A new round of residual indoor spraying as part of the fight against malaria is underway. Lessons have been learnt from last year's exercise.
The spraying campaign, which is intended to kill mosquitoes or make them infertile, is only one part of a comprehensive strategy implemented by the national program for the fight against malaria (PNILP in its French abbreviation), which also includes malaria treatment, sensitization and research concerning the disease.
Although in recent years some targeted spraying had been carried out to control epidemics, last year's campaign (from August 13 to October 14) was the first preventive spraying exercise after 1994.
And it was a big success. Targeting the three districts of Kigali City (Gasabo, Nyarugenge and Kicukiro), it was initially estimated that 85% of all households could be visited. In the end, however, the campaign covered 156,826 houses, or 96.5%.
This achievement is all the more remarkable given that at the onset the spraying was greeted with much skepticism, and some religious groups even called upon their adherents to refuse it.
One of the main concerns of people during the 2007 campaign was the occurrence of side effects, with some even claiming that the spray might cause infertility. Yet these rumors were dismissed from the start, with PNILP entomologist Emmanuel Hakizimana declaring to Focus at the time that "this is a chemical spray, so it might cause skin allergy with some people. However, this is temporary, and it is a common allergy which is not harmful."
The final assessment of the campaign confirms this, with only 441 cases of side effects registered (or 5 for every 10,000 beneficiaries). The most common complaints were skin rashes, eye irritation and headaches.
However, staff at health centers and district hospitals had been trained to deal with these side effects, and students of the Kigali Health Institute were deployed together with the spraying teams to monitor the occurrence of possible allergic reactions.
Obviously, given that this exercise was the first of its kind, there were lessons to be learned. The final evaluation report of PNILP sums up the improvements made in the four major components of the campaign-communication, preparation of the campaign, implementation and monitoring and evaluation.
As for communication, the aim is to make people understand the benefits of spraying, so that they actively participate in the operations and actually own the campaign.
Specific areas for improvement here were to conceive a better sensitization campaign, before as well as after the spraying; to adjust the messages to the various target groups involved, yet making sure that they are harmonized; and to better inform people where they can get treatment for side-effects.
It was also noted that the teams implementing the spraying campaign had to be better informed about their respective roles and responsibilities, especially the sprayers who are in direct contact with the people and should be able to answer their questions.
When it comes to the preparation phase, PNILP considered that it had to make sure it had accurate information on the places to treat-accessibility, delimitation, surface so as to determine the quantity of insecticide needed, etc.
Moreover, treatment of secondary effects needed to be planned well in advance, and during implementation the campaign should be closely monitored so as to adjust it to any problems that might arise. Furthermore, the sprayers were selected more carefully, so as to deploy individuals who inspire confidence in the people rather than distrust.
In the implementation of the spraying campaign, the improvements mainly came down to making sure that the people who go into the field are well trained and made aware of their tasks, as well as making sure that measures are in place to tackle any health or environmental problems that might occur.
Given that the spraying campaigns require considerable human, material and financial means, PNILP also decided it was necessary to monitor the activities more closely, so as to ensure an efficient use of all resources.
Therefore, follow-up committees have been set up on the district level, so as to assess the progress of the campaign whenever required, but at least during weekly meetings.
Given the lessons learnt from the 2007 campaign, PNILP has this year extended the geographical range of its activities-this is also in line with the objective to finally cover the whole country.
Considering the fact that the insecticides used in such exercises are effective for a period of maximum six months (except for DDT, the use of which is however prohibited in Rwanda), the three districts of Kigali City will once again be covered, to which Kirehe in Eastern Province and Nyanza in Southern Province have been added.
However, the extension of the geographical area required the campaign to be better targeted-last year's operation dealt with all households in the selected districts.
A variety of selection criteria were thus applied, including ecological, epidemiological and socio-economical factors. In the end, some 200,000 households have been identified in the 36 sectors involved, and nearly 850,000 people are set to benefit from this year's exercise.