Malaria in Rwanda: A success story?

This is a very number heavy post with lots of links, so please bear with me. :)  If you are interested in more information about this very important topic, then go ahead and click on any of the links. But I was a brief as I could be, with possible sacrifices in the economic and emotional impact of this devastating pandemic.

Malaria is an interesting disease partly because it is very possible to eradicate it from a country.  For example, the United States used to have widespread Malaria but eliminated it.  When I went to Ghana for six weeks in 2011, three people I knew got Malaria during that time and virtually everyone got it almost every year.  Before I’d been there, I thought you simply died from Malaria. The end. No chance for recovery.  However, there were constantly commercials on TV about how inexpensive treatment is, so please treat your kid when s/he gets it.  It was considered just a part of life, similar to the flu.  That is part of the reason Ebola is kind of hard to control in West Africa right now. People are thinking they simply have Malaria or other endemic diseases and are not too concerned.

However, it is not like that at all in Rwanda. I have asked several people in Nyamata and Kigali when they last had malaria and they all have to pause and think about it because it has been many years.  However, it has not always been this way, to illustrate their success, according to the National Institute of Statistics in Rwanda, in 2005 62% of all deaths under 5 were caused by Malaria (1,012 deaths). Comparatively, in 2010 only 13.05% of all deaths under 5 (175 deaths) were caused by Malaria.  That is a huge difference.  However, it is important to note that if you do the math, there were 1632.29 deaths in 2005 vs 1349.99 deaths in 2010.  That's unfortunately not a lot of progress in childhood mortality.  But I digress.

So how did they make so much progress in such a short time?  In 2005, President Bush started the President’s Malaria Initiative around the world which has been a huge help.  There are four main measures they take: 

1. Free Insecticide treated-mosquito nets

                 -I sleep under a mosquito net but I doubt it is treated anymore as it is fairly old

                -“83%of households nationwide own at least one mosquito net and 71% of children under five had slept under a mosquito net the night before the survey. Overall 73% of pregnant women age 15-49 slept under a mosquito net the night before the survey.”

2. Indoor residual spraying

3. Preventative treatment for pregnant women 

                -Free treated mosquito nets are distributed to women at their first antenatal doctor visit

4. Diagnosis with rapid testing and treatment 

-94% of all children diagnosed with Malaria are treated within 24 hours (compared to 62% in 2008)

My own contribution is that the country is very clean, which makes it harder for mosquitoes to find breeding grounds (although the buggers are still around to bite me!)  A big part is the outlawing of plastic bags in the country, which then can’t fill up with stagnant water.

Six districts account for 60% of the Malaria burden and the rest of the country is not as concerned about Malaria.  The goal is to achieve zero Malaria deaths in Rwanda by 2017, which is lofty, impressive and actually appears achievable if the progress is kept up. However, with this success comes the problem of complacency and the possibility of a resurgence.  Despite the statistics quoted above, I know many people (Rwandan and expat) in urban areas who do not use a mosquito net because they do not see Malaria as a problem.  Expats do not take Malaria preventative pills (I stubbornly refuse to stop, you can see the prescription bottle on my nightstand in the picture above).  At the same time, people are losing their immunity to Malaria as they get fast acting treatments or are not exposed to the pathogen at all. And the parasite and insects are starting to become resistant to the nets and the treatments.  But no one is too concerned right now because there is so much progress.