AUTHORITIES in Kagera Region were recently alarmed following an outbreak in 29 villages in Muleba District which had already been covered under the Indoor Residual Spraying (IRS) Programme.

Several children died since the outbreak on may 25, this year while hundreds were admitted to Rubya, Kagondo and Ndolage hospitals in Muleba District.

Our reporter ORTON KIISHWEKO who was in Kagera Region recently reports. AS the rainy season descends in Kagera's Ngara District, hospital beds around were expected to increasingly fill with patients suffering from malaria, as it was in earlier years.

Like at the country's level, the disease is Kagera's number one killer, initially accounting for 1000 deaths a year, or 48 per cent of all deaths in the region. A vicious cycle had seen malaria incidence rates in the region triple before in the last 30 years, while its economy has deteriorated at the same period.

In a district where 34 per cent of the population now lives below the poverty line, most households have lost breadwinners to malaria and struggle to support family members afflicted with the disease. The public cost is also high.

Malaria accounts for an estimated 40 per cent of public health expenditures, draining a health system already overburdened by HIV/AIDS and a shortage of health workers. Lowered productivity as a result of malaria infections has further crippled the government's ability to implement measures to control the spread of the disease.

A new partnership between the government, international donors and the Non-Governmental Organisations that make up the country's existing Roll Back Malaria campaign aims to break the cycle, with an ambitious plan to reduce malaria deaths in the country by 75 per cent over the next three years.

Optimism about Kagera's chances of attaining its goal of reaching 80 per cent of the population with prevention and treatment measures is seen in the level of cooperation taking place between government, local NGOs and international donors, which include the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank and the Bill & Melinda Gates Foundation.

In the past, sporadic efforts by individual donors to implement malaria control projects lacked an integrated approach. "What we've got going here is a national programme donors are buying into and contributing to rather than vertical projects, "said the Minister for Health and Social Welfare Dr Hussein Mwinyi.

Technological advances such as rapid diagnostic test kits, MRDTs brought into Kagera Region in 2007 and the new artemisinin-based malaria drug, Coartem, have provided additional tools for tackling malaria. But even low-tech solutions, such as awareness raising, insecticide spraying and the provision of insecticide-treated bed nets, had been beyond the means of many rural people before 2007.

Reaching the most remote rural communities with malaria prevention and treatment measures is again dependant on partnerships, this time with faith-based organisations and traditional healers, which provide the majority of healthcare services in those areas.

Nyamwenda Albert, 43, manages a local initiative of distributing mosquito nets at Benaco in Ngara District. Nyamwenda described how previous efforts to distribute mosquito nets had failed because the recipients were not sufficiently educated about how the nets could protect them. Some nets were sold to more savvy town-dwellers or converted into fishing nets.

Others were turned into wedding dresses. The solution, said Nyamwenda, is to work with local leaders and traditional healers to educate communities about the proper use of mosquito nets. Through the Traditional Healers Association, healers are also being trained to recognise malaria symptoms and refer patients to clinics for treatment.

At the Kagera Region Commission's office, the Regional Medical Officer Helman Kabirige says they have applied almost evangelical zeal to achieve the goals the region has set for itself. Malaria rates have already decreased by 40 per cent in the last two years. With more funds, Kabirige said his region and its partners could move forward more rapidly.

"We need to look at innovative and cost-effective means," he said. One such approach is to integrate efforts with those already being used to combat HIV/AIDS. "We distributed 5,000 nets in a short time, and we now have our caregivers checking to see if they're being used," he said.

As malaria infection has been shown to increase viral load in those infected with HIV, and HIV infection can, in turn, increase the severity and likelihood of contracting malaria, this integrated approach has a medical basis. "I think the nexus of TB, malaria and AIDS are the basis for making many people vulnerable," he said.

"So it only makes sense to use and promote those tools available to deal with all three in an integrated fashion." Kagera Region's figures showing that malaria cases are already decreasing can be attributed in large part to the replacement of chloroquine as the primary drug for treating malaria with Coartem, an artemisininbased combination therapy.

Increased resistance to chloroquine had resulted in treatment failure rates as high as 50 per cent in most areas of the country before financing from the Global Fund made it possible for the government to switch to Coartem.

Kagera did so some two years after Zanzibar had effected ACTs. Kagera Region hospital, one of the first facilities to begin prescribing Coartem in 2007, saw its malaria caseload drop from nearly 1,000 a year in 2003 to under 50 cases in 2008.