Area: 28,000 km² 

Population: 7,571,000 inhabitants ( HCR facts 1996 ) 

Capital: Kigali 

Currency: Rwandan Franc 

Official Languages: French, Kinyarwanda 

The typology of Malaria in Rwanda is complex.

Together, Anopheles gambiae / Plasmodium falciparum are responsible for virtually all cases of malaria. There is said to be the odd occurrence of Plasmodium malariae and the role played by Anopheles funestus remains badly documented. 

The country can be roughly divided into 3 large geographic zones: 

The Congo Nile Crest, at an altitude between 1,900 m and 2,300 m. These high land regions have a typical mountainous facies with perpetual transmission in the depressions and epidemics in the high plateaux regions.

The central plateaux regions and the lake Kivu area, with an altitude between 1,600 m and 1,900 m. Transmission of malaria is virtually perpetual but the variations witnessed from one year to another are considerable and depend on many factors: rainfall, temperature, population movement. The growing number of people in the region means that the ecosystems are in constant change.

 The Eastern Plateaux, at an altitude between less than 1,400 m and 1,600 m. Malaria occurs much more frequently here and the transmission is perpetual with harsh seasonal outbreaks. There are outbreaks of epidemic proportions in the heart of newly established populations.

Finally, the town of Kigali, built upon the many hills that overlook the lower cultivatable land with its areas of standing water, gives rise to an urban highly unstable form of malaria with facies that differ from one hill to another.

Anopheles gambiae is the main if not exclusive malaria vector in Rwanda (S. Aldighiéri, comm. pers.).

However, Jacques Brunhes et al. (Les anophèles de la région afro-tropicale, logiciel ORSTOM Ed., 1998) registered 20 different species of anopheles in the country: Anopheles ardensis, Anopheles christi, Anopheles coustani, Anopheles cydippis, Anopheles demeilloni, Anopheles funestus, Anopheles gambiae s.l., Anopheles garnhami, Anopheles gibbinsi, Anopheles implexus, Anopheles letabensis, Anopheles marshalii, Anopheles moucheti moucheti, Anopheles natalensis, Anopheles paludis, Anopheles pharoensis, Anopheles squamosus, Anopheles tenebrosus, Anopheles wellcomei s.l. and Anopheles ziemanni.

1. Resistance to chloroquine: 

The first cases of chloroquine-resistance were described in 1984 (3). 

The next three cases were recorded in September 1985 in Nyarutovu, a malaria-free community, in Rwandans who had traveled in malaria infected regions (2).

In December of the same year, in the same community a chloroquine treatment dosed at 30 mg/kg over 3 days for 54 patients, showed a chloroquine resistance of 31% (4, 5).

In 1987 in Kigali, the chloroquine-resistance rate was evaluated at 73% in children classified as being asymptomatic parasite carriers, following a treatment of 25 mg/kg of chloroquine. The rate for children treated with 50 mg/kg was 67% (8). 

In vitro, the chloroquine-resistance rate was at 59% (16 resistant strains out of 27) (8).For J. Garcia-Vidal et al., the chloroquine-resistance rate in vivo in Nyarutovu went from 31.5% in 1985 to 65.6% in 1987 (11). 

In 1994, the in vivo resistance rate in 39 refugee children treated with 25 mg/kg of chloroquine over 3 days was at 79.5% (21). 

A 1997 study into the effectiveness of chloroquine for the treatment of uncomplicated malaria caused by Plasmodium falciparum showed 22.9% early failures and 20.8% late failures in urban zones (Kigali) compared with 37.5% and 28.6% respectively in rural areas (Health District of Butare)(S. Aldighiéri, comm. pers.). 

2. Resistance to other antimalarial drugs: 

amodiaquine: 

- In 1985, a drug rate failure of 13% was reported for 54 patients treated (4, 5).

- In 1988, this rate rose to 24% in children treated with amodiaquine after the failure of chloroquine (9). 

sulphadoxine-pyrimethamine combination:The In vivo resistance to this combination was at 3.7% in 1985 (5), and passed to 37% in 1987 (11) and to 65.8% in 1994 (21). However, in 1986, P. Deloron et al. did not find any resistance at all (9). 

Other antimalarial drugs:One in vitro test performed in 1987: out of 29 strains all were sensitive to quinine and mefloquine (8).

The program is directed by the Doctor Rwacondo (nominated in October 1998), who manages a team of 12 people. 

In 1997, the program trained 103 microscope-technicians in parasite diagnosis, 128 health officers in the handling of simple malaria patients and 11 doctors in the handling of severe malaria patients. It was also responsible for a campaign to promote the use of mosquito nets treated with long lasting insecticide in 3 health districts (Kigali, Butare and Gitarama). 27 stalls were set up selling a total of 13 020 treated nets (27). 

Also in 1997 Rwanda was selectioned by the WHO for the "Accelerated anti malaria action plan”. This operation should cover the whole country (28) but no results have yet been published.