Rwanda has seen tremendous progress in the fight against malaria but the entire population of 12 million is still at risk. One of the objectives of the Malaria and Other Parasitic Diseases Division (MOPDD) of the Ministry of Health is to ensure that 95% of the population has correct knowledge of malaria prevention and treatment.

Transferred by a parasite and transmitted through mosquito bites, malaria can be prevented with insecticide-treated nets (ITNs), insecticides and medicines.

Malaria transmission occurs year-round with two peaks from May to June and November to December. The MOPDD has classified 19 of the country’s 30 districts as malaria endemic and the remaining 11 as epidemic-prone.

In 2013, there were 483 720 confirmed cases of malaria in Rwanda and according to World health statistics 2014, only 69% of children under 5 years of age were sleeping under ITNs. This percentage remains significantly below the 80% target set by the World Health Assembly, the decision-making body of the World Health Organization.

Indoor residual spraying (IRS), or spraying on the inside walls of structures has played a major role in reducing malaria rates throughout the country. IRS has shown to significantly decrease mosquito and larvae populations where stagnant water is present, such as those near mines, farms or brick-making operations.

IRS is part of an ambitious malaria prevention and control program in Gisagara where district leaders hope to reach zero malaria deaths by 2017.

"Since the launch of IRS in the district in 2011 absenteeism at work, on farms and educational establishments due to malaria has decreased tremendously contributing immensely to the economic development of the district,” said District Mayor Leandre.

Another goal of the MOPDD is to ensure that 90% of the population is effectively protected by at least one appropriate preventive measure. This can be seen in Rwanda’s malaria in pregnancy (MIP) control interventions.

Unknown to many, malaria can be transmitted during pregnancy as well as before and/or during childbirth. Malaria contracted at this time is called congenital malaria and is a major cause of infant death.

To help prevent pregnancy-related complications, all pregnant women receive two of the three recommended MIP control interventions. First, an ITN is provided to women during their first pregnancy, usually on their first antenatal visit. Second, pregnant women with fever are immediately tested for malaria and then treated if appropriate.

Significant gains have also been made in managing and treating malaria co-infections. Pregnant women who have co-infection of HIV and malaria often suffer from anaemia, pre-term birth and low-birth weight babies.

Several medications are available for chemoprophylaxis such as atovaquone-proguanil, doxycycline or mefloquine. No antimalarial drug is 100% protective and must be combined with the use of personal protective measures such as:

• Avoiding going out between dusk and dawn when mosquitos are most active;

• Wearing long-sleeved shirts and long trousers;

• Using ITNs in bedrooms at night;

• Applying insect repellent on any exposed skin and using IRS in the home.

Dr Couillard is an international health columnist that works in collaboration with the World Health Organization’s goals of disease prevention and control.