Rwaniro Malaria Program

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Rwaniro Malaria Program Update

By Niesha, Regional Malaria Coordinator, Southern Province, Rwanda

SUMMARY

To combat malaria at the household level, families from Rwaniro Health Center participated in a pilot program initiated by Peace Corps Volunteers Ryan Sandford, Andrew Abram and Niesha Ford. The program consisted of each family receiving a calendar with daily reminders to sleep under a mosquito net, and weekly reminders to maintain their net.

During the first month of the program, 40 families participated. By the second month, 26 families participated.

In addition, the mothers of these households participated in weekly malaria prevention activities during the first month of the program. These activities included bed net repair training, a one-hour comprehensive training, and true/false. All activities were concluded with the Rwandan proverb: Amagara ntaguranwa Amagana (Health before Wealth).

 RESULTS

At the initiation of the program, all participants were asked the following questions:

·        How many people in your household, including yourself, got sick with malaria in the last month?2

·        Did you sleep under a mosquito net last night? How many people in your household did not sleep under a mosquito net last night, not including yourself? 2

·        Did you sleep under a mosquito net for one full week, every night?

 These same set of questions were asked three times, the last being 20/03/2019. Below are the responses, listed as the questions are above. For the first date only, numbers are the total out of 40 families. For the subsequent dates, the numbers are the total out of 26 families.  

DISCUSSION & ANALYSIS

The first thing to note about the data, is the decline in participants from the first month to the second month. One reason for this, is five people from the group stated they had no mosquito net in their household. Therefore, for the second month they opted out of receiving a calendar. Additionally, all participants were given a calendar the first month, but for the second, we asked who was interested in another calendar and gave out accordingly (26 people showed interest and took a calendar). Furthermore, absence on the day of distribution also played a factor in the decline.

What makes the data interesting, is when asked who liked the calendar, people who do not show interest in the calendar for the second month, said yes to liking the calendar. When asked why they didn’t ask for another, the responses were: I was absent that day, I don’t have anything to hang it, and it is not necessary. When probed about the last response, the person said I can use the same one. With this person as an exception, you would assume that since 31 people said yes to liking the calendar, 30 people would want another. On the contrary, when asked who wants another, 2 people who said they like it, said they don’t want another. The reason? Although they enjoy the overall idea of the calendar (they think it is good),they believe that they already  know to sleep under a mosquito net, and they don’t need the daily reminders.

The data also brings to light a pressing issue in rural areas like Rwaniro. The people who personally slept under a mosquito net vs the rest of their family. Many families only have one mosquito net in their household, which is typically reserved for mother, father and small child. All other children are left sleeping without a mosquito net, and in households of 2-8 people, sometimes that means that an upward of 6 people could be sleeping without a mosquito net (if only mom and dad are using it and they have 6 children). This is the explanation for the huge jump in numbers when asked if they slept under a mosquito net vs. who in the family did not. Taking this into account, it seems odd that the malaria cases are going down every time participants are asked ‘how many people in their household got sick with malaria in the last month?’ The answer to this, is most likely another form of malaria prevention that was initiated in Rwaniro before the calendars.

Around the middle of January, Rwaniro Sector began an IRS (Indoor Residual Spraying) campaign. During this campaign nearly all the houses in Rwaniro Sector got their walls and roofs sprayed. This is the most probable reason for the decrease in malaria cases, especially if many people in households continue to sleep without a bed net.  

 

Some concerns mothers have brought up throughout the program included the folllwing:

·        Are you going to give me a bed net? Why not?

·        Should I put a check on my supernet icon if we only have 1 supernet and not everyone in the household is sleeping under it?

·        What if I need more mosquito nets but I don’t have money?

·        How do I fix my mosquito net?

·        I don’t tuck my mosquito net, why do I have to tuck it?

 It should also be noted that during this program, house visits were done as part of a separate project. Thus far, we have visited 27 households and out of the 27, even if the calendar was from the first month, 24 people had calendars hanging in their houses.

 CONCLUSION & NEXT STEPS

The calendar is a good idea to get people to think about malaria prevention at the household level. However, it lacks to address the bigger, and harder to deal with issue: bed net supply and demand. What can be done by the lack of bed nets?

During this program, all trainings (expect the bed net repair) emphasized alternatives to protecting against malaria without a bed net. And although people seemed to understand that closing windows and removing standing water could help, they were very aware that having a bed net and/or getting IRS was far more superior. Is there any cheaper alternative to protect people while they sleep?

Over half the participants liked the calendar and would like to continue to get one. Even those who didn’t ask for another, seem to still have it hanging in their homes.

If this program is repeated, it would be best to use it in an area that has not gotten IRS, to see how effective the calendar alone is at reducing malaria cases.

The only next steps I can foresee, is to consider if the investment is worth the participation, or if we should consider an alternative.

 

Kigoma Program: New Levels of Community Partnership and Transmission Education


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On March 12, the STOMP team continued their integrated management approach with coffee farmers in Kigoma sector, joining the San Francisco Bay Coffee Company business meeting, and starting with a malaria intervention co-facilitated with Joseph, one of the community health workers involved in the project.

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Seventy two farmers attended the training and participated in the sessions, which were led in kinyarwanda. STOMP representatives led segments of the sessions, with follow up health messages and direction from the community health worker.

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There were three areas of focus within the discussion and intervention:

  1. Seek early treatment for malaria and call your community health worker to help you if you are unable to do so (Symptoms were outlined in detail)

  2. Malaria reduces your productivity and ability to support yourself and your family (Loss of productivity and work hours lost during harvest)

  3. You have a responsibility to yourself and to your community to protect yourself from malaria—you can cause a female Anopheles mosquito that does not have malaria to pick up the parasite and spread it to others (Conducted In-Depth Transmission Lesson)

  4. Take the information to your neighbors using a kinyarwanda proverb “Amagara Arasesekara Ntayorwa” (Life lost cannot be recovered, pursue a higher quality of life for a better tomorrow)

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STOMP Training: Eastern Province

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On Friday, March 1, PCVs Maggie Marsh and Anjali Pradhan, Regional STOMP coordinators for the Eastern Province, led a malaria training for Peace Corps Volunteers in the surrounding area.

The goals and objectives of the training included:

  • Educating volunteers about malaria epidemiology, transmission, and prevention methods,

  • Mobilizing volunteers to implement STOMP activities in their communities,

  • Equipping and motivating volunteers to participate in World Malaria Month (April 25-May 25) activities in their communities.

The majority of attendees were volunteers from the Ed sector. These volunteers and teachers successfully came away from the training with increased knowledge and enthusiasm regarding how to help their communities eliminate malaria. Volunteers gained insight regarding the materials available to them through the STOMP team. Both STOMP National Coordinators Andrew and Ryan attended the training and led a session on a new pilot program that the team is currently implementing called Nightwatch (an action-plan centered and community based intervention focused on behavior change and malaria prevention strategies).

Activities have been tentatively scheduled around the Eastern Province at various volunteers’ sites to occur during the upcoming World Malaria Month to promote malaria knowledge in our communities.

“We are excited to continue fighting malaria in the Eastern Province and working with our communities to eliminate malaria in Rwanda.” - PCV and STOMP RMC Anjali





Western Province Update: STOMP Regional Coordinators Lead Malaria Training

Lake Kivu in Rwanda’s Western Province

Lake Kivu in Rwanda’s Western Province

On Sunday March 24th, Peace Corps Volunteers in the Western province met at Kumbya in Nyamasheke District for a regional Malaria training. The goals of the training were to educate volunteers about the disease and discuss resources and best practices for promoting behavior change in volunteers’ communities.

 The training covered topics including the biological basis of malaria, epidemiology, symptoms, treatment, and prevention of the disease. The training concluded with a discussion of activities and trainings that volunteers can help to facilitate in their communities to promote malaria prevention techniques.

 The training was also scheduled to help volunteers begin preparing for World Malaria Month coming up in May.

“Although World Malaria Month doesn’t technically start until May, I think it’s really important for volunteers to understand the resources they have available to them as early as possible. This helps to increase the number of malaria prevention trainings volunteers can do before, during, and after World Malaria Month”, said Taylor Fitzpatrick-Schmidt, Western Province Regional Malaria Coordinator (RMC).

Taylor Fitzpatrick-Schmidt, Regional Malaria Coordinator

Taylor Fitzpatrick-Schmidt, Regional Malaria Coordinator

 In addition, this training aimed to provide volunteers with the most recent updates on national malaria prevention best practices in Rwanda.

For example, this year Rwanda will be conducting net distribution campaigns across the country, targeting different key high exposure areas with nets that contain a new component to combat insecticide resistance among Anopheles mosquitoes.

“This was also a great opportunity to facilitate discussions about malaria prevention techniques, and keep volunteers up to date with exciting updates, such as a newly discovered malaria vaccine and the Nightwatch Curriculum,” says Kyla Kortering, Western RMC.

Western RMCs hope to implemet a second training in the Western province before World Malaria Month to plan regional activities, including a Western Region Malaria Tour and a Regional Music Video Competition.

Kyla Kortering, Regional Malaria Coordinator

Kyla Kortering, Regional Malaria Coordinator


With rare exceptions, all of your most important achievements on this planet will come from working with others—or, in a word, partnership.
— Paul Farmer

Net Repair: DO's and DON'Ts

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1. Wash your net no more than 2-3 times a year.

Every time you wash your net, you reduce the efficacy of the net’s insecticide.

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2. Do not vigorously wash your net!

Wash it gently so that you do not tear it,

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3. Repair FAST, Repair AGAIN so it LASTS

When repairing your net, use a rubber band or tie a knot to close up the hole as a quick fix, and then go back to sew it later.

Sewing a net that has ripped is most effective when using a small patch or piece of fabric to cover the hole.

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4. DO NOT USE POWDER SOAP

Do not use powder soap when washing your net! Use bar soap.

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5. Dry the net in the shade.

NOT IN A SUNNY AREA.

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6. Convert it!

6. When hanging your net, if you don’t have four nails to hang it with, use a bucket top to turn the net into a conical net.

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7. ALWAYS TUCK.

When using your net, make sure that you tuck it in on the sides of your bed. Anopheles mosquitoes are designed to search for an opening and will travel on a downward trajectory to find this net breach when they come across the barrier.

GOOD LUCK!

PCV Niesha and her malaria prevention mamas are cheering you on!

Week 2 of Rwaniro Health Center Malaria Intervention Program

Week 2 of Rwaniro Health Center Malaria Intervention Program

Malaria HYSTERIA: The Curious Case of the Tightrope Walker

Malaria HYSTERIA: The Curious Case of the Tightrope Walker

You are standing at the bus stop, when you look over and see a dimly lit figure walking on a tightrope 10 feet above the ground between two small boutiques, and another walking on a broad log 40 feet above the ground between two tall trees. You are shocked. You wonder, “Who is at greater risk?” Read to the end, to see the solution to this perplexing conundrum. 

GS Kanogo Day Camp: What is transmission and community responsibility?

GS Kanogo Day Camp: What is transmission and community responsibility?

By the end of the day, a  majority of the students were able to identify symptoms of malaria and explain different important prevention behaviors like removing stagnant water and seeking treatment as early as possible.

However, over 80% of the students said that they believed if they contracted malaria, they did not increase the risk of malaria for those around them. 

STOMP LOG 4: What is a Hero?

The WHO estimates that in 2015 there were 214 million new cases of malaria resulting in 438,000 deaths. Others have estimated the number of cases at between 350 and 550 million for falciparum malaria. The majority of cases (65%) occur in children under 15 years old. (See full report)

Solving this threat to children and families in Sub-Saharan Africa requires heroes.

Part of my job is to speak out when I see these heroes in action. 

Joseph is a hero.

Kingfisher Kayaking with a Cause

Kingfisher Kayaking with a Cause

Within the STOMP initiative to prevent malaria in Rwanda, there are many volunteers doing excellent work with students, but PCV Taylors prevention efforts stand out.

During world malaria month, Taylor completed 4 Grassroots Soccer interventions in primary and secondary levels. In her data, she found that the students significantly increased their malaria prevention knowledge throughout the lessons. Primary students are an at-risk population when it comes to malaria, and Taylor’s work will help protect them and keep them in school.

Can malaria be Eliminated in Rwanda?

Can malaria be Eliminated in Rwanda?

This post serves as an introduction of sorts. Starting in January 2019, I will be working alongside Peace Corps Response Volunteer Andrew Abram in leading the STOMP Out Malaria Initiative in Rwanda. Andrew and I will check in on here time to time, as we begin this new chapter. Andrew will have more to say about himself and his already existing work in this initiative, but I will give some of my background, so you know who you are reading/talking to in these future updates.