There has been a threefold increase in the number of malaria cases recorded in the former M23 rebel stronghold of Rutshuru, in the Democratic Republic of Congo's (DRC) North Kivu Province, compared to past years. Insecurity is exacerbating the spread of the disease, say health officials.
"Between 2009 and 2012, the cumulative number of malaria case has never exceeded 25,000 per year. But just in 2013, as of 20 November, we had 76,343 cases, of which 27,340 were children younger than five. This is what pushed us in early November to declare an epidemic," Félix Kabange Numbi, DRC's health minister, told IRIN.
Of the 76,343 cases, 19,639 are of severe malaria. So far, some 40 people have died, among them 33 children younger than five.
Although Rutshuru typically records malaria cases during the rainy season, which extends from August to April, insecurity has fuelled the upsurge in numbers. Rutshuru was an M23 stronghold for about 18 months before the rebels group's 5 November surrender.
"Because of the insecurity, the fear of looting and attacks, the people were spending the night in the bush or in the fields, where the risk of exposure to malaria is very high," explained Francesca Mangia, the head of the Médecins Sans Frontières (MSF) base in Goma.
"People were seeking refuge in the swamps where they grow rice," added minister Numbi, noting that such environments provide an ideal breeding ground for mosquitoes. Malaria is caused by the plasmodium parasite, which is transmitted through the bites of mosquitoes.
According to Numbi, the situation is "under control", with response activities ongoing. Supplies from the Global Fund to Fight AIDS, Tuberculosis and Malaria, such as medication, rapid diagnostic kits and other supplies, have been dispatched to health facilities in Rutshuru. A blood collection campaign is also planned.
The initial beneficiaries of the free blood transfusions will be children younger than five who are especially at risk in case of severe malaria, said Numbi. Malaria can lead to anaemia, as the infection is associated with a reduction in haemoglobin levels.
Since August, some 24,000 malaria cases have been recorded in Rutshuru, with numbers peaking to about 3,000 cases per week in early October, according to an 18 November MSF communiqué. The malaria cases were more than twice the UN World Health Organization epidemic alert, noted MSF, which runs the Rutshuru general referral hospital, located 80km north of Goma, North Kivu's capital.
At present, the Rutshuru hospital is receiving 1,500 to 1,600 patients, 70 percent of them children, per week, making for a huge workload. "The number of patients with malaria is five times higher than last year on the same date," noted MSF.
To decongest the Rutshuru hospital, MSF is recommending the treatment and observation of patients suffering from severe malaria in two of its mobile structures, said Christophe Biteau, MSF Rutshuru project coordinator. DRC health authorities have also beefed up staff numbers in response. In the area of Kiwandja, 5km from Rutshuru, the Mapendo and Buturande health centres have also been reinforced to attend to malaria cases.
Prevailing levels of severe and chronic malnutrition in children younger than five, at 1.6 and 60.6 percent respectively, may have aggravated the malaria infections.
"With the fighting, the people who live off farming… did not cultivate their farms, much less harvest, [and] suddenly could not eat," said Jean-Claude Bambanze, the president of Rutshuru's civil society.