Considering the Global Technical Strategy (GTS) for Malaria to reduce malaria burden by 50 per cent for 2023 and by at least 90 per cent for 2030, malaria still represents a public health threat in Rwanda despite a number of combined efforts put in place. Dr Aimable Mbituyumuremyi, malaria and other parasitic diseases division manager, Rwanda Biomedical Centre (RBC), says malaria continues to represent a real public health concern in Rwanda. He says malaria cases increased between 2012 and 2016 and the most affected districts are in the Eastern and Southern parts of the country. Following the Malaria Contingency Plan put in place in 2016; a 50 per cent decrease in severe malaria cases and mortality in the last two years were registered. WHAT IS RECOMMENDED? He says the national malaria control programme recommends combining interventions in fighting malaria in Rwanda. These, he says, include regular and consistent use of bed nets, indoor residual spraying using effective insecticide, early diagnosis, and treatment at community level or health facility level. There is also environment management to remove mosquito’s habitats or breeding sites, (closing doors and windows early evening) among other measures that see one stay away from malaria. In addition to that, he says there is the use of mosquito repellent products for the purpose of protection, which is recommended. PREVALENCE Malaria has been increasing in Rwanda since 2012 reaching more than 4.8 Million malaria cases in 2016/2017. Following the National Malaria Contingency Plan implemented in 2017, the country has now recorded more than 50 per cent decrease in severe malaria cases from fiscal year (FY) 2016/2017 to 2018/2019. Also, more than 50 per cent decreased in mortality due to malaria from fiscal year 2016/2017 to 2018/2019. There has been a decrease in malaria incidence from 409 per 1,000 in FY 2016/2017 to 321 per 1,000 in FY 2018/2019. An increase in early diagnosis and treatment at community level has been recorded as well, whereby today, 57 per cent of all malaria cases are being managed by community health workers. Rwanda has noted estimated reductions in its malaria burden, with 430, 000 fewer cases in 2017 than in 2016, according to a WHO Malaria Report 2018. There has been a slight decrease in malaria cases from 4,812,883 in 2017 to 4,142,933 in 2018. From 2016 to 2018, malaria cases decreased more than 10 times in Nyagatare and Kirehe districts where indoor residual spraying (IRS) has been sustainably implemented. “This is one of the malaria control interventions in early diagnosis and treatment aiming at preventing severe malaria and malaria-related deaths,” says Mbituyumuremyi. THE WAY FORWARD The Government of Rwanda is putting more efforts into malaria control through different ways. First and foremost, its distribution of effective mosquito nets countrywide to the general population and vulnerable groups. The vulnerable group includes pregnant women, children under five, and boarding school children, among others. There is also another measure known as extending and sustaining. This one is simply indoor residual spraying which is done in at least 12 districts from the fiscal year 2019/2020. There is as well ensuring access to malaria diagnosis and treatment at community and health facility level. Another measure is the introduction of new malaria control tools, such as new types of mosquito nets. Increasing access to mosquito repellent products, introducing insecticide wall paints, community based mosquito larval source management, are some of the measures put in place to curb malaria cases in the country. METHODS TO ADOPT According to experts, although some methods are not included in Rwanda control interventions, it’s ideal for individuals to take caution. Also, there is a need to engage the community in malaria control. Full multi-sectoral collaboration in malaria control is also the key when it comes to fighting malaria, which is recommended by Rwanda Malaria Control Interventions. Other measures, Prosper Dusengeyezu, a public health officer at Rwanda Pharmaceutical Students’ Association (RPSA), says, include the use of camphor as a repellent. He explains that one can light camphor in the room with all the doors and windows closed. Leave it for about 15 to 20 minutes to keep the mosquitoes away. Besides, Dusengeyezu notes that one can also use the lemon and clove technique by sticking some cloves in a half-sliced lemon and keep it near their bed while they sleep. Using a mosquito bed net appropriately while sleeping is also important as far as keeping malaria at bay is concerned, according to him. Alternatively, Dusengeyezu says that one can wear long-sleeved shirts, pants, and socks. Again, wearing covered shoes when outside will help ward off any anopheles that might bite you. Meanwhile, Dusengeyezu says avoiding exercising outdoors in the evenings is important since mosquitoes get attracted to sweat. To stop mosquitos from breeding, he says, it’s important to empty and clean all containers that hold water, such as flower pots, flower vases, dump, and animal dishes at least once a week. “Keep your surroundings clean, ascertaining that there is no stagnant water, which is a breeding ground for the mosquitoes,” he adds. Meanwhile, he says, nowadays, people who are bitten by mosquitoes immediately visit their nearest health care provider and buy treatment when they have signs or symptoms. This, he explains, will make them consequently develop resistance to treatment as a consequence of using drugs inappropriately. “I deeply advise people to reach out to healthcare professionals as quickly as possible and follow guidelines after diagnosed properly. Sleeping under a mosquito net is the best way to avoid this disease,” he adds. WHAT HAS STOOD OUT SO FAR? So far, the achievements have been attributed to many factors, including the role played by community health workers. With the introduction of Home-Based Management of Malaria (HBM) for both adults and children through community health workers, Mbituyumuremyi says malaria patients are being diagnosed and treated early. Before, he says, patients had to travel to health facilities far from their homes to seek medical services, which delayed service delivery and in turn, limited or rather increased the number of severe malaria cases and mortality. “Empowering community health workers through training in malaria diagnosis and treatment has been key to this success,” he points out. Before 2015, community health workers would only manage malaria in the under-five, but in 2016, results showed that adult people can also be managed by well-trained CHWs. With strong supervision of health centres in the heavily affected areas, the medic notes that CHWs are well equipped to manage fever at the community level, and also provide other health-related services as they are trained on how and when to refer or notify any complicated cases. *** THEIR VIEWS It’s advisable for people to use insect repellents when outdoors, proper use of mosquito nets and most importantly, having an environment that discourages mosquito breeding, i.e. clearing bushes and stagnant water. Dr Charles Nkuranga, Epidemiologist -- Hospitals should aim at doing regular malaria screening in people and treating positives. Also, regular indoor residual insecticide spraying is vital. Dr Celestin Karangwa, Physiotherapist - TCM Technology Clinic, Kicukiro -- To fight Malaria, we need strong awareness of the issue, demystify the illness, test, and treatment nearest to the people. Healthcare accessibility is also needed at all levels of the community, as well as increasing prevention sessions and availability of drugs. Emmanuel Ntakiyisumba, Nursing coach - Ndera Hospital -- When it comes to malaria, parents should ensure children under the age of five are protected by sleeping under treated mosquito nets. It’s also vital to take the child to health facilities when they are unwell. Julius Habimana, General practitioner
