Using an intervention mapping approach for planning, implementing and assessing a community-led project towards malaria elimination in the Eastern Province of Rwanda

Abstract

BackgroundActive community participation in malaria control is key to achieving malaria pre-elimination in Rwanda. This paper describes development, implementation and evaluation of a community-based malaria elimination project in Ruhuha sector, Bugesera district, Eastern province of Rwanda.MethodsGuided by an intervention mapping approach, a needs assessment was conducted using household and entomological surveys and focus group interviews. Data related to behavioural, epidemiological, entomological and economical aspects were collected. Desired behavioural and environmental outcomes were identified concurrently with behavioural and environmental determinants. Theoretical methods and their practical applications were enumerated to guide programme development and implementation. An operational plan including the scope and sequence as well as programme materials was developed. Two project components were subsequently implemented following community trainings: (1) community malaria action teams (CMATs) were initiated in mid-2014 as platforms to deliver malaria preventive messages at village level, and (2) a mosquito larval source control programme using biological substances was deployed for a duration of 6 months, implemented from January to July 2015. Process and outcome evaluation has been conducted for both programme components to inform future scale up.ResultsThe project highlighted malaria patterns in the area and underpinned behavioural and environmental factors contributing to malaria transmission. Active involvement of the community in collaboration with CMATs contributed to health literacy, particularly increasing ability to make knowledgeable decisions in regards to malaria prevention and control. A follow up survey conducted six months following the establishment of CMATs reported a reduction of presumed malaria cases at the end of 2014. The changes were related to an increase in the acceptance and use of available preventive measures, such as indoor residual spraying and increase in community-based health insurance membership, also considered as a predictor of prompt and adequate care. The innovative larval source control intervention contributed to reduction in mosquito density and nuisance bites, increased knowledge and skills for malaria control as well as programme ownership.ConclusionThis community-based programme demonstrated the feasibility and effectiveness of active community participation in malaria control activities, which largely contributed to community empowerment and reduction of presumed malaria in the area. Further studies should explore how gains may be sustained to achieve the goal of malaria pre-elimination.

Core components, concepts and strategies for parasitic and vector-borne disease elimination with a focus on schistosomiasis: A landscape analysis

“…Several key informants pointed out that early childhood education has proven effective in adapting and improving WASH behavior and is applied for trachoma and soil-transmitted helminth (STH) control and prevention through habit formation. Community participation was identified by key informants and in the literature as crucial to maximize acceptance, gain a sense of ownership and empowerment and achieve sustainability of interventions and activities including vector control, WASH, surveillance, treatment, health education and behavior change communication in programmes targeting malaria, dengue, schistosomiasis, Guinea worm and other parasitic and vector-borne diseases [ 11 , 24 , 43 , 46 , 53 , 60 – 62 , 72 – 76 ]. Caregivers, social groups, religious or community leaders, teachers and health staff should be engaged in control activities, intervention planning and design of tools [ 77 ].…”

“…Toolkits, as developed during the Zanzibar Elimination of Schistosomiasis Transmission (ZEST) program and adapted to local context offer guidance and educational material for engaging with pupils and communities in activities related to prevention, control and treatment ( https://www.eliminateschisto.org/resources/teacher-toolkits-for-schistosomiasis ). Community participation in sensitization and awareness raising also increased acceptance of preventative measures (vector control) for malaria control in Rwanda [ 53 ].…”

Local stakeholders’ perceptions of community sensitization for school-based deworming programme in Kenya

“…Access to safe water, sanitation and hygiene and environmental conditions which require community awareness and participation have an impact on prevalence and intensity of re-infection after deworming [ 21 ]. Sustainability of disease control programmes through prevention of re-infection as reported in other studies requires the local stakeholders to be actively involved, empowered and be given responsibilities [ 22 , 23 ].…”

Co-Designing a Citizen Science Program for Malaria Control in Rwanda

“…Still, in our case there was also a clear societal reason for why to start this CSP, i.e., addressing the burden of malaria. The selection of gathering observations of nuisance and mosquitoes was based on the best available knowledge and successful experiences elsewhere [13,15]. In addition, the research team wanted to see whether participants would come up with their own mosquito collection method.…”

“…These include the increase of public awareness and engagement in the topic (for example about mosquito-borne diseases) [23]. In addition, participation in citizen science creates new opportunities for connections between various stakeholders such as researchers, citizens, policy makers, funding agencies, and decision-makers, thereby extending their own social network [24], and it can strengthen community-based management of residual foci of malaria transmission [13].…”