Kurandura Malariya
By Ashley Williamson, RPCV Mauritania ’09-’10, Rwanda ’10-‘12
"I didn’t get into malaria, malaria got into me." John Tongren, the resident advisor of President’s Malaria Initiative
(PMI) in Rwanda explained how he became passionate about malaria. He got it.
(PMI) in Rwanda explained how he became passionate about malaria. He got it.
Tongren was a Peace Corps Volunteer in Ivory Coast in ‘93-‘96 when one night he came down with the infamous feverish chills. Upon experiencing the horrible waves of sickness, Tongren was eventually saved by anti-malarial medications but
he never managed to escape the malaria field. As a third year volunteer and part of the Peace Corps Malaria Initiative, I was assigned to Tongren to work with some of PMI‘s imple-menting partners.
I was working with Research Triangle Institute, an organization based in North Carolina that works as a contractor in various countries. In Rwanda they have been the implementers of the indoor residual spray campaign (IRS), which began in 2007 and just finished their 7th round.
IRS uses the insecticide deltamethrin, a form of py-rethrum, to spray on the walls of houses in endemic dis-tricts. This form of malaria control targets the mosquito that has just taken a blood meal and lands on the wall to rest. The mosquito picks up traces of deltamethrin and is killed, stopping possible transmission. The spray lasts up to 6 months and is not toxic to humans in the doses used.
During round 7, October/November 2011, around 1.5 million people were protected by IRS. Insecticide spraying is most effective when combined with other preventative treatments.
he never managed to escape the malaria field. As a third year volunteer and part of the Peace Corps Malaria Initiative, I was assigned to Tongren to work with some of PMI‘s imple-menting partners.
I was working with Research Triangle Institute, an organization based in North Carolina that works as a contractor in various countries. In Rwanda they have been the implementers of the indoor residual spray campaign (IRS), which began in 2007 and just finished their 7th round.
IRS uses the insecticide deltamethrin, a form of py-rethrum, to spray on the walls of houses in endemic dis-tricts. This form of malaria control targets the mosquito that has just taken a blood meal and lands on the wall to rest. The mosquito picks up traces of deltamethrin and is killed, stopping possible transmission. The spray lasts up to 6 months and is not toxic to humans in the doses used.
During round 7, October/November 2011, around 1.5 million people were protected by IRS. Insecticide spraying is most effective when combined with other preventative treatments.
"Malaria is not stupid," comments Tongren, "insecticide and drug resistance increases through evolution of the parasite and vector. In East Asia resistance to ACTs [combination therapies of medication] is strong."
This is why there are additional control methods. There are mass distributions of insecticide treated bed nets that are long lasting (up to 4 years). ACTs are becoming more affordable and accessible. Testing is becoming simpler and in places where there are no microscopes Rapid Diagnostic Testing kits are swiftly appearing. There is even a new vaccine in phase III of testing called RTS,S. This vaccine would be given to children during their regular vaccination rounds and targets the sporozoite form of the parasite, protecting the child from becoming sick. I talked to Dr. Mary Hamel, who works for Center for Disease Control as the chief investigator of RTS,S trials in Kenya. "40 years [since initial research] have passed with no approved vaccine," Hamel said, "This is the first time it・s shown efficacy in children at an acceptable level, but it will not be released until around 2015." This is a huge step for malaria control and opens up a world of possibilities in research and development. Though a great discovery the vaccine is still only 30-50% effective and was tried on children who were generally sleeping under mosquito nets as well. "Combination of interventions must be used together, it・s not 100%. Bed nets, IRS, Intermittent Preventative Treatment for Pregnant women and good treatment…It all has to be there!" |
Through conversations with Rwandans and PCVs I found that many believe malaria is no longer a large problem. It‘s true that Rwanda has made tremendous media-recognized strides in malaria control, reducing the burden by practically two thirds in the past few years. This is highly due to the large amount of support from the Global Fund, which accounts for about 70% of malaria funding.
Yet people are still dying, mostly children under 5, every day. 13% of all deaths annually are attributed to malaria in Rwanda.
Nyagatare, Gisagara, Kirehe and Bugesera account for more than 50% of this burden. Rwanda has extensive funding for the time being but recent cuts in Global Fund‘s program leave gaping holes in the future.
Thinking that it isn‘t a problem is exactly how malaria can reemerge. With complacency come obvious back-lashes. In 2009 Rwanda witnessed such a setback. New nets were not redistributed while old ones, distributed in 2006, became ineffective. The reported malaria cases went from around 700,000 in 2008 to 1.3 million in 2009. This was followed by a distribution of new nets and subsequent drop to about 600,000 cases.
Yet people are still dying, mostly children under 5, every day. 13% of all deaths annually are attributed to malaria in Rwanda.
Nyagatare, Gisagara, Kirehe and Bugesera account for more than 50% of this burden. Rwanda has extensive funding for the time being but recent cuts in Global Fund‘s program leave gaping holes in the future.
Thinking that it isn‘t a problem is exactly how malaria can reemerge. With complacency come obvious back-lashes. In 2009 Rwanda witnessed such a setback. New nets were not redistributed while old ones, distributed in 2006, became ineffective. The reported malaria cases went from around 700,000 in 2008 to 1.3 million in 2009. This was followed by a distribution of new nets and subsequent drop to about 600,000 cases.
Funding for malaria and interest in the cause are directly related to reducing morbidity and mortality.
PCVs can have a significant impact. A malaria initiative that was started by a small group of PCVs in Senegal was launched internationally in 2011 is now active in 17 Peace Crops countries across Africa, with plans to add 6 more by 2014. This initiative is Stomping Out Malaria in Africa. PCVs work with local organiza-tions to join the cause and in May 2012, the new PCVs for Rwanda will begin. PCVs in those 17 countries right now are making educational videos, participating in bed net distributions, blogging, facebooking, making PSAs for local radio stations, assisting with product chain management, working with health centers and community health workers and much much more –you can be involved too! |
"As PCVs in Rwanda you are part of a community and that is an amazing tool, to have that is incredible." Said Tongren, "No matter what you do, explore it." Tongren claims he made the most difference sitting with the chief and his friends drinking palm wine. These types of exchanges helped identify and unravel his and their misconceptions about malaria.
Working with Tongren I saw his passion for eliminating malaria. Throughout all his accomplishments and frustrations
he warns, "The worst thing you can do is to think it‘s gone."
To learn more visit
WEBSITE: http://stompoutmalaria.org/
FACEBOOK: http://www.facebook.com/StompOutMalaria
TUMBLR: http://stompoutmalaria.tumblr.com/
TWITTER: @StompOutMalaria
Working with Tongren I saw his passion for eliminating malaria. Throughout all his accomplishments and frustrations
he warns, "The worst thing you can do is to think it‘s gone."
To learn more visit
WEBSITE: http://stompoutmalaria.org/
FACEBOOK: http://www.facebook.com/StompOutMalaria
TUMBLR: http://stompoutmalaria.tumblr.com/
TWITTER: @StompOutMalaria
MALARIA QUIZ
1. Which STD was treated by purposefully giving patients malaria during WWII?
2. What tree can be used to make a home-made mosquito repellent?
3. Universal Coverage of mosquito nets defined as _____ net(s) per household?
4. What % of Rwanda population at risk of malaria?
5. When is World Malaria Day?
Answers:
1. Syphilis
2. The Neem Tree
3. 2
4. 100%
5. April 25th
1. Which STD was treated by purposefully giving patients malaria during WWII?
2. What tree can be used to make a home-made mosquito repellent?
3. Universal Coverage of mosquito nets defined as _____ net(s) per household?
4. What % of Rwanda population at risk of malaria?
5. When is World Malaria Day?
Answers:
1. Syphilis
2. The Neem Tree
3. 2
4. 100%
5. April 25th