Rwanda: Health Experts Call for More Efforts in Malaria Prevention

10 November 2019

Rwanda still grapples with challenges to reduce its malaria burden but experts say the dream to eliminate disease by 2030 is possible if public sensitisation about malaria prevention is stepped up.

Central African countries surveyed in the opinion study issued at an RBM Partnership to End Malaria conference in Abuja recently believe that halving malaria deaths is more achievable than elimination by 2030.

Malaria experts however are very concerned that climate change could increase the threat of malaria in the region: Surveillance and programme delivery need to improve to drive progress.

Dr Nathan Mulure, Head of the East and Southern Africa Cluster for Novartis Social Business expressed the need for more sensitization around malaria prevention if the country is to eliminate malaria by 2030.

"Rwanda has large water bodies around, including rivers, which could be a source of mosquito breeding sites. The parasite also requires adequate treatment to avoid possibilities of resurgence. Human beings need to be well informed of the need to ensure they are tested before treatment and also to complete their dose once treatment is initiated.

Unfortunately, countries around Rwanda are still heavily infested by malaria. DRC has one of the highest number of cases in Africa at 70 million cases per year.

Uganda is suspected to have up to 60 million cases per year. Due to cross-border movements, it is highly possible to have many imported cases that need to be tracked and treated," he said.

Already, officials from Southern Province and the Ministry of Health, launched a campaign to raise awareness about malaria prevention in Gisagara District prior to the rainy season.

The move has been partly prompted by the fact that Gisagara District had the highest number of malaria deaths in the country.

The report which was the latest extension of the Malaria Futures for Africa (MalaFA) study however, also showed that Rwanda is fighting to maintain momentum in its battle with malaria in the face of other health challenges, climate change and other threats.

It revealed that from 2016 to 2017, malaria cases in Rwanda stabilized, with 4,746,958 confirmed cases reported in 2017, minimally decreased from 4,794,778 cases in 2016. National incidence remained stable with 401 cases per 1,000 population in 2017 compared with 403 in 2016

Although cases rose slightly in the Eastern (up 14 percent) and Southern (up 1 percent) Provinces, case declines were noted Provinces. In all, 17 of 30 (57 percent) districts saw malaria cases decline from 2016 to 2017. Severe cases and deaths also declined with severe malaria incidence decreased from 39 per 10,000 cases in 2016 to 24.5 per 10,000 cases in 2017.

The report involved interviews with 23 politicians, senior civil servants, malaria programme directors, researchers and NGOs in Cameroon, Democratic Republic of Congo (DRC), Republic of Congo, and Rwanda. All four are countries that have a significant malaria burden and differing policies in place to fight the disease.

In Rwanda, respondents were mainly positive about the country's fight against the disease, citing high levels of political support and funding. The World Health report, showed that Rwanda managed to reduce malaria deaths by 40% in 2015/16 and a further 43% in 2016/17.

According to Mulure, Rwanda has over the years managed to reduce the number of cases and deaths due to intensive activities including provision of mosquito nets and highly effective anti-malarial drugs, and a targeted approach by the malaria control program.

"Community health workers were also equipped with diagnostic kits to track malaria cases in the villages and administer treatment at the community. This enhanced treatment outcomes as early diagnosis and treatment is the best way to achieve good outcomes. Rwanda has also increased surveillance and operational research to monitor gains in malaria and ensure treatment is readily available, he told Sunday Times.

He also attributed the milestone to the health care system through the Ministry of Health, which has put in place response mechanisms to quickly contain malaria in case of outbreaks. Rwanda has also implemented universal health coverage for the first time in 2011. Through support of PMI, indoor residual spraying will target 360, 000 households.

According to 2017 data, deployment of community health workers provided treatment to 53% of all malaria patients in Rwanda.

In May 2015, the World Health Assembly adopted a global strategy by the World Health Organisation (WHO) with a vision to make the world free of malaria in 2030.

The ultimate goal is to reduce malaria cases and deaths by 90 per cent and to make at least 35 countries free of malaria as compared to that of 2015.

Dr Richard Nchabi Kamwi, Ambassador for the Elimination 8 countries and a co-chair of the study, said: "Maintaining momentum against malaria requires strong political leadership, resilient health systems and securing additional resources.

The pledges made at the recent Global Fund replenishment are heartening signs that critical resources are forthcoming".

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