Anti-malarial resistance in Rwanda

Rwanda's 7.2 million people are still reeling from the effects of genocide, war and large-scale population displacements. 54% of the population is illiterate and 66% live below the poverty line. 1.2 million cases of malaria are reported every year. Malaria is the first cause of death, and mortality is particularly high among infants. The disease is endemic in many areas of the country, including Kicukiru (Kigali), Gikongoro, Mashesa (Cyangugu), Kivumu (Gisenyi), Rwaza (Ruhengeri), Nyarurema and Rulara. Resistance to anti-malarials Resistance problems were first identified in 1997. Studies carried out in 1999 confirmed that resistance to chloroquine was high: 33% in Rwaza and 44% in Nyarurema for example. Rates varied according to region and altitude. Resistance to sulphadoxine-pyrimethamine (SP, also known by its brand name Fansidar®) was in general lower (e.g. 16% in Rwaza), except in Rukawara where resistance was 45%. National malaria programme and treatment protocol Because of the high rates of resistance to chloroquine recorded around the country, the Rwandan Ministry of Health (MOH) first switched its protocol from chloroquine to Fansidar® for first-line treatment of malaria. Aware of the evidence in favour of drug combinations, the MOH recently decided to introduce combination treatment. But the more effective artemisinin derivatives will not be included - they are too expensive for the government to afford on their own. Instead, a combination of amodiaquine Fansidar® will be used. Given the already significant rates of resistance to Fansidar® in many areas of the country, using this combination will often be equivalent to using amodiaquine on its own. Resistance to both drugs is likely to increase rapidly as a result, and switching to even more expensive drugs such as - quinine, mefloquine or co-artemether - will eventually become necessary. MSF project in Rwanda MSF runs several projects in Rwanda, mostly in and around Kigali. Most focus on HIV/AIDS and mental health. A malaria project was set up three years ago in Bushenge to offer support to the district health system.