Control of malaria in Rwanda

25th April is, “World malaria day”, a day to remind people that still a tiny insect can cause havoc with people’s health and lives. I remember a conversation with a taxi driver in Kenya, while visiting as a tourist last year. He was pointing out different buildings including the public hospital. I asked him about the severity of malaria in his area. His reply was that since mosquitoes are there to stay on mother earth, malaria is also going to stay. This man like many others did not know that it is difficult but not impossible to conquer malaria. Rwanda has demonstrated this to be possible. Yes mosquitoes are here but number of malaria cases and resulting deaths has reduced dramatically. Malaria was one of the major killer diseases in Rwanda like in any other tropical developing country. It is said that in Africa, a child dies every 30 seconds because of malaria. Poverty and malnourishment added to the morbidity and mortality. But today Rwanda stands apart from all other tropical countries in that it has succeeded in bringing malaria down. Malaria in Rwanda is due to the deadly falciparum species of malarial parasite (parasite causing malaria). Before, the bulk of patients coming to the hospital were due to malaria. But now the mortality due to malaria has dropped to only 7%, a dramatic 60% reduction in just over 2 years. How has this been achieved? It has been possible due to the initiative of Ministry of health, resources provided by UNDP and Global Fund, committed work by doctors, health personnel down to the community level and active participation by motivated people. It was indeed a challenging task. In a nation which faced a man made catastrophe, with meager resources at hand, aiming to control malaria seemed to be a far fetched dream. Before 2005, the government had provided about 30,000 mosquito nets in a bid to fight against malaria. In 2005, after receiving the first grant from Global Fund, about 300,000 mosquito nets were supplied in communities. As more funds arrived, 1.4 million bed nets impregnated with long lasting insecticides (LLIN), were given to vulnerable populations, particularly children aged 6 months to 5 years. One can indeed imagine the herculean task involved in distribution of these nets in far flung remote areas in a hilly terrain. In 2006, the ministry of health, introduced new and effective anti malarial drugs and withdrew drugs ineffective and now resistant to malaria from all public and private pharmacies and clinics. This minimized the chances of people being exposed to drugs which are no longer efficacious against malaria. Pregnant women were given medicines intermittently to make them less susceptible to malaria. Community health workers were trained to provide home based management of fever. Tests and medicines for malaria were made available in health centers. Initiation of health insurance made the people utilize the available health facilities more. Thus anti-malarial treatment became accessible for almost all and that too without having to travel far for it. All these efforts were combined with extensive dissemination of education about malaria and its prevention among the public, even in remote rural areas. People were sensitized about use of mosquito nets. This was achieved by means of road side speeches, pamphlets, and campaign on radio. Indoor spraying of insecticides was taken up, providing protection against malaria in over 190, 000 homes in vulnerable areas. It is common knowledge that stagnant water present in cesspools and ditches provides breeding ground for mosquitoes. One who has been around this nation, can truly appreciate how clean Kigali and other towns have become over the recent years. This has been possible only through guidance by the leaders and motivation of the people. How can mosquitoes grow in such clean environment? Naturally their number and malaria caused by them will also decline. Whatever cases of malaria are occurring now, will definitely reduce with more education of people and their economic development. If the gains obtained are consolidated, Rwanda stands out as a model country in the world, which has achieved a seemingly difficult task of successfully controlling malaria. Ends