Malaria Elimination Program for Ruhuha (MEPR)

Summary of Activities (Dec 14 - Aug 15)

Annual comprehensive household follow-up survey

To inform malaria interventions in Ruhuha sector, a follow up household survey including behavioral, biomedical, economical and entomological aspects was conducted among 1410 households from December 2014 to January 2015 and some key findings were that:

With regards to malaria control measures coverage; 93% and 72.3% reported bednet ownership and use  respectively.  Low usage of bed nets and increased risk of malaria transmission was observed among males, households where most members do not sleep on beds, where there were more sleeping spaces   than   available nets, and households of low socio- economic status. The proportion of households where indoor residual spraying was conducted in the last 12 months was 95%.

Knowledge of more than three malaria symptoms, health insurance ownership as well as high self efficacy in deciding seeking care and taking medication as prescribed were found as strong predictors of timely and appropriate health care seeking behaviors.

The entomological monitoring survey performed in 145 houses shown a total 4368 mosquitoes collected among which 175 have been identified as Anopheles gambiae s.l. (malaria vector). When compared with first survey conducted in 2013 density decreased from 8,3 to 1,2 An.gambiae s.l. per trap and per night. Meanwhile, the density of mosquitoes in general collected increased from 18 to 30 mosquitoes per trap and per night.

Resistance of Anopheles gambiae s.l. to pyrethroid insecticides was found out in Ruhuha respectively to  Permethrin   0,75%  (78%) and Lambdacyhalothrin 0,05% (87%) usually used for LLINs and IRS. Therefore, the classes of Carbamates and Organophosphates were fully susceptibility and should be promoted for malaria vector control

 Larval source management using biological substances

Existing malaria control measures in Rwanda target adult malaria mosquitos. With the current evidence towards outdoor mosquito biting, there is need to target mosquito larvae in malaria prevention and in  this  framework,  MEPR  planned and implemented a larval source control  program  (LSM)  in  Ruhuha. As part of its formative analysis, a   socio economic survey using mixed methods was conducted to evaluate community knowledge, acceptability and willingness to invest in larviciding. The quantitative survey included about 300 rice farmers while qualitative study involved a cross section of about 45 community members. As results, there was a high knowledge on malaria transmission and prevention measures. Rice fields were recognized as potential breeding sites in the area thus LSM was deemed important for man-made breeding sites despite some challenges highlighted and addressed accordingly. The actual LSM implementation started from 18 February to 9 July 2015 and performance of 18 weekly application rounds of microbiological larvicide “Bacillus thuringiensis Var. israelensis: Bti” for mosquito larval control in three rice fields, marshland and rain water dams of Ruhuha sector. Performance of 10 bi-weekly entomological evaluation surveys in mosquito breeding sites treated with Bti and one as control site. At each survey round, mosquito larval stages were assessed every 100 meters in three transects per marshland and adult mosquitoes were collected in 30 houses using CDC light traps. åå

 Community Malaria Action Teams (CMATs)

The platforms (a community health worker, village leader and youth representative) were initiated at village level, in June 2014 with the aim to identify local malaria issues and look for community collaborative solutions. Monthly community meetings were organized by CMATs to provide malaria preventive measures and supported by monthly progress reports. Quarterly meetings organized by MEPR research team were conducted for validating CMATs terms of reference, using reporting forms, household survey and LSM intervention community preparedness as well as sharing research findings. Since established in 2014, CMATs preventive messages on malaria contributed to the increase in health insurance ownership, community acceptance of indoor residual spraying (fully coverage) and to the reduction of fever/ malaria experience in the local community. Furthermore, the platforms contributed to the health system strengthening via capacity building of community members, created a sense of community ownership through peer education sessions and involvement of youth and local authorities in addition to community health workers.

MEPR results dissemination workshop

In collaboration with Knowledge Translation Network for Africa (KTNeT), MEPR hosted a second workshop entitled MEPR Training and Research Findings Dissemination in July 2015. The MEPR research team and its stakeholders were trained on how to package evidence for policy makers including using policy briefs & policy dialogues in order to increase the use of research findings in the policy making process. The training was followed by series of disseminations of recent MEPR research findings among primary, secondary and tertiary stakeholders, validated findings, discussed implications of findings and propose a way forward.

RWANDA PRODUCTS.

Policy brief:   Working with community malaria action teams (CMATs) contributes towards achievement of malaria elimination