In 2012, Rwanda’s Nyagatare District, located in the northeast corner of the country bordering Uganda and Tanzania, had 40% of all malaria cases in Rwanda. Due to its relatively flat geography, high temperatures and cross-border contamination, Nyagatare has all the ingredients for a malaria disaster. During the months of December 2013 and February 2014, the Ministry of Health (MOH) and the President’s Malaria Initiative (PMI) were able to conduct rounds of Indoor Residual Spraying (IRS) to every house in Nyagatare District, which, according to the 2012 national census, is the second most populous district in Rwanda. This was not the first time Nyagatare residents had been selected for rounds of IRS. It was, however, the first time PMI had used a different chemical compound in the insecticide from the first rounds because studies were showing resistance already building in mosquitoes.
After both rounds of IRS, my counterpart, Kibingira Claude, and I went to 50 households and talked to 259 residents of my village and surrounding areas. We conducted a survey to find out their perceptions of IRS. We wanted to know if they experienced any negative side effects from the new chemical as well as their opinions of IRS in general. The results were overwhelmingly positive in favor of IRS. Out of 50 houses only two homes reported that they would not want IRS to be done again. One interviewee said she didn’t like strangers entering her house, and the other said she thought that the IRS had increased the bugs in the home.
However, one unexpected negative result was that because IRS has worked so well, villagers were convinced that they no longer needed to worry about malaria or sleep under their mosquito nets each and every night. In June of 2013, my health center had over 1,700 people test positive for malaria. This past June we had less than 10. In order to keep the community engaged in the fight against malaria, I knew I needed to do something.
Over the past two weeks, three counterparts and I trained 119 community health workers on malaria prevention, behavior change communication, interactive education & community mobilization. As Rwanda has a huge culture of per diem for trainings, I decided to not pay the CHWs in full until they showcased what they had learned at the training in each of their villages. By planning with them to create over 42 community-based interventions on malaria prevention, the CHWs will use their new knowledge to engage their own communities.
By the end of August we expect each village in my health center’s catchment area to have had their own community education event. The month will conclude with a completion ceremony with certificates (of course), and new electronic thermometers for CHWs to use in helping detecting fever and promoting patients to seek treatment early. Also, thanks to a SPA Grant, the health center will receive a laptop for data collection, as well as a projector to be used in future trainings or as an income generating activity for the center to have movie nights with health messaging “half-time”shows.