MALARIA: Rwanda: Malaria in Pregnancy & Elimination

 Bill Brieger : 25 Jan 2012
Malaria in Pregnancy in Rwanda as We Move Closer to Elimination
Malaria incidence and prevalence has been dropping quickly in Rwanda, below 2% in children under 5 years old. Malaria in Pregnancy (MIP) is still a risk some and may be more severe as the disease becomes rare and immunity reduces. The US President’s Malaria Initiative is supporting a prevalence study of MIP through its Maternal and Child Health Integrated Program (MCHIP) and the National Malaria Control Program (NMCP) so that appropriate data will become available to design appropriate MIP interventions as the country moves towards malaria elimination.
The study focuses on pregnant women during their first visit to focused antenatal care (FANC) for their current pregnancy. Four FANC visits promote maternal and newborn health through 1) Early detection and treatment, 2) Prevention of complications and disease, 3) Birth preparedness and 4) Health promotion.
The study of over 4000 women is at the half way mark. Supervisory visits determine if data such as RDT, Microscopy and PCR tests, are being gathered correctly.



Pictured here are Alice and Donatien who are nurses based at Gakoma Health center in Gisagara District and were trained for the the MIP prevalence study. They are seen here taking blood samples for the study. They have integrated the study procedures into the routine FANC they provide. This makes it easier for the client as well as the nurses who also extract study data on age, parity, hemoglobin, bednet ownership and fever history which is normally collected as part of FANC.

Since data collection began in late December, Alice and Donatien have enrolled about half of their target number of clients. When the results from all 38 health centers across the country are compiled in April, the National Malaria Control Program will have valuable information to plan how best to protect pregnant women as the country moves closer to malaria elimination.
http://www.malariafreefuture.org/blog/

MALARIA: Rwanda: Malaria On the Rise Among Workers At Nyagatare Rice Scheme

Nyagatare — Many workers at Kilimburi Rice Scheme in Nyagatare district have been hit by Malaria due to lack of mosquito nets.
The scheme in Tabagwe Sector, Nyagatare District, is run by Rural Sector Support Project (RSSP) and is set to produce 21,000 tonnes of rice annually with a projected annual income of Rwf 4.5 billion once complete.
When The Sunday Times visited over 170 workers camping in tents in Cyenjojo cell, most of them were suffering from severe malaria.
"I have slept in this tent for a week without going to work because of severe Malaria that hit me last week. We don't get access to mosquito nets yet this place is home to mosquitoes due to its terrain," narrated one Nzabamwita, a casual worker at the rice scheme...

http://allafrica.com/stories/201201300306.html




Nyagatare — Many workers at Kilimburi Rice Scheme in Nyagatare district have been hit by Malaria due to lack of mosquito nets.

The scheme in Tabagwe Sector, Nyagatare District, is run by Rural Sector Support Project (RSSP) and is set to produce 21,000 tonnes of rice annually with a projected annual income of Rwf 4.5 billion once complete.

When The Sunday Times visited over 170 workers camping in tents in Cyenjojo cell, most of them were suffering from severe malaria.

"I have slept in this tent for a week without going to work because of severe Malaria that hit me last week. We don't get access to mosquito nets yet this place is home to mosquitoes due to its terrain," narrated one Nzabamwita, a casual worker at the rice scheme...

http://allafrica.com/stories/201201300306.html

MALARIA: Rwanda wins award for fighting malaria

The New Times: January 31, 2012

President Paul Kagame, yesterday, received on behalf of Rwanda the prestigious 2012 African Leaders Malaria Alliance (ALMA) award. Rwanda was among the seven African countries to receive the Excellence Award for ‘exemplary leadership in accelerating and sustaining access to malaria control and treatment’.
The award was presented to President Kagame during a luncheon hosted by ALMA, held on the sidelines of 18th Ordinary Session of the African Union. In his acceptance speech, President Kagame noted that the reduction of malaria is a result of the numerous efforts geared towards improving the welfare of the Rwandan people. “Thank you for the award, which I receive on behalf of Rwandans who work so hard to make their lives better” Kagame said.“The efforts recognized today are proof of what can be done with the resources at our disposal, relevant policies, and a great deal of commitment.” Current figures indicate that deaths due to malaria in Rwanda dropped to only 7% from 60% following years of a rapid scale-up.
The battle against Malaria in the country was characterized by massive distribution of insecticide treated bed nets, indoor residual spraying and a combination of therapies.
Addressing the high profile gathering, that included Heads of State and governments, attending the AU summit, President Kagame called for collaboration among countries in the fight against malaria. “Shared information translates into shared and reduced costs thus helping countries to overcome the issue of insufficient funds,” “If we work together and direct more domestic resources to malaria control, I believe this challenge can be overcome, and we can make even greater strides towards a healthier African population.” Kagame said, adding that cross border anti-malaria efforts are needed in areas such early detection of drug resistance and harmonization of control interventions. Award recipients were grouped into two categories.
In the First category, Rwanda, Burundi and Mozambique were recognized for having banned the importation and use of oral artemisinin –based monotherapies and removal of tariffs on all essential commodities used in the fight against Malaria. The second category included Benin, Cameroon, Kenya and the United Republic of Tanzania.
The four countries were recognized for having made outstanding progress in malaria control over the last year. Liberia’s President Ellen Johnson Sirleaf was announced the new chair person of ALMA replacing Tanzanian President, Jakaya Kikwete.
info@newtimes.co.rw

MALARIA: Battling Africa’s Number One Killer

April 22nd, 2011
Jennifer Weiss – health advisor for Concern Worldwide, an international humanitarian organization. She currently manages Concern’s Child Survival programs in Rwanda, Burundi, and Niger. A former Peace Corps volunteer in Honduras, she holds a Masters in Public Health from Tulane University.





Mukarurangwa Cecile, a community health worker in Marebe, Rwanda visits the home of Valentine, 3, to examine the cause of his fever. Photo: Esther Havens, Rwanda.

According to estimates from the United Nations and the World Health Organization (WHO), nearly one million children do not reach their fifth birthday because they die from malaria each year. Ninety percent of these deaths occur in Africa, where malaria remains the number one killer of young children. An additional 30 million pregnant women and their newborns are also at risk of malaria infection, which may lead to stillbirth, spontaneous abortion, low weight, and neonatal death.
Pregnant women and children die from malaria because they lack access to low-cost, effective solutions to both prevent and treat the disease. Concern is working to change this through our USAID-funded Child Survival programs in Rwanda, Burundi, and Niger, which provide life-saving malaria prevention and control to a total of 1.2 million women and children.


 Josepine Mukahirwa, a community health worker of 3 years, visits the home of Tuyishime Sylvie, 26, in Gasambu to educate on the importance of using a bed net. Photo: Esther Havens, Rwanda

The most obvious way to control malaria is to protect people from being bitten by malaria-carrying mosquitoes in the first place. People are at the highest risk of being bitten at night, while they are sleeping. Therefore, sleeping under a mosquito net, which is treated with a long-lasting insecticide, is a simple solution with dramatic results: at an average cost of about $10, long-lasting insecticide treated bed nets have been shown to reduce malaria transmission by 90 percent.
Concern works with local partner and governments to provide long-lasting insecticide treated nets to the people that need them the most: pregnant women and children under 5 years of age. Concern’s cadre of Community Health Workers then provides one-on-one counseling during household visits to further encourage parents to have their young children sleep under the bed net, and answer any questions or address any challenges the family may be facing in their use.
In Rwanda, Concern’s Child Survival Program is on target to ensure that 85 percent of all households own at least one bed net, and that pregnant women and children under the age of five are sleeping under them each night.
Another life-saving prevention technology recommended by WHO is to provide all pregnant women with at least two preventive treatment doses of an effective anti-malarial drug during routine antenatal clinic visits. Intermittent preventive treatment (IPT), as it is called, has been shown to dramatically reduce maternal anemia and low birth weight, and other adverse effects of malaria during pregnancy. However, many country governments are struggling to provide this service to all pregnant women during their antenatal care visits.
In Niger, Concern’s Community Health Workers are educating mothers about the importance of IPT, and the program is training health facility staff to provide IPT, in order to ensure that 70 percent of all mothers received the recommended two doses of IPT during their last pregnancy.

 Early diagnosis of malaria is critical to ensure prompt access to life-saving treatment. Photo: Esther Havens, Rwanda

However, in 2009, only 35 percent of malaria cases were confirmed with a diagnostic test, which requires a skilled laboratory technician and appropriate equipment. Therefore, the majority of malaria diagnoses in sub-Saharan Africa are based on symptoms alone—many of which (fever, difficulty breathing, reduced appetite) are also symptoms of pneumonia. Treatment of pneumonia alone may result in death from malaria, while the unnecessary, ‘presumptive’ treatment of malaria may result in malarial drug resistance.
However, in 2010, the World Health Organization, approved the use of a a new technology, called Rapid Diagnostic Tests (RDTs), which health facility staff may use to make malaria diagnosis without the use of sophisticated laboratory technologies.
In Rwanda, Concern is partnering with the Ministry of Health to conduct the initial roll-out of this ground-breaking tool, and is already seeing improved results: from December 2010-February 2011, Community Health Workers saw a total of 2,944 cases of fever. With the help of RDT, 33 percent were confirmed as cases of malaria and treated accordingly.
For many people, even if a child has been diagnosed with malaria, the nearest health facility is a several hours’ walk away, and parents may not seek treatment until it is too late. Concern’s Child Survival programs bring malaria treatment directly to people who are most vulnerable through an approach called “Community Case Management.” Concern trains Community Health Workers to screen for and treat simple cases of malaria with locally available, effective and safe anti-malarial drugs.
Through the Community Case Management approach in Burundi, Concern is working to increase the percentage of children treated with an effective anti-malaria drug within 24 hours of registering a fever from 26 percent to 60 percent.


 Bahomwana care group meets in Gasambu village, Rwanda where they exchange ideas and discuss ways to overcome challenges to improve their work as Community Health Workers. Photo: Esther Havens, Rwanda

Following treatment, the Community Health Worker monitors sick children, and, if they are not improving, ensures that they seek further treatment from the health facility immediately.
Much work remains to be done if we are to significantly reduce the rate of death from malaria worldwide. Concern is contributing to the fight against malaria through the application of proven solutions, as well as new technologies, to reach those most vulnerable to malaria. Preventing the huge numbers of child deaths from malaria that occur each year is no longer an impossible dream.

http://blogs.concernusa.org/2011/04/22/world-malaria-day/

MALARIA: Rwanda: Malaria Decreases By 70 Percent

Fred Ndoli : 21 Mar 2011 : New Times (Kigali)
Rwanda is on track to enter the malaria pre-elimination phase.
According to a Rwanda malaria performance program review, by 10 external experts, the country has managed to bring down the disease by 70 percent.
The period studied was between 2001and 2010.
The review findings indicate that there was a 61 percent decline in deaths caused by malaria within the same period.
The report also indicates an improvement in malaria case management as it rose from 77.4 percent in 2006 to 85.7 percent by December 2010.
According to the report, there was also an increase in the percentage of children - under five years - with malaria who received treatment within 24 hours, from 62 percent in 2008 to 89 percent in 2010, whereas among pregnant women, it rose from 60 percent to 89.2 percent in 2010.
The acting Director General of TRAC Plus, Dr. Corine Karema, said the country intends to reduce Malaria infection by 90 percent by 2012.
"In a quick survey we conducted, the household ownership of mosquito nets is now 98,99 %, but the usage of them is still low, people still have wrong perception about them," said Karema, adding that more campaigns will be conducted to influence behavior change in communities.
Over six million mosquito nets have been distributed since 2009 in which each household has at least three mosquito nets.
However, Dr Karema called on stakeholders for more financial support to meet their malaria pre-elimination goals.
"There has been declining gap in funding malaria control, from 2009-2011; funding gap of 55% whereas from 2012 to 2013 there is gap of 70%," Karema said.
After presenting the review findings, representatives of the stakeholders, jointly signed a statement committing to work together to follow up on the recommendations and support activities aimed at achieving a malaria free Rwanda.
The stake holders included, the Mission Director of USAID, the WHO Represenative, the RDO Executive Secretary, the Director of SPH, Dr Karema and the Permament Secreatry, Dr Agnes Binagwaho, on behalf of the Ministry of Health.
Dr. Binagwaho, attributed the improvement in the fight against malaria to the government's leadership and evidence-based policies on health sector.
"These tremendous trends couldn't have been achieved without the particular emphasis of the government, especially our President," she said.
Binagwaho added that there is still a challenge of cross-boarder threats, and there is need to harmonise malaria control interventions in the region.
"We are going to go for a regional approach so that there is integration of the same interventions," she noted.
The country Director of USAID, Dennis Weller, urged the health sector to continue being more vigilant on malaria control surveillance.
http://allafrica.com/stories/201103210021.html

http://www.fightingmalaria.org/news.aspx?id=1593