Determinants of malaria control in a rural community in Eastern Rwanda

Malaria disease – particularly that caused by infection with Plasmodium falciparum parasite - remains a leading cause of severe morbidity and mortality particularly in sub-Saharan Africa, of which Rwanda is part.
Infection of P. falciparum parasites into the body after a bite with in infected mosquito is followed by invasion of these parasites into red blood cells where they are transported around the body including into vital organs like the kidneys and brain where they frequently sequestrate to cause to severe disease forms. However, despite the severity of the disease, malaria remains largely preventable. Control measures include use of artemisinin-based combination therapies (ACTs) for effective treatment; insecticidal treated nets (ITNs) and indoor residual spraying (IRS) with insecticides and intermittent preventive therapy for pregnant women (IPTp).
In this thesis, we assessed key determinants of malaria control in a defined community in eastern Rwanda where malaria transmission, despite high levels of coverage with the principal malaria control tools of long lasting insecticide treated nets (LLINs), IRS and access to ACTs for the treatment of malaria clinical cases, burden remains high. We explored P. falciparum parasite characteristics, malaria clinical disease epidemiology for both clinical and asymptomatic cases, bed net access, ownership and use following mass LLIN distribution, and a malaria control stakeholder analysis to better characterise current malaria situation as well as identify key gaps that, when addressed, may lead to declines in malaria transmission and eventually achievement of malaria pre-elimination status in the study site.