From hygiene education to snakebite awareness: Rwanda’s fight against NTDs

Rwanda Biomedical Center (RBC), Rwanda NGO Forum On Aids And Health Promotion, and Water, Sanitation, and Hygiene (WASH) partners, journalists, and social media influencers have completed a campaign dubbed ‘End Neglected Tropical Diseases (NTDS)’. The week-long campaign steered in diverse districts of Rwanda including Gisagara, Rubavu, Burera, Kirehe, Kayonza, and Rwamagana aimed at raising awareness on NTDs burden, solutions and multi-sectoral actions. ALSO READ: Gisagara: RBC, partners kick off NTDs prevention campaign Residents of Gisagara District where the campaign was launched were lauded by RBC for participating in the sanitation programme to combat neglected tropical diseases. The common NTDs that affect residents of Gisagara are intestinal worms and jiggers due to poor sanitation, such as drinking and using dirty water, using bushes and gardens to ease themselves, and more. However, through education on the risk factors of the diseases and the construction of toilets for some residents who lacked them, jiggers have been completely combated in the district. ALSO READ: We should all be fully committed to ending NTDs – health activist Eliminating poor WASH practices In Bunyove village, Bihungwe cell, Rubavu District, residents shared their success stories in fighting NTDs with the support of faith-based organisations. Pastor Etienne Nsanzimana, a leader at Brethren church in Rwanda, noted the challenges the church encountered due to people’s negative perceptions while attempting to raise awareness of NTDs. “People had nicknamed us pastors of the marginalised community, doubting any financial support they would get from us. However, the church persisted, focusing on educating the community about hygiene, especially the importance of washing their clothes,” Nsanzimana said. He added that the water challenge in the community was solved as WASH partners constructed water tanks, to curb poor sanitation. Nsanzimana highlighted the ongoing efforts aimed at deepening the community’s understanding of hygiene to combat diseases stemming from poor practices. While rainfall provides water, the absence of filters and the need for water pumps and electricity is still a challenge. Access to these resources would significantly improve the community's water situation, the pastor said. Previously, the lack of proper facilities led to the spread of diseases, particularly affecting children. However, the introduction of several toilets has contributed to the complete eradication of these diseases, marking a positive shift in the community’s health. The priority was to educate and raise awareness among people. This was achieved through collaboration with partners such as religious organisations, community health workers, and the Private Sector Federation. “Together, we contributed to building standard toilets and distributing water tanks to the residents. These partners chose to assist us because our residents were previously considered a marginalised community. However, through campaigns, our residents have been educated, and their mind-sets have changed to align with the established standards applicable to all Rwandans,” Nsanzimana said. He said before this transformation, residents would casually walk without washing their clothes and use bushes as toilets. Fortunately, these practices have stopped, indicating a positive behaviour change. Residents of Cyanika sector, Burera District have achieved a significant milestone in the elimination of NTDs. They reported that using industrial fertilisers instead of human waste fertilisers in farming has improved their hygiene and helped protect them from worms and other NTDs caused by poor sanitation. According to Ildephonse Semiryango, a resident of the area, human waste was used as fertiliser in farms. However, it was discovered that the waste contains eggs of intestinal worms that can survive for up to five years in the soil. Health workers advised that when harvesting and bringing yields home, these worms could lead to the spread of diseases. “As a result, we stopped using human excreta and switched to industrial fertilisers, which proved more effective than anticipated. This shift significantly increased our harvests and resulted in consistent profits. Currently, nobody uses human waste for fertilisers, as doubts about its usefulness persist. Agriculturalists and community assistants raised awareness, prompting an immediate transition to industrial fertilisers,” Semiryango stated. Experts explain that intestinal worms, typically present in soils, are transmitted to vegetables like spinach, amaranthus (the leaves), and cabbage when it rains. During harvesting, these worms are often included unintentionally, and some individuals boil the vegetables without adequate washing. Consequently, these invisible intestinal worms can get attached to the vegetables or transferred when consuming unwashed food. Proper disposal of toilet waste is crucial to prevent schistosomiasis, a disease caused by freshwater parasitic worms in specific tropical and subtropical regions. Claudine Dukuzumuremyi, a community health worker in Cyanika sector, highlighted the risks of using human waste, explaining how it could damage hands or harm plants with excessive chemicals. “The consequences of plant damage were visible—burnt plants meant disposal, resulting in a loss. A hectare yielded two sacks of harvest, but industrial fertilisers have increased the yield to up to eight sacks,” she added. As a health worker, Dukuzumuremyi assured the reduction in worm diseases, stressing how diarrhoea cases have notably decreased from receiving 10 children a week to one or two, and sometimes none, indicating a positive impact. In addition, people are advised to practice proper hygiene, including hand washing before breastfeeding and eating, collectively contributing to the reduction of hygienic diseases. Tackling snakebite envenoming In Nasho sector, Kirehe District, snakebite envenoming is a neglected public health issue. Dorothea Mukanyumbyire, a resident, experienced a snakebite two years ago while digging in her banana farm. She sought hospital first aid but there was no improvement. “Eventually, I turned to traditional healers, known as “abagombozi” who used a ‘snake-stone’ to press on the wound, leading to my recovery after a year,” she said. Juvenal Habimana, a resident of Rugoma, a locality in Nasho, Kirehe District said that in the past, people in this area faced fatal outcomes due to the considerable distance to “abagombozi”. The remoteness led to deaths and physical disabilities for some. “Nowadays, there is already established awareness, prompting immediate hospital visits after experiencing a snakebite.” Nathan Hitiyaremye, the NTDs-WASH Coordination Officer at RBC, said 12 individuals in Nasho sector have experienced snakebites in just a year. The district (Kirehe) has around 52 cases, highlighting a significant problem, and it’s evident that snakes pose a serious threat. He highlighted that various healthcare providers have been trained to ensure prompt treatment for anyone suffering from a snakebite, noting that immediate care is crucial to prevent unnecessary deaths. “In cases where reaching a hospital immediately is challenging, ambulances are available, including one at the Mulindi health post in this area.” Addressing reliance on traditional healers, Hitiyaremye said it is essential to understand that they don’t effectively treat snakebites. Seeking assistance from experienced doctors in hospitals is advisable for proper treatment and other necessary healthcare services. He said traditional healers resort to dangerous practices, such as cutting the affected area, leading to potential complications and endless bleeding. They also lack proper hygiene materials, posing a risk of contracting other diseases such as tetanus. “Residents should take preventive measures like cutting surrounding trees which attract snakes, and maintaining cleanliness by pruning and slashing areas likely to be snake habitats. Avoid the domestication of wild animals, and sleep in mosquito nets. In the incident of a snakebite, residents should immediately call an ambulance, RBC, or a nearby community health worker,” Hitiyaremye said. A concern for all At Groupe Scolaire Gishanda, Kayonza District, learners are trained in hygiene and sanitation practices. The school has emphasised the significance of these practices for individuals and their families. Marie Solange Mukamuganga, the director of the school, said the school has achieved commendable sanitation levels in both primary and secondary education as learners are taught to prioritise personal and collective hygiene. “Every morning, we conduct inspections covering clothing, body, haircuts, and nail care to ensure everyone maintains cleanliness. After the last lesson, we also clean the classrooms, making the school environment clean. “In case of identified hygiene-related issues, we collaborate with students’ peers to address concerns promptly. We also provide hygienic tools and support to ensure cleanliness.” In Rwamagana District, Godfrey Kabagambe, Managing Director of SATO, (a company that assists communities in introducing hand washing as an everyday practice, changing behaviours that can mitigate health risks – all while saving water), explained that they ensure that residents have standard toilets, providing hygienic tools, and offer knowledge sharing and training on cleanliness and hygiene. This has improved hygiene in the area. “We collaborate closely with community workers, who serve as sales agents and possess valuable knowledge about sanitation in villages. They are the forefront individuals in playing a big role in understanding and improving people’s lives.” The most common NTDs in Rwanda are intestinal worms (affecting 41 per cent of Rwandans, with a prevalence of 48 per cent in adults), bilharzia/schistosomiasis (1,000 cases), podoconiosis (about 6,000 cases annually), scabies (100,000 cases), taeniasis (3,000 cases), cysticercosis, rabies from dog bites (1,000 cases) and snakebite envenomation (1,500 cases). Neglected diseases are mostly found in sub-Saharan Africa. They are neglected because they do not receive the same attention as other diseases that affect the world.

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From hygiene education to snakebite awareness: Rwanda’s fight against NTDs