BY JAMES BUYINZA The majority of these deaths occur among children under five years of age and pregnant women in sub-Saharan Africa. Yet, this disease is preventable and treatable with existing tools. With more than 1.5 million cases of malaria were treated in Rwanda’s public health centres last year, and with more than 90 per cent of the population vulnerable to the disease, malaria is responsible for one half of all outpatient visits to Rwandan health clinics and is a leading cause of death especially among children and pregnant women. A survey conducted by the ministry of health indicates that 52 per cent of the households have one mosquito treated nets and they thus remain vulnerable to malaria. The clinical disease burden is especially high among children below the age of five, pregnant women, those suffering from HIV/Aids as well as those living in extreme poverty since they have less immunity against the disease. Recognizing the devastating impact that malaria has on communities in many parts of the world, especially in Africa and the need for a comprehensive approach to rolling back the disease, the U.S President George Bush in 2005 announced a five year initiative that will provide $1.2 b toward anti-malaria programmes in those countries that are severely hit by malaria including Rwanda with the aim of reducing the disease, under the Presidential Malaria initiative (PMI). The indoor residual spraying (IRS) programme comes as a complement to the existing malaria prevention interventions included in the PMI led by USAID. The State Minister in charge of HIV/Aids and other Epidemic diseases, Innocent Nyaruhirira said that IRS and the use of ICON pesticide in general is an effective way of reducing the spread of malaria and urged the masses to support the program. “Mosquito treated nets protect only a few people but IRS will protect the whole family and the community as a whole” Nyaruhirira explained recently. The US Ambassador to Rwanda, Michael Arrieti said that his government is committed to supporting the programme as one of the methods of scaling down the impact of malaria in Africa. Malaria Prevention and Control Programme focuses on these biologically vulnerable groups, particularly those living in especially poor and hard to reach communities. These communities often have limited access to primary health care and to simple and effective preventive tools such as insecticide-treated mosquito nets. In addition, they are less likely to have access to basic information regarding the disease and how to avoid it. One of the unique aspects of PMI is that it continues to be formulated around relevant operational research that seeks to better understand how to ensure that communities access proven, evidence-based interventions of malaria prevention. Such interventions include: Long-lasting insecticidal nets (LLIN), accurate diagnostic tools and effective treatment with new artemisinin-based combination therapies (ACT) and intermittent preventive treatment for pregnant women (IPTp) and infants (IPTi). Fidel Uwizeye a resident of Mbandazi Cell, Rusororo sector in Gasabo district and one where IRS program started had this to say; “I have seen so many people lose their lives to malaria, especially children. It is terrible to lose a child and worse to lose one to a disease which is preventable and treatable. I am lucky I have not lost any of my children to malaria. I know many who have.” IRS is the application of small amounts of insecticide to the anterior walls and eves of a home or structure to interrupt the spread of malaria by killing mosquitoes. Beneficiaries are informed before the homes are targeted. All furniture and food should be removed from the house prior to the arrival of the sprayers and anything remaining inside should be covered. A household representative must be present during the spraying and residents should stay out of their home for two hours after the spraying. This exercise is completely voluntary, no one will be forced to do so but you should value since it maybe costing your life to reject this chance. Therefore, the perception of the masses should be changed towards IRS programme for it to achieve its intended objectives and these may include; Developing innovative participatory communication tools that are picture and discussion driven for raising awareness about anti-malaria spraying campaign at community level where literacy skills, especially among women, may be limited. Testing novel approaches to malaria control among rural communities and those that complement ICON use of mosquito treated nets, observing sanitation by clearing bushes around our homes and avoiding water stagnation. People should also not rely on IRS, they should always go to health clinics whenever they fall sick and use of mutuelle de sante, a health insurance scheme will minimize on the costs incurred. Assessing the feasibility and subsequent impact of home-based management of malaria especially in remote locations is needed to have all the facts about how residents have participated in the ant-malaria campaigns. Identifying and evaluating ways to expand antenatal care service provisions beyond the formal health sector is required for those living extra mile a way from health centres. Poverty and disease burden mapping for the improved targeting of subsidised public health commodities such as long-lasting insecticidal mosquito nets, is required to complement the indoor residual spraying so as to curb malaria. Integrating malaria and HIV/Aids programme activities is required as it is now acknowledged that people living with HIV/Aids are more prone to severe malaria, and malaria infection itself can lead to a rise in HIV viral load. Research Triangle Institute (RTI) the implementer of IRS and the National Malaria Control Program (PNILP) are working hard to achieve a malaria free environment but there is need to support them to have the objective achieved. Ends
