The Ministry of Health, through Rwanda Biomedical Centre (RBC) has rolled out a Mass Drug Administration (MDA) campaign countrywide to treat intestinal worms and bilharzia. Bilharzia is an infection caused by a parasitic worm that lives in freshwater in subtropical and tropical regions, targeting both children and adults. According to the World Health Organization (WHO), the MDA intervention also called preventive chemotherapy or mass deworming, is a public health intervention of giving the medicines to the entire or targeted group of the population from a defined geographical area known to have a certain level of disease infections that cause a public health concern. Intestinal worms and bilharzia are two of the 20 Neglected Tropical Diseases (NTDs) recognised by WHO and are among diseases controlled through MDA. Through the ongoing campaign which will end on July 15, RBC is providing chewable tablet (pill) of mebendazole (500mg) or albendazole (400mg) for treatment of intestinal worms and praziquantel (600mg) tablets that are taken with water or some meal for treatment of bilharzia. The two diseases contribute to malnutrition and stunting, school absenteeism, mental retardation, hospitalisation and deaths and therefore, according to Jean Bosco Mbonigaba, Acting Director of Neglected Tropical Diseases and Other Parasitic Diseases Unit at RBC, investing in their reduction as well as elimination is an urgent health priority. He said that the intervention targets students aged between 5 to 15 and those aged above 15 who are at school, adding that they are receiving the tablets from their respective teachers under the school programme. “Each Community Health Worker (CHW) provides deworming tablets to adults from households of his/her catchment area (isibo) – a catchment of 15-25 households),” he continued. Mbonigaba declared that six districts (Rwamagana, Bugesera, Kamonyi, Nyarugenge, Gasabo and Kicukiro) that have low overall prevalence of intestinal worms, are only treating children aged 5 to 15 years except for some of their sectors with Bilharzia cases. He added: “In those 6 districts, they may have some communities without adequate standards of water, sanitation and hygiene, therefore, it is planned this year to work with districts, sectors and health centres to enumerate those communities so that adults from those communities are treated in future deworming campaign as well.” Mbonigaba also declared that health centres and health posts are also administering deworming tablets to all arriving patients who are visiting them for other medical services. This, according to him, is to maximise the reach of all target populations and cut the re-transmission rate of intestinal worms and Bilharzia. Why intervention now According to Mbonigaba, the 4 per cent decline in intestinal worms’ prevalence from 2014 to 2020 was not significant, likely due to the high rate of transmission from untreated adults to treated children as in 2020 adults had the highest prevalence of intestinal worms (48 per cent). He declared that factors that include the risky behaviour of some community or household members that expose them to infections such as not washing their hands after using the latrine; open defecation for certain occupational groups such as farmers; some gaps in access to treated water, adequate sanitation and hygiene and the use of human excreta as fertilizer might have contributed to the persistence of intestinal worms among school age children despite repetitive deworming campaigns since 2008. Despite the highlighted challenges, he said that the Ministry of Health has set a target to reduce to below 20% the prevalence of intestinal worms and to eliminate schistosomiasis (Bilharzia) as a public health problem by 2024. He believes that the target will be achieved through multi-sector collaboration with partners working in water, sanitation and hygiene to jointly address factors favouring persistence of those diseases and through continued mass deworming of all at-risk populations, including adults.
