From Waste to Wellness: Mudende’s Battle Against Intestinal Worms

In the Mudende sector, Rubavu district, community-led initiatives have made significant progress in reducing intestinal worm infections among children and adults. As part of Rwanda’s National Neglected Tropical Diseases (NTD) Strategic Plan, the country is striving to eliminate these infections, which remain the most widespread NTDs—affecting 46.1% of adults over 16, 38.8% of children aged 5–15, and 30.2% of those aged 1–4. These parasites, often contracted through contaminated food, water, or unwashed produce, contribute to malnutrition and anemia, particularly among children and women. In response, Mudende residents have strengthened sanitation practices, including discontinuing the use of human waste as fertilizer, to safeguard public health.

A 2020–2023 survey by the Rwanda Biomedical Centre (RBC) uncovered that the community’s use of untreated human waste as fertilizer contributed to the problem. Worms from such waste can survive in soil for up to five years, perpetuating infections.

For many years in Mudende, there was a high prevalence of children with swollen stomachs, malnutrition, anemia, and diarrhoea.

The local community had been using human stool as fertilizer because it was cheap and efficient.

Gloriose MUKASINE, a Mudende resident, explained that everyone in the area used human stool fertiliser, as it was cost-effective and readily available. The fertilizers were bought for about Rwf5, 000, and a local dealer facilitated their sale.

Mukasine shared that while the human waste fertilizer seemed like a good business, they began to notice health problems, including swelling in both children and adults.

“Although the human waste fertilizer was cheap, our crop yields decreased drastically,” she said, noting that a hectare of Irish potatoes that initially produced 35 sacks would only yield 10 sacks in subsequent harvests.

However, after awareness campaigns about hygiene, Mukasine’s family experienced significant health improvements. “Before, my family suffered from intestinal worm diseases. Now, we have clean water, proper toilets, and no longer use human waste as fertilizer. Our health has greatly improved,” she said.

Health authorities took action, providing medical treatments to the residents and educating them about the dangers of using human stool fertilizer, which affected both health and crop yields.

Innocent Hakizimana, a community health worker, attributed the success to government support in capacity building and disease education.

 “We conducted door-to-door campaigns, helping residents understand the risks associated with human waste, and they responded positively,” Hakizimana explained.

Valentina MUKAREMERA, the Director of Mudende Health Center, reported a significant reduction in intestinal worm cases, from 91% to 9%. The number of patients with intestinal worms dropped from 70 per month to just 10. She called on authorities and partners to improve access to clean water in the area to further eliminate intestinal worms.

“Access to clean water has been a major concern, contributing to infections, but we are hopeful that the district will soon ensure clean water for the community,” Mukaremera said.

Nathan HITIYAREMYE, an official of the NTDs Program at RBC, noted that while the use of stool as fertilizer no longer poses a major health risk, intestinal worms remain a challenge in other districts.

He emphasized the importance of addressing these infections, which can lead to severe consequences like malnutrition, anemia, and impaired development in children. He added that intestinal worms cause fatigue, stunted growth, and a weakened immune system, making children more susceptible to other diseases and hindering their education.

Dr. Jules Mugabo Semahoro, Head of Malaria and NTDs at WHO Rwanda, praised the progress in Mudende as a successful example of Rwanda’s efforts to eliminate Neglected Tropical Diseases (NTDs) by 2030.

He also announced that more de-worming tablets would be donated annually to support these efforts.

Intestinal worms continue to pose a significant public health challenge in Rwanda, highlighting the urgent need for focused intervention and awareness. As one of the 6 neglected tropical diseases affecting the country, their widespread impact underscores the importance of addressing these health threats proactively. By prioritizing prevention, education, and treatment efforts, Rwanda can work toward mitigating the long-term consequences of these diseases and improving the overall health and well-being of its population.