Insecticide resistance in Anopheles mosquitoes and drug resistance in Plasmodium parasites are among the key issues contributing to the resurgence of malaria cases in some parts of the country, a health official has said. ALSO READ: Rwanda to introduce new drugs to combat malaria resistance Between January and October 2024, reported cases rose, with 630,000 cases recorded, compared to 432,000 during the same period in 2023. The month of October alone saw 112,000 cases, with 89% of these cases focused in 15 districts, according to the national malaria programme. Of the 112,000 cases recorded in October 2024, a total of 58,000 cases (52%) were registered in only 25 sectors from Gisagara, Bugesera, Gasabo, Kicukiro, Nyanza, Nyamasheke, and Nyagatare districts. Dr. Aimable Mbituyumuremyi, the Malaria and Other Parasitic Diseases Division Manager at Rwanda Biomedical Center (RBC) said the resurgence is primarily due to increasing resistance to antimalarial drugs and insecticides. “We are facing two main types of resistance; parasite resistance to drugs, and mosquito resistance to insecticides,” Dr. Mbituyumuremyi explained. On January 4, the Minister of Health, Dr. Sabin Nsanzimana, stressed the need for intensified efforts to combat the disease, as cases increased in districts including Gasabo, Kicukiro, Bugesera, Gisagara, and Nyamagabe. Inappropriate use of medicine In 2024, over 50 malaria-related deaths were recorded, continuing the rising trend from 67 fatalities in 2023, Dr. Mbituyumuremyi added, pointing out that inappropriate use of medication is another key driver of parasite resistance. “When people don’t complete their full dosage or take medication incorrectly, it can lead to the parasites adapting and becoming resistant,” he said. “Self-medication where individuals purchase malaria drugs without consulting a healthcare professional is also a contributing factor. Taking incorrect dosages, such as giving children adult doses, and vice versa, can fail to eliminate the parasite, allowing it to develop resistance.” ALSO READ: Minister urges redoubled prevention efforts as Malaria cases surge In addition to medication misuse, environmental factors like increased rainfall and stagnant water have created more breeding sites for mosquitoes, further fuelling the rise in malaria cases. Eastern Province, in particular, has seen a high malaria burden due to these conditions, Dr. Mbituyumuremyi noted. He stated that after years of using pyrethroid-treated bed nets, mosquitoes adapted, prompting the use of new insecticide-treated nets, such as PBO nets and G2 nets, which are more effective against resistant mosquitoes. “Since 2020, we have been using PBO nets and G2 nets to combat this resistance. The government is already preparing to roll out the next phase of insecticide-treated nets this,” said Dr. Mbituyumuremyi. He also pointed out how human behaviour plays a part in the resurgence. For instance, in many high-risk areas, people either fail to use bed nets properly or delay seeking treatment, worsening the problem. This, he said, is especially prevalent in areas where people work outdoors at night, such as farmers, miners, and security guards, who are more likely to be exposed to mosquitoes and less likely to seek timely treatment. “Timely diagnosis and treatment are essential, for early intervention in preventing severe cases and fatalities,” Dr. Mbituyumuremyi stressed. Pregnant women and children under five are particularly vulnerable to malaria, he said. To protect these groups, the government opted for routine distribution of treated bed nets during antenatal visits and vaccination sessions. Self-medication remains a major concern as many individuals purchase malaria drugs without professional guidance, often taking incorrect dosages or discontinuing treatment prematurely. “Self-medication is particularly common in areas with high malaria burdens where people may experience recurrent infections and attempt to treat themselves without professional guidance.” To tackle the growing resistance, Rwanda is introducing new antimalarial drugs, like Dihydroartemisinin Piperaquine (DHAP) and Artesunate Pyronaridine (ASYP). The two medicines are among the drugs recommended by the World Health Organization (WHO) for the treatment of malaria among children and adults under artemisinin-based combination therapies (ACTs). Increased public awareness Dr. Mbituyumuremyi believes that defeating malaria requires a combination of better treatment practices, more effective insecticide use, and increased public awareness. He stated that Rwanda is one of the few countries on track to meet the World Health Organization’s malaria elimination goals. Dr. Mbituyumuremyi pointed out that the country is aiming to reduce malaria cases by 75% in 2025. However, he admitted that achieving the 2030 malaria elimination target will require continued effort, especially in light of the rising challenges posed by resistance. Countries like Nigeria and Egypt made progress in eliminating malaria through integrated vector control strategies. According to Dr. Mbituyumuremyi, Rwanda can follow a similar path if resistance issues are addressed and strategies continue to evolve. He called for greater community involvement in malaria control efforts, in collaboration with local leaders and stakeholders in sectors like agriculture and mining, for ongoing efforts to succeed.
