Removing the neglect from neglected tropical diseases: the Rwandan experience 2008-2010.

While there has been increasing recognition of the importance of neglected tropical diseases (NTDs), national scale action and funding remain limited. In 2007, a 3-year, $1 million per year programme was launched in Rwanda to address NTDs. While more than $100 million had flowed into Rwanda's health sector annually, not $1 was allocated for NTDs. This article describes the development of a national NTD strategy in Rwanda and outlines lessons learned, with particular regard to integrated approaches to NTD prevention. A baseline survey revealed that more than 65% of children had intestinal worms with high levels of concurrent multiple parasite infection. Within a year, mass treatment administration was provided for the first time. A repeat survey found that prevalence of soil-transmitted helminths and Schistosoma mansoni infection had been reduced significantly, including a reduction in prevalence of S. mansoni of 82% and of 72% in hookworm. Infection intensity and signs of early clinical morbidity also decreased significantly. Despite ongoing global neglect, the Rwandan NTD response presents a promising and unheralded success in science-based national public health action at scale. Looking forward, greater integration of the NTD response with water and sanitation activities are needed to consolidate impact and sustainably reduce the disease burden.

The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda.

This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five 'imidugudu' or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights.

Polyparasite helminth infections and their association to anaemia and undernutrition in Northern Rwanda.

BACKGROUND: Intestinal schistosomiasis and soil-transmitted helminth (STH) infections constitute major public health problems in many parts of sub-Saharan Africa. In this study we examined the functional significance of such polyparasite infections in anemia and undernutrition in Rwandan individuals. METHODS: Three polyparasite infection profiles were defined, in addition to a reference profile that consisted of either no infections or low-intensity infection with only one of the focal parasite species. Logistic regression models were applied to data of 1,605 individuals from 6 schools in 2 districts of the Northern Province before chemotherapeutic treatment in order to correctly identify individuals who were at higher odds of being anaemic and/or undernourished. FINDINGS: Stunted relative to nonstunted, and males compared to females, were found to be at higher odds of being anaemic independently of polyparasite infection profile. The odds of being wasted were 2-fold greater for children with concurrent infection of at least 2 parasites at M+ intensity compared to those children with the reference profile. Males compared to females and anaemic compared to nonanaemic children were significantly more likely to be stunted. None of the three polyparasite infection profiles were found to have significant effects on stunting. CONCLUSION: The present data suggest that the levels of polyparasitism, and infection intensities in the Rwandan individuals examined here may be lower as compared to other recent similar epidemiological studies in different regions across sub-Saharan Africa. Neither the odds of anaemia nor the odds of stunting were found to be significantly different in the three-polyparasite infection profiles. However, the odds of wasting were higher in those children with at least two parasites at M+ intensity compared to those children with the reference profile. Nevertheless, despite the low morbidity levels indicated in the population under study here, we recommend sustainable efforts for the deworming of affected populations to be continued in order to support the economic development of the country.