A comparative analysis of risk factors of malaria. case study of Bugesera and Gisagara district DHS 2014/2015

Abstract

Malaria is caused by infection with protozoan parasites of the Plasmodium species. Plas- modium falciparum is widespread in African countries while P. vivax, P. ovale, and P. malariae infections are less common and geographically restricted. The parasites are transmitted by Anopheles mosquitoes, with An. gambiae sensu stricto, An. funestus, and An. Arabiensis being the most prevalent in African counties. Malaria remains a major public health problem worldwide. Estimates of 3.2 billion people worldwide are reported to be at risk of malaria by The World Health Organization in 2013 (WHO). During 2015, 89% of malaria cases and 91% of malaria deaths of the global burden of malaria were attributed to Sub-Saharan Africa(2,3). Between 2001 and 2015, policies for malaria control interventions in Sub-Saharan Africa countries highlighted that Insecticide-treated nets (LLITNs) and Indoor residual spraying (IRS) contributed for 70% of the 943 million in reduction of malaria cases(3). In East-Africa, Uganda ranked at the third position of total malaria cases among African countries and Mauritius is the only Sub-Saharan country to achieve malaria elimination target(4,5). Algeria is the one of the countries aiming to eliminate malaria, thus, the second Global Forum report the zero indigenous case of malaria during 2017 which was the fourth consecutive year of the similar report on malaria cases for Algeria, whereby 448 imported cases and seven introduced cases. The only high risk of malaria cases in Algeria includes the area of the Southern Province of Tamanrasset bordering both Mali and Niger considered as the endemic area attributed 81% of the imported malaria. Therefore, Algeria requested the free-malaria certificate from World Health Organization(6).

From 2002 to 2011, the Rwandan Health Facilities reported more than five millions cases. Therefore, during 2005 to 2012, a recorded of 86% and 74% reduction in malaria incidence and malaria mortality respectively was observed in Rwanda. During 2013, one million of malaria cases were reported and high prevalence was observed in rural areas(2–4).

An estimated Malaria incidence in Rwanda decreased from 418 per 1000 during the period of 2016-2017 to 389 per 1000 in 2017-2018.However, during 2012 an increase in malaria cases with the most affected Districts of Bugesera, Kamonyi and Gisagara Districts was observed(2,3). The reports revealed that the risk factors attributed to the increase of malaria in Rwanda are Substandard Long Lasting Insecticide treated Nets (LLINs), Climatic data anomalies such as rainfall and changes in ambient temperature and Insecticide resistance through documented emerging parathyroid resistance all of these factors contributed high burden of malaria in Rwanda(2,3).

During 2014, the reports have shown that the high malaria burden presented mostly in districts located in Eastern Province represent a prevalence of 41% of the total cases and these are: Kirehe, Ngoma, Bugesera, Kayonza, Rwamagana. In Southern Province, the districts with high burden of malaria represent a prevalence of 38% of total cases of malaria. These are : Gisagara, Nyanza, Huye, Kamonyi, Ruhango, Muhanga(1,7). During 2017- 2018 reports revealed that a record of 11 death cases and plus attributed to malaria where by Gisagara and Bugesera were among the top high with malaria deaths cases. Therefore, in a period of 2017-2018, 13 districts were identified to be high endemic areas of malaria including Gisagara and Bugesera Districts(1,7).

Malaria incidence trends could be attributed to the factors such as climatic, environmental and socio-economic factors(5,7,8). Recently, Rwanda is among sub-Sahara African countries in which the prevalence of malaria is high. The Ruhuha Sector in Rwanda is one area burdened by malaria prevalence, with an estimated slide positivity rate of 5%.The area is located in Bugesera District of the Eastern Province, household survey results conducted in Ruhuha classify it as hypo-endemic for malaria, with cases clustered around marshlands. Individuals from households with high socioeconomic status have a lower risk of contracting malaria(2). However, the Rwanda HMIS of 2012 revealed that the Eastern and Southern Province of Rwanda are the areas burdened by malaria morbidity and mortality where Bugesera District is one of the areas of high risk. On the other hand Gisagara District was the most affected area of malaria in the Southern Province. Thus, both districts share some characteristics such as geographical location that are bordering Burundi. The research question of the study is as follows: o What is the prevalence of malaria in Gisagara and Bugesera Districts? o Why Gisagara District of the Southern Province and Bugesera District of