Rice farmers’ contribution to malaria elimination in Eastern Rwanda

By Alexis Rulisa*, Leon Mutesa*

*Malaria Elimination Project at Ruhuha (MEPR), Kigali, Rwanda

Economic activities may entail negative externalities for public health. The case of rice farming in eastern Rwanda fits this description, as it provides breeding sites for malaria-infested mosquitoes, creating significant malaria risk but at the same time generates cash income and improves nutritional standards locally (Figure 1). So far, none of the interventions that have been proven to be effective in tackling rice farming-induced mosquito breeding sites has been implemented in Ruhuha. Therefore, a project that aims to eliminate malaria (MEPR project) in this area has decided to use external funds to support a larviciding intervention with Bacillus thuringiensis israelensis (Bti), but for just one rice cultivation season (semester). Future interventions will thus depend on co-payment of rice farmers and the wider community. The first study aims to assess the impact of rice farming to malaria risk while the second conducted prior to Bti application aims to assess the resource mobilization among rice farmers for larviciding.

To this purpose, a large-scale survey was conducted among more than 4,000 households in the area from June to December 2013. Data on household demographics, economic status, malaria prevention efforts as well as health-seeking behaviour have been collected. All households members have also been screened for malaria parasitemia and anaemia, and a malnutrition assessment was carried out for under-five children.

To assess the resources mobilization for malaria elimination, a cross-sectional study has been conducted in January 2015. Out of 1,914 rice farmers organized into four cooperatives, 320 farmers were randomly selected to participate in this study. The maximum willingness to pay (WTP) was elicitated through a contingent valuation exercise using the ”bidding game method”.

Our findings showed that rice farming is positively and significantly associated with households’ wealth, food security, health insurance status, and protection against malaria. At the same time, it was confirmed that rice farming practices increase the risk of malaria transmission through expanded mosquito populations.

For the resources mobilization, the mean WTP was US$ 2.2 per farmer per season. The median WTP revelead that 50% of the participants were willing to pay at least US$ 1.4.

Again our results revealed that the proportion of households reporting that rice farming was their most important crop was 8.1%. However, it is worth noting that there were many other households involved in rice farming which were cultivating other crops with more importance for them. Beans and cassava were reported as the most important crops grown, 77.5% and 69.4%, respectively.

It has also been discovered that rice farming was positively and significantly associated with better standards of living mainly due to income generated by this activity. Rice farmers were 3.5 times more likely to live above standards, compared to their non-rice farming neighbors.

Rice farming plays a crucial role as farmers keep 20% of their production for eating at home and sell 80%. This helps them improving household food security and nutritional status as nutrient intake may consequently increase. They also save money that they should use to buy rice, which can serve to satisfy other family needs. The same applies for income generated from rice to buy other foodstuffs so that they can often afford a balanced diet.

The preliminary results of this on-going project indicate that the risk of malaria was significantly two times higher for non-rice farmers than for their neighbours who were growing rice. This testifies the protective effect as rice farmers are more protected against malaria because they enjoy better living conditions including housing with roof, floor and walls that are not favourable for mosquitos. They are also able to pay workers to remove peri-domestic breeding sites, to acquire and use additional bed nets, and to join health insurance schemes.

These results also revealed that malaria risk is higher in villages located closer to the marshlands where rice is grown. The more a village is nearby the marshland, the higher the prevalence of malaria. The population surrounding these marshlands which does not have or use preventive measures is more affected by malaria.

In conclusion, rice farming leads to private benefits in the economic domain, which spills over into the health domain, but at the same time creates a public health risk. As a result, the “paddy paradox” hypothesis is confirmed at the level of rice-producing households, but rejected at the wider community level. Hence, strategies need to be developed that are able to tap the private benefits of rice cultivation and re-direct these to fund collective action against malaria.

While acceptability of Bti intervention appears generally high, as witnessed for instance by a stated willingness to invest (non-compensated) labor time in applying Bti once it is established that it is effective in reducing malaria incidence, the WTP levels reported can only cover one fourth (1/4) of the full intervention cost (US$ 9 for lumpsum and US $ 1.8 per acre). To fill this gap, financing models need to be developed to support rice farmers and their communities to increase the sustainability of the intervention.

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