Increasing cases of malaria infections in Rwanda have led to a shortage of medicines, including in the big pharmacies, which has caused unease among patients.
In various parts of the country, hospitals and clinics are full of malaria patients, a situation which has been blamed for the shortage of malaria drugs. The popular pill Coartem, which is normally recommended for the treatment of malaria, has particularly been missing from the shelves in many pharmacies in Kigali.
In an interesting twist, however, officials skirted the issue, with the Permanent Secretary in the Ministry of Health, Solange Hakiba Itulinde, pleading ignorance about the reported scarcity of the vital medicine.
Contacted on Wednesday, Ms Itulinde told Rwanda Today: “I don’t know of any shortage of malaria drugs.
“I will have to check and find out why the shortage issue is coming up, but it’s nothing that I know of.”
Earlier, a patient who spoke on condition of anonymity for fear of reprisals had told Rwanda Today: “I was down with malaria and I was admitted.
“I went to at least three pharmacies and they had no Coartem. The drug is in short supply as we speak. Something needs to be done.”
But it is not the first time the country is facing endemic malaria infections. The disease has affected many people in the past three years, but with concerted efforts it was at a certain extent contained, although it is still prevalent.
In 2013, more than 900,000 cases of malaria were diagnosed and 409 people died of the disease, 30 per cent of them being children under five years. Malaria cases increased by 68.6 per cent in 2014 to reach 1,598,076, according to figures released by the Ministry of Health.
The government mounted a campaign against the malaria-causing mosquitoes throughout the country. This involved carrying out widespread indoor spraying of houses with mosquito repellents and distribution of treated mosquito nets.
Laxity in preventive efforts
However, it seems there has recently been a laxity in preventive efforts, hence the latest spread of the disease.
In an interview, Dr Theobold Hategekimana, the head of Kigali University Teaching Hospital (Chuk), said there has been an increase in malaria infections.
“It is true that we have an increase in malaria cases,” said Dr Hategekimana. “Many of these are treated in district hospitals.”
But he seemed to evade the question about the reported shortage of the medicines, only saying: “About the shortage, I don’t know whether there is a shortage of malaria drugs.”
Patrick Mulindwa, who runs a private clinic, Clinique Bien Naitre, told this newspaper that the number of malaria infections started rising sharply in the second half of last year.
“By June 2015, there were a few cases of malaria,” said Mr Mulindwa. “But in the months that followed, malaria started increasing and, of late, it has become rampant.
“The problem we face is that other hospitals refer to us malaria patients who are badly off. They come when they are badly off; we have been treating them; we have anti-malarial drugs in our emergency kit.”
The Minister for Health, Dr Binagwaho, acknowledged that malaria cases have increased in the country.
“But this is not a unique case for Rwanda,” she said. “We are partnering with Egypt in a project to seek another effective insecticide that kills mosquitoes.”
Dr Binagwaho made the revelation at the recent National Dialogue. She added that her ministry was seeking alternative medicine to address drug-resistant malaria.
Climate change to blame
She noted that malaria was also on the increase because of climate change-related conditions such as global warming and high temperatures, which stimulate the multiplication of mosquitoes in many African countries. This is in addition to resistant malaria parasites.
The Health Ministry has previously attributed the increase in the number of malaria cases to poor quality of mosquito nets.
A mosquito net procurement deal which the ministry inked with Danish company Net Protect went sour, causing the loss of Rwf10.5 billion in taxpayers’ funds.
The government paid Net Protect to supply up to three million mosquito nets in 2013 but the company delivered substandard products. The nets lacked adequate insecticides to kill mosquitoes, so they were not effective.
Although the government said it was preparing a legal suit against the firm, nothing seems to have come out of the threat. The company neither replaced the nets nor refunded the money it was paid for them, with sources privy to the scandal saying the government stood to lose the case if it sues.
The nets, which were supplied by Balton Rwanda, were imported on the recommendation of the World Health Organisation (WHO).
Laxity of officials
Speaking at the same National Dialogue as Dr Binagwaho, President Paul Kagame attributed the increase of malaria cases to laxity of some unnamed people in the system.
Ms Itulinde said the ministry was working on a contingency plan for malaria. She said: “We are still working on a contingency plan for malaria.
“It involves the different new measures we are taking about. It will come out next week.”
Ministry of Health officials said the ministry, in collaboration with that of Local Government and others, are organising a sensitisation drive for citizens about removing breeding grounds for mosquitoes.
There are other plans of producing insecticides within the country, a source said. It is expected that soon every Rwandan will be able to test for malaria while children under five years will be diagnosed for the disease by community health volunteers.
Malaria claims more than 600,000 lives a year, mostly children in Sub-Saharan Africa. It is the fourth-deadliest disease in Rwanda after neonatals, lung and cardiovascular diseases.