Beyond the rice fields: Bugesera’s battle to stop Malaria before it strikes

By Elias Hakizimana. 

In the marshlands of Ngeruka, where rice feeds households and fuels the local economy, a silent enemy drains families of time, income, and sometimes life itself. Bugesera’s most productive fields remain trapped in a health crisis that thrives in water: malaria.

At daybreak, rice farmers wade through Nyakayenzi’s mucky plantations as the sun rises over the deep green marsh. Their feet are submerged in warm, stagnant water. The sound of boots trampling soil blends with the hum of insects—mosquitoes that carry a disease still shaping daily life in Bugesera.

On November 19, officials from the Rwanda NGOs Forum on HIV/AIDS and Health Promotion (RNGOF), the Rwanda Biomedical Centre (RBC), civil society organizations and local leaders met in Ngeruka to launch an intensive outreach campaign to reduce malaria infections among high-risk communities. With support from the Global Fund, the initiative targets populations that are physically accessible, yet still heavily affected.

Despite national progress in malaria control, Bugesera continues to rank among Rwanda’s hardest-hit districts. And at the center of this struggle stands Ngeruka Sector.

A landscape that feeds—and infects

Ngeruka’s proximity to Lakes Cyohoha North and South and its vast rice-growing wetlands are its economic lifeline. Yet these same waters create breeding grounds for mosquitoes, keeping malaria rates disturbingly high.

“People of Ngeruka live and work surrounded by water, and that is why malaria remains high,” said Aimable Khadaffi, the Sector’s Executive Secretary. “We cannot talk about development in agriculture if we are not healthy enough to benefit from it.”

Records from Ngeruka Health Center paint a similar picture. Out of 4,457 patients seen in October, 2,815—nearly half—were treated for malaria. Most cases were mild, but health officials warned that severe malaria is rising in Rwanda. National statistics show a 50 percent spike in severe cases and a 23 percent increase in deaths last fiscal year.

 “Malaria becomes severe because we wait too long. Let’s go to the health centers the moment symptoms start.”  Says Yvette Imanishimwe, Vice Mayor of Bugesera in charge of social affairs.

Delayed treatment, lost harvests

For rice farmer Eugene Hategekimana, malaria is more than a health problem—it is an economic blow. A week before the campaign, his wife fell seriously ill.

“She had a headache, then muscle pain, and on the third day she couldn’t walk,” he said. “I worked alone in the fields. We lost income, and I was afraid she would get worse.”

His story reflects a common pattern: families delay seeking care, assuming symptoms will disappear. Some reported waiting because community health workers did not have malaria medicines readily available.

Addressing this, Bugesera’s Vice Mayor Yvette Imanishimwe explained that Rwanda is shifting away from Coartem to a more effective treatment, DHA-PPQ.

“We had to train community health workers before distributing the new medicines,” she said. “They will receive them soon.”

 “In October, almost half of our patients had malaria. Prevention must be daily, not seasonal.”— Donatha Musengimana, Titulaire of Ngeruka Health Center

Prevention starts at home

Bugesera completed indoor residual spraying (IRS) earlier this month, achieving 101 percent coverage after reaching unregistered households. Yet officials stressed that spraying alone cannot reverse malaria trends.

“We cannot spray houses while people still keep bushes around their homes or live surrounded by stagnant water,” Imanishimwe warned. She emphasized the impact of simple hygiene, noting that “even a bottle cap can breed 2,000 mosquitoes, and 100 female mosquitoes can infect a whole community.”

Residents learned how to identify symptoms early, protect themselves with treated nets, and eliminate mosquito breeding sites. Music, community drama and live demonstrations helped translate health messages into practical daily habits.

Another threat in the water

Beyond Malaria, Bilharzia Lingers in the Rice Fields

Rice farmers also raised concern over bilharzia (schistosomiasis), a disease caused by parasitic worms in contaminated water. The worms penetrate through bare feet when farmers work without protection. Farmers requested low-cost boots, gloves and mobile toilets to reduce contamination. District authorities pledged advocacy but reiterated that malaria remains the most urgent threat due to the rise in severe cases and deaths.

 “We protect our crops. We also need to protect our bodies.”
— Ladislas Minani, KOPEKITEKI Rice Farmers Cooperative President.

NIYONSHUTI Pierre Amidei, Malaria Coordinator for the Eastern Province at RNGOF on HIV/AIDS & HP, urged rice farmers in Ngeruka Sector to stop defecating in marshlands, warning that bilharzia worms penetrate the feet and contaminate water, eventually becoming a serious cervical health threat.

He advised parents to wash hands before cooking and breastfeeding, keep toilets clean and covered, and avoid using human waste as fertilizer, noting that bilharzia eggs can survive in soil for up to five years and spread through food, hands, and farm work.

The campaign in Ngeruka mirrors Rwanda’s broader ambition to build healthy, productive communities by fighting diseases that thrive in everyday environments. From mosquito-infested canals to parasite-ridden marshlands, prevention now depends not only on government programs, but on habits within households and farms.

As the country pursues its Zero Malaria national vision, local actions—clean sanitation, early treatment, hygiene, and correct use of bed nets—remain the frontline defense. In the spirit of the national theme, the message echoed through Ngeruka: “Zero Malaria Starts With Me.”

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