Understanding Malaria Treatment Adherence in Rwanda: Implications for Artemisinin Resistance

Area of Science:

• Public Health
• Infectious Diseases
• Global Health

Background:

• Prompt malaria diagnosis and treatment are vital interventions.
• Emerging artemisinin resistance in Rwanda highlights the need for optimal community treatment practices.
• Community knowledge and adherence significantly influence malaria treatment outcomes.

Purpose of the Study:

• To examine malaria knowledge, attitudes, and practices (KAP) among febrile patients in Rwandan government clinics.
• To identify factors influencing malaria treatment practices and adherence.
• To address challenges in malaria treatment in the context of rising antimalarial resistance.

Main Methods:

• A cross-sectional study was conducted in six health facilities in moderate to high malaria transmission areas of Rwanda.
• 406 febrile patients or caregivers of children with fever were enrolled and interviewed using semi-structured questionnaires.
• Data collection occurred from December 2023 to February 2024.

Main Results:

• High malaria knowledge was observed: 81% identified symptoms, 72% understood transmission, and 74.6% knew control measures.
• Despite high knowledge, only 46% of those treated completed the full 3-day antimalarial course.
• Poor adherence (stopping treatment early or late) was prevalent, and 27% took antimalarials for fever, often obtained from drug outlets.

Conclusions:

• High malaria knowledge in Rwanda does not translate to consistent treatment adherence.
• Poor adherence to antimalarial medication regimens is a critical factor contributing to the risk of drug resistance.
• Effective interventions are urgently required to improve antimalarial adherence in sub-Saharan Africa, especially where resistance is documented.