Malaria resurgence: What exactly went wrong?

As Rwanda Joins the rest of the World today to mark malaria day, the resurgence in malaria cases comes as a surprise considering the amount of effort invested by government to fight the disease. Figures from the health ministry indicate that the country registered close to two million malaria cases last year, almost four times more than the 514,000 cases reported in 2012. Still in 2013, over 800,000 cases were diagnosed and these soared to 1,598,076, an increase of an eyewatering 67 per cent, a year later. While the role of government in ensuring safety against such diseases is largely known, the fight against malaria could require more than just ministry interventions. From villages to towns, measures that include use of insecticide-treated mosquito nets, slashing bushes, clearing stagnant water have been put in place. And now the ministry has embarked on indoor residual spraying to clear all traces of the female anopheles mosquito. But what could be going wrong to justify these rising cases? Health Minister Dr Agnes Binagwaho, blames the soaring cases on conducive environments where mosquitoes breed. In fact she points out that districts with a predominantly cold weather pattern such as Gicumbi and Burere faced increased cases contrary to the past when fewer cases were registered. Environmental experts support the minister’s views, maintaining that with warmer weather expected next year, the situation could even get worse. The minister also pointed out that the laxity in implementation of existing preventive measures to avoid malaria out-break could be contributing to the upsurge. “Besides the rising temperatures, we think people abandoned use of mosquito nets even if they own them or even closing doors and windows in the evening. Stagnant water, bushes and wastes also surround houses yet they are breeding ground for mosquitoes,” Dr Binagwaho said in an earlier briefing. Bad users remain more prone Most times, government gives out insecticide-treated mosquito nets. Others who can afford purchase their own nets, but experts point out that those who use nets poorly remain prey for mosquitoes. Like Stanley Ngarukiye, a public health consultant at Mountain Kenya University and member of the anti hepatitis group in Rwanda, says, people have a huge role to play in preventing malaria in homes. “Most people have nets, but they end up using them wrongly. For example, a net so close to the skin means mosquitoes can easily bite you. Whose role is it to ensure that mosquito nets are tied properly?” he asks, adding, “There is no way mosquitoes can find space to infect people if nets in good condition are used in addition to other interventions.” While mosquito nets have a longevity of up to five years, several findings assert the fact that only those who use them well can reduce the spread of malaria in infants. When insecticide-treated nets are used properly by three-quarters of the people in a community, malaria transmission is cut by 50 per cent, child deaths are reduced by 20 per cent, and the mosquito population drops by as much as 90 per cent. Ngarukiye also says that since mosquitoes normally get in the house from 4pm, windows and doors should be properly closed during evenings. “Whether in towns or villages, it is important to close the windows and doors, but proper hygiene and sanitation around the house should always be checked. Tall bushes and rubbish around the house provide good breeding sites for mosquitoes and clearly this is an issue of management,” he adds. The Ministry of Health has launched an indoor residual spraying drive to curb rising cases of malaria. (Net photo) According to the World Health Organisation, a decline in malaria cases across the globe was registered but concerns over resurgence of the disease were highlighted. For example, in 2000, an estimate of 86 per cent of malaria deaths occurred in children aged under 5 years and that the disease accounted for 12 per cent of all deaths in children aged 1–59 months globally. Sub-Saharan Africa is most affected and 22 per cent remain susceptible. Costly treatment of cases The government of Rwanda spends hugely on interventions for diseases and for this financial year an allocation of Rwf2.4 billion for prevention of malaria and other parasitic diseases was given out through Rwanda Biomedical Centre. Most experts, however, argue that even though malaria treatment is available across all health centres, delayed management yields severe complications. Dr Albert Ndata, a physician in Kigali, explains that severe malaria is a potential threat for most body organs. “Due to delays in getting treatment and poor management, there are risks to cerebral malaria which cause severe damage to the central nervous system yielding signs such as seizures and coma, respiratory distress,” says Dr Ndata. The other complication is that individuals with malaria may require ventilatory support, but this worsens the situation for some body organs such as the kidneys as they need extra support to perform effectively. “Renal failure is a common complication of poorly treated malaria. Spontaneous bleeding is another complication due to clotting disorders as a result of malaria. Others include severe hepatosplenomegaly, anemia, hypoglycemia, vomiting and some times patients who remain in shock are unable to feed,” he adds. Dr Ally Kambale, a general practitioner at Kabaya Hospital in the Western Province, supplements these views explaining that when some people fail to seek medication on time, especially in the villages, eradicating malaria remains a challenge or induces resistance. “Once a mosquito bites a person with the disease, more people will get the disease, and delayed treatment leads to more resistance,” says, Dr Kambale. He adds that people living in villages should ensure good hygiene standards for their surroundings not to provide breeding sites for mosquitoes to multiply irrespective of the season. “Some people just ignore sleeping under their nets because they only think that mosquitoes only come during the rainy seasons,” he adds. Malaria is a vector borne disease, spread by an infected female anopheles mosquito. New infections are acquired through mosquito bites and killing mosquitoes or preventing their bites through the use of mosquito nets helps prevent the spread of the disease. Unfortunately, mosquito nets are used as fishing gadgets in some communities which only worsens the situation. editorial@newtimes.co.rw ********************************************** Why have cases of malaria in the country risen? Francis Kazungu, a general practitioner at Clinic de Medicale Francis Kazungu I think most people don’t follow instructions from health facilities when they are given mosquito nets. For example, they are supposed to wash it with tablet contained inside and leave it to dry before using it, which is ignored by most people. Calmina Izabayo, a medical student at UR Calmina Izabayo I believe some people rarely maintain a clean environment. That’s the first chance they are creating for the mosquitoes to breed. Another thing is that during the rainy seasons, they don’t clear out the stagnant water around their residences. Jean Nisingizwe, an employee at Royal TV Jean Nisingizwe I think it’s because people are used to self-medication. That implies that they may not know when they are suffering from malaria because they always treat the pain without getting proper tests done. Most people also don’t know about the preventive measures. Iba Mayale, a gynecologist Iba Mayale I believe sometimes it’s just ignorance among people. Despite the government efforts in putting in place measures to ensure no one is affected by malaria, some people especially pregnant women have chosen to sleep under the nets during the rainy season only, which is so dangerous. Clarisse Kaligirwa,a student Clarisse Kaligirwa I think people still need to be educated more on the causes and prevention of malaria, especially those in rural areas where most grown up people are not educated. Also, people find it hard to replace old and torn nets. Compiled by Lydia Atieno