we have started the process of having an investor coming in to produce quality nets and we hope that this year, we will have the factory up and running and probably the next net distribution campaign can purchase those ones made in Rwanda.

What else is being done?

Dr Mbituyumuremyi: We are combining all our efforts, for instance, we have sprayed five districts and we are expecting a decrease in those areas. We are also improving case management in people with malaria and we are hoping that the numbers will drastically fall in terms of severe cases and death.

What have been some of the biggest challenges in efforts geared at eradication of malaria?

Dr Mbituyumuremyi: We still have many challenges. The first one is lack of community awareness about malaria control. We need everyone to be fully involved but some people are not yet there.

Another challenge is climate change which we cannot control.

Another major challenge is funding. Like I told you, we are so far only spraying in five districts yet our wish would have been to do it all over the country. The cost of doing this is around Rwf1.5bn, so it’s about Rwf50bn countrywide and it’s required at least once a year. It’s a big budget and though we can say that spraying is an effective method, the affordability is a challenge.

The last challenge is the failure of people to take advantage of the services that are being offered. So far, we are still registering people dying of malaria yet it’s a disease that can be prevented or treated in just three days. People delay to seek medical help and malaria ends up killing them.

This should not be happening in a country where we have community health workers that are always ready to deal with such. People should be sensitised to use our services to make sure that no Rwandan dies of malaria when there are all these resources.

And what would you say has been the highlight of these efforts?

Dr Mbituyumuremyi: As I said, we have managed to distribute mosquito nets to everyone and we have decentralised services for malaria diagnosis and treatment in every village thanks to the more than the 30,000 community workers trained and equipped particularly for that. We thank our community workers who are volunteering to take on this noble role.

We are also thankful for the decision taken last December by the Cabinet that people under Ubudehe I and II will be receiving malaria diagnosis and treatment free of charge. We do not have the exact numbers as of now but the last numbers showed almost 48 per cent (of the population).

If there was one thing that you felt people must know, what would it be?

Dr Mbituyumuremyi: Some people seem not to understand exactly how they contract malaria. Malaria is caused by a parasite called plasmodia and it lives in the blood of human beings as its reservoir and also within a mosquito. When you have a mosquito, you have a vector.

The mosquito is a vector of the parasite from one person to another. When you have malaria and a mosquito bites you, it gets infected and can transmit this parasite to another person. That’s why we advise people to concentrate on eliminating mosquitoes because if you are able to deal with them, it is easier to control malaria because without the vectors, anyone with malaria can be treated and the process ends there.

We can eliminate malaria, simply by insisting on hygiene. We need to clear stagnant waters because mosquitoes lay their eggs in water. Without this water, there are no mosquitoes, without mosquitoes, there is no malaria, without malaria, there is no death (resulting from the disease).

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