Rwaniro Malaria Program Update
By Niesha, Regional Malaria Coordinator, Southern Province, Rwanda
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).
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.