Towards Malaria Pre-Elimination in Rwanda: Active Case Investigation in a Low Endemic District

A poster entitled “Towards Malaria Pre-Elimination in Rwanda: Active Case Investigation in a Low Endemic District” was presented by members of Jhpiego’s Rwanda Team and colleagues:

Noella Umulisa, Angelique Mugirente, Veneranda Umubyeyi, Beata Mukarugwiro, Stephen Mutwiwa, Jean Pierre Habimana, and Corrine Karema, at the 65th annual meeting of the American Society of Tropical Medicine and Hygiene in Atlanta. The abstract follows …

case-detectionRwanda has seen an increase in malaria cases recently with an increase from 514,173 cases in 2012 to 1,957,402 cases in 2015. This change can be attributed to an increase in temperature, rainfall, and resistance to insecticides.

Despite this setback, Rwanda is aiming to reach the pre-elimination phase by 2018. In January 2015, 11 health facilities in Rubavu, a low endemic district, started implementing reactive active case detection after training 55 health care providers and 11 lab technicians on the topic. This strategy involves screening and treating individuals living in close proximity to passively detected cases, also known as index cases. Index cases can be used to identify population groups that are sources of infection.

cases-confirmed-investigatedFrom January 2015 to December 2015, 16,434 cases of Malaria were detected and treated at 11 health facilities in Rubavu District. Among these cases, 2,917(17.8%) index cases were investigated and 4,943 individuals (between 1 and 2 contacts for each index case) living in proximity of index cases were tested using rapid diagnostic tests by health care providers. Of these, 508 (10.3%) tested positive for malaria and were treated according to national guidelines.

These data shows that the number of investigated cases is still lower than the national guidelines of screening 5 individuals residing between 100 to 500 meters of every confirmed case. This low rate could be due to the increase of malaria cases in Rwanda which has placed a burden on health care providers and health facilities in areas like Rubavu which used to be low endemic malaria areas. Additionally, data gathered through supervision activities has indicated a need for additional training on screening investigations in order to adhere to national guidelines and conduct the investigations more efficiently.

Active case investigation could be improved by training and involving more health care providers such as community health workers who could reduce the burden on health center staff. The additional support for case investigation activities and improved training can help to achieve higher coverage of individuals located near index cases.

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