Towards achieving malaria pre- elimination status in Eastern Rwanda: Use of an integrated community focused model

Abstract

Background: Rwanda has made substantial progress in reducing malaria burden in the recent past and has embarked on achieving malaria pre-elimination status by 2017. Due to changing transmission patterns and decliningmalaria incidence, community awareness of and involvement in malaria control may be declining. This project focuses on community empowerment towards use of integrated malaria control interventions as key to sustainable malaria transmission reduction. Methods & Materials: This study uses a community driven approach to evaluate the impact of interventions formulated in collaboration with community and the national malaria control program. Three open space sessions were held with community representatives in order to establish communitywillingness to participate in such interventions and to assess current knowledge, attitudes and practices towards malaria elimination. Thereafter, a malariometric household survey, including evaluations of entomological and socio-economic and malaria burden parameters, was conducted from June to November 2013. Results: Malaria was recognized as major health concern and poverty as a key contributory factor. Despite a general belief that malaria control is primarily a responsibility of the government, the community expressed willingness to participate actively and invest in malaria control efforts. In a total of 4,768 households in 35 villages, 18,570 persons were screened for malaria infection by microscopy. Malaria infection was found in 579 subjects (5.1%cases). In a concurrent entomological surveyconducted in315 households, the number of bites per person per night of Anopheles gambiae s.l. was 12.5 in the same area. A follow-up malaria case spatial clustering and risk factor analysis to assess for currentmalaria distribution and associated risk factors is ongoing. Conclusion: Malaria elimination will require community engagement to facilitate efficient tracking and management of remaining pockets of malaria. In this community with a highPlasmodium spp. reservoir, awareness ofmalaria as a challenge and willingness to invest in its control were observed. Together these data will guide a targeted use of a package of interventionswith annual follow-up household studies to measure impact of these interventions on entomological inoculation rates, malaria, sero-prevalence and community involvement, acceptance and ownership conducted.