Malaria rates drastically reduce in rural areas of Huye district
The story of Agnes Mukarwema BY GEORGE KAGAME


Agnes Mukarwema gently covers the head of her five four year old son Albert Butera to shield him from the protruding sun rays through the hospital window.
She is nursing her son who has been in the children’s' wing of Kabutare hospital for two weeks now.

Mukarwema traveled 47 kiliometres from her village of Cyinya in Nyamagabe district before reaching the premises of Kabutare, the biggest hospital in the Southern Province. Prior to the admission at Kabutare, Butera's persistent fever became worse one Saturday night, his was transported from Nyamagabe health centre almost in a coma, the health centre is 11 kilometres from her home.


The extra ordinary journey from the centre to the hospital is the reason Butera's mother fully understands and can easily talk about malaria control programmes in the country. "that ambulance drive saved my son, my happiness. My son was going to die if the authorities at the health centre had not called the ambulance from Butare," she says. Mukarwema attributes her son's salvation to the improved performance of workers at her health centre. Her child now looks health, he can smile and hold a conversation: "we shall be out of here soon," says Butera.

His mother is more direct; "had it not been that ambulance, my child would be dead now," Mukarwema says.



Dr. Jean Claude Ntagarukanwa, the Director of Kabutare hospital says the hospital keeps on standby three medical ambulances; "we have two that work during the day and one at night, the night ambulance is the one which collected Butera and his mother." He adds that the vehicles are part of many measures that the hospital has undertaken to improve health services to the more than 272000 population it covers. "or malaria control we have sensitization campaigns accompanied by mosquito nets, officially sanctioned malaria drugs, and encouraging all people in the area through local government authorities to enroll for Mutuelle De Sante health insurance scheme.


Such efficiency is what has made Rwanda a success story in the fight against malaria in Africa says Dr. Corine Karema the director general of the National Malaria Control Programme, PNLIP; "we have adopted several mechanisms and we are hopeful that the disease will cease being a burden to the development of the country."


According to the recent National Health Management Information Survey, the use of health centres in the country was at 75 percent in 2007 while use of Mutualle de Sante schemes was at 73 percent of the population of Rwanda.

In May 2008, Novartis, the manufacturers of Coartem has also reduced the cost of the drug had been reduced by 20 percent, making it much more affordable for many people in the area.


There are several mechanisms in the control of malaria as Karema says, these have involved sustained massive awareness campaigns for Rwandans to be conscious of their health, supply of insecticide treated mosquito nets, and subsidizing Coartem, a malaria dose that is currently recommended by the World Health Organisation as the most effective drug in the fight against malaria.

Coartem according to Karema is subsidized "so that with Frw 300 as many Rwandans as possible can assess the treatment and the cost reduces with possession of Mutuelle de sante cards. With possession of a Mutualle De Sante cards a patient is required to pay only 15 percent of the total cost health care in public hospitals through out the country.
For long malaria and its related infections have been responsible for 60 percent of deaths in the country.

Development experts have stated that it is a serious bottleneck to efforts in reducing poverty in the Sub Saharan Africa. However currently, Rwanda is the model country among developing nations in combating the most serious health threat in the country.


The government in August 2007 adopted the Indoor Residual Spray (which has controversially been stopped since February 2008 by the national malaria control programme due to safety concerns) on top of massive distribution of mosquito nets distribution, cheap malaria drugs and the provision of safe and clean drinking water through supplying at cheaper rates water purifying substances.


Professor Michael Kramer, the director general of the Infectious Diseases Centre said Rwanda is performing very well in fighting malaria; “we are on top of Africa in controlling malaria, we also a model country by WHO in fighting the disease."
In Huye district alone, malaria prevalence has reduced greatlys says Ntagarukanwa, he says the prevalence of malaria among the total number of patients admitted in the hospital was 5.2 percent and in May 2008, band this figure had reduced to 4 percent of the total number of patients admitted in the hospital.

Karema says; “Under-5 child mortality rate through out the country has greatly reduced to and the proportion of child related deaths attributable to malaria is currently below 5 percent.”

After two weeks at Kabutare, Mukarwema is optimistic, she says her family faces the normal problems that poverty "carries with itself," but currently health care issues are no longer a permanent worry; "from the recovery of my son, i know health issues now have greatly improved."


Ntagarukanwa says malaria is a big problem in the district but is no longer alarming; "the ministry of health has set for us several measures to control the disease," he adds that the supply of insecticide treated mosquitoes as being particularly important in reducing the prevalence rate of malaria in Huye district.

According to Kabutare hospital records, there was only one malaria related death among the total number of patients admitted in the month of June, the hospital authorities however could not release the total number of patients and the nature of their illnesses.


Malaria according to Ntagarukanwa is still a problem in the district but he adds that there's a new ambitious plan launched by the ministry of health recently. The new plan known as Home Based Treated of malaria trains health workers to regularly check on children with malaria complications in their families, he says this has targeted especially children below the age of five.
"Here we have more cases of adults suffering from malaria than children because we have been able to monitor the health of every born child in the hospital. We do this through a broad network of community health workers, grass roots local government officials, public and private health centres through out the area which our hospital serves."


The efforts to save Huye from malaria according to Ntagarukanwa has in large part been due to the national health insurance scheme known as Mutuelle De Sante, through this scheme Rwandans pay to local government authorities a small fee after which they are given cards, upon presenting these cards at public health centres, patients are required to pay just a small fraction of the total cost of treatment. This scheme has been particularly helpful among the rural communities where the levels of poverty are high.


Mukarwema is able to pay the bill for her two weeks stay in the hospital thanks to the Mutuelle system. However, Ntagarukanwa adds that these insurance cards have not been fully utilized by Rwandans; "many times we get young people admitted here after an accident or something, they don't normally acquire these cards.
The younger generation assumes that because they have no one to take care of, they have no need for mutuelle de sante cards. "Many times they have discovered the importance Mutuelle cards too late."