The use of mosquito nets is still one of the main elements in preventing malaria. (photo Timothy Kisambira).

“Many Rwandan parents or caregivers prefer to purchase treatment from local pharmacists and pill sellers who are close by and charge less than health centers for medication, but who often do not provide high-quality medication or proper advice regarding dosing and duration of treatment”, Paul Safari of the malaria control program says.

In Rwinkwavu district, for example, community health workers reported 588 deaths of children under age 5 in 2002, almost three-quarters of which were attributed to malarial fever. Only 42 of these deaths occurred in health facilities.

In a survey conducted in two health districts by the National Malaria Control Program, children less than 5 years of age were found to get appropriate treatment for malaria an average of three days after the onset of fever, much later than the World Health Organization-recommended treatment window of 24 hours after onset.

These factors account for Rwanda’s low use of government-sanctioned health facilities, less than 0.24 visits per person per year. Additional surveys conducted in 2004 by three NGOs – Concern Worldwide, the International Rescue Committee (IRC), and World Relief – showed that few young children with fever receive ant malarial treatment as recommended by the Ministry of Health.

Only 16% of children included in the study in Kibilizi district, 9% in Kirehe district, and 20% in Kibogora district received timely and appropriate treatment. About one-third of children received no treatment.