1

INTRODUCTION

Since the end of 2012, Rwanda has experienced an

increase in malaria morbidity (1); while the number of

monthly malaria deaths remained stable (2).

The country therefore implemented a malaria

Contingency Plan and activities successfully achieved

during the last quarter of 2016 include:

The Mid Term Review of the Malaria strategic

plan 2013-2018, with strong evidence-based

recommendations for malaria control in Rwanda;

The home-based malaria treatment of fever in

adults, which implementation started in five districts in

May 2016 and was expanded countrywide in October

2016;

The mass distribution of more than 4million

Long-Lasting Insecticide-treated bed Nets (LLIN), which

started at distribution sites by end December 2016 and

was followed by distribution to end users in January

2017;

And indoor residual spraying (IRS) in three

districts (Gatsibo, Kirehe, and Bugera) to support existing

malaria control malaria interventions.

Also, health teams in collaboration with local leaders

through community health workers continue to

communicate key malaria prevention messages to the

population, including the importance of LLIN use and

early treatment seeking behavior.

Malaria Bulletin

Volume 1, Issue 1

March 2017

Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, KG 17 Avenue Kigali,

www.rbc.gov.rw

The MALARIA SURVEILLANCE

BULLETIN is produced by the Malaria

and Other Parasitic Diseases Division

and is a quarterly production.

CONTENT

1. Introduction

2. Outpatients confirmed malaria

cases, 2015-2016

3. Malaria incidence, 2015-2016

4. Malaria cases per level of care, 2016

5. Monthly test positivity rate, 2015 and

2016

6. Malaria burden (morbidity and

mortality)

7. Conclusions and recommendations

EDITORIAL TEAM

PROGRAM MANAGER

Dr Aimable MBITUYUMUREMYI

WRITERS

Dr Monique MURINDAHABI (RBC)

Dr Aline Uwimana(RBC)

Mr. Emmanuel Hakizimana (RBC)

Mr. Didier UYIZEYE (RBC)

Dr. Albert TUYISHIME (RBC)

Dr Candide TRAN NGOC (WHO)

Dr Michel GASANA (WHO)

CONTACT:

Rwanda Biomedical Center/Malaria and

Other Parasitic Diseases

Email:

aimable.mbituyumuremyi@rbc.gov.rw

2

OUTPATIENTS CONFIRMED MALARIA CASES

Figure 1 below shows the trend of malaria cases at health facility and community level. We can

see that the number of malaria cases increased from 2,473,387 in 2015 to 4,669,687 in 2016.

It should also be noted that data from October 2016 include malaria cases at the community

level, which were not previously reported for all age groups. Treatment of adults at community

level was indeed extended in all 30 districts in October 2016.

Figure 1 Number of outpatient confirmed malaria cases in 2015 and 2016

Source: HMIS, March 2017

MALARIA INCIDENCE

Figure 2 below shows the malaria incidence (number of confirmed malaria cases for 1,000

population) for 2015 and 2016 which is illustrating the seasonal variation around April-May-

June and October-November-December, with an annual incidence of 203.44 per 1,000 in 2015

and 404.88 per 1,000 in 2016.

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Monthly malaria cases, 2015 and 2016

2015

2016

3

Figure 2 Malaria incidence per 1,000 population (2015 and 2016)

Source: HMIS, March 2017

MALARIA CASES PER LEVEL OF CARE

Figure 3 below shows the monthly malaria cases in 2016 per level of health care. This indicates

that in 2016, 71% of malaria cases (3,324,678) were treated in health facilities, while 29%

(1,345,009) were treated through home-based management by community health workers

(CHWs) for all age groups as the treatment of adults at community level was extended in all 30

districts in October 2016.

18.86 13.59 11.36 11.99 12.99

20.57

12.44

5.55 9.13

18.53

29.02

39.41 44.55

31.41 26.41 26.81

37.50 36.12

17.07

11.15

18.44

36.20

62.14 57.07

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Malaria incidence per 1,000 population 2015 and 2016

Malaria incidence 2015 Malaria incidence 2016

4

Figure 3 Monthly malaria cases by level of health care, 2016

Source: HMIS, March 2017

SEVERE MALARIA CASES

Figure 4 below shows the monthly severe malaria cases in 2015 and 2016, with an increase from

13,092 in 2015 to 17,248 in 2016. We can see that the trend for severe cases is similar to the

trend of simple cases.

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Monthly malaria cases, 2016

Number of malaria cases in health facilities

Number of malaria cases at community level

Total number of malaria cases

5

Figure 4 Monthly severe malaria cases, 2015 and 2016

Source: HMIS, March 2017

MALARIA DEATHS

The figure 5 shows the monthly malaria deaths in 2015 and 2016. From 2015 to 2016, the total

annual number of deaths increased from 514 to 715. This is augmentation is less pronounced

than the increase of malaria cases, showing that a proper clinical management of malaria cases is

implemented at health facility level.

-

500

1,000

1,500

2,000

2,500

3,000

Monthly severe malaria cases, 2015 and 2016

2015 2016

6

Figure 5 Monthly malaria deaths, in 2015 and 2016

Source: HMIS, March 2017

TEST POSITIVITY RATE

Figure 6 below shows the monthly trend of the test positivity rate (TPR) in 2015 and 2016,

which was 40.6% and 49.5% for the entire year, respectively.

42

25 32

26 24

53

37

26

35

59 64

91 98

64

31

56

66 65

57

27 31

61

76 83

0

20

40

60

80

100

120

Monthly malaria deaths, 2015 and 2016

2015

2016

7

Figure 6 Monthly test positivity rate in 2015 and 2016

MALARIA BURDEN

Figure 7 below shows the districts with the highest malaria morbidity burden, ranked according

to their malaria incidence, in 2015 and 2016. Together, they account for 61% of all malaria cases

in the country.

44.5

36.8

28.7 30.2 28.3

39.1 37.1

29.9

36.4

47.2

52.6 54.8 55.7

48.0 43.5 45.4

40.9 41.8

37.1 38.1

42.9

54.2

64.0 61.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Monthly test positivity rate , 2015 and 2016

Test positivity rate (TPR) 2015 Test positivity rate (TPR) 2016

8

Figure 7 Top 10 high malaria morbidity districts, in 2015 and 2016

Figure 8 below shows the districts ranked according to their percentage change in number of

malaria cases from 2015 to 2016. During the reporting period, we noticed an increase in number

of malaria cases in all districts, ranging from 22% for Gatsibo district to 75% for Rubavu district.

Kirehe was the only district that was able to reduce its number of malaria cases in a quite

dramatic manner (172%).

502.0 492.3 489.3 460.5 418.6 407.0 392.8 344.8 341.9 248.0

641.6 636.6 539.7

455.5 448.6 444.2 439.2

428.4 402.1

356.2

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

Ma

lari

a O

PD

ca

ses

pe

r 1

,000

po

pu

lati

on

Top ten malaria morbidity district according to malaria incidence, 2015 and 2016

2016

2015

9

Figure 9 below shows the districts with the highest mortality burden, in 2015 and 2016.

Together, they represent 56% of all malaria deaths countrywide.

-200%

-150%

-100%

-50%

0%

50%

100%

% change in malaria cases from 2015 to 2016

% change from 2015 to 2016

Figure 8 Percentage of change in number of malaria cases from 2015 to 2016

10

Figure 9 Top ten high mortality districts, in 2015 and 2016

Figure 10 below shows the districts ranked according to their percentage of change in number of

deaths from 2015 to 2016. We can notice a 100% increase in Burera district, while Kirehe

reduced its malaria deaths by 100%.

0

20

40

60

80

100

120

Top ten malaria mortality districts, in 2015 and 2016

2016

2015

11

Figure 10 Percentage of change in number of deaths per district from 2015 to 2016

CONCLUSIONS AND RECOMMENDATIONS

Our conclusions are as below:

The number of malaria cases has been increasing by almost twice from 2015 to 2016.

This trend is similar to the augmentation of severe malaria cases;

The number of malaria deaths also increased, but this was less pronounced, which

indicates a good performance of the health system in general and especially in the malaria

case management at health facility level;

Kirehe district, which was among the top ten high malaria morbidity burden districts, is

the only one that showed a reduction in number of cases from 2015 to 2016;

Again, Kirehe district showed a high reduction in number of deaths from 2015 to 2016.

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% change in number of deaths per district from 2015 to 2016

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12

As recommendations, one could suggest:

1. To investigate the probable causes of malaria increase/reduction in both morbidity and

mortality in districts using secondary data analysis;

2. More particularly, to assess the factors potentially associated with the reduction in

number of malaria cases and deaths in the Kirehe district and to sustain this decrease;

3. To conduct a Malaria Indicator Survey (MIS) to assess the malaria prevalence in all age

groups in order to have the general picture of malaria prevalence and to asses the level of

attainment of LLINs universal coverage.

REFERENCES

1. Rwanda Ministry of Health. 2015 Annual Health Statistics Booklet [Internet]. 2017 [cited

2017 Jan 12]. Available from:

http://moh.gov.rw/fileadmin/templates/hmis_reports/2015_20Annual_20Statistical_20boo

klets_20V13_20Signed.pdf

2. World Health Organization (WHO). World Malaria Report 2016 [Internet]. 2016.

Available from: http://www.who.int/malaria/publications/world-malaria-report-

2016/report/en/