Understanding Malaria Treatment Adherence in Rwanda: Implications for Artemisinin Resistance

Prompt diagnosis and effective treatment are key malaria interventions that rely on community knowledge and adherence to treatment. With the emergence of artemisinin resistance in Rwanda, ensuring optimal malaria treatment practices within communities is essential. This study examined malaria knowledge, attitudes, and practices among febrile patients at government clinics to identify factors influencing malaria treatment practices. A cross-sectional study was conducted in six health facilities in moderate- to high-malaria-transmission areas of Rwanda. Patients or caregivers of children with fevers were enrolled and interviewed using semistructured questionnaires. From December 2023 to February 2024, 406 participants were enrolled; 71% (n = 289/406) of participants owned insecticide-treated nets, and 51% (n = 205/406) received indoor residual spraying. Malaria knowledge was high among respondents, with 81% (n = 329/406) correctly identifying symptoms, 72% (n = 291/406) understanding transmission modes, and 74.6% (n = 303/406) aware of effective control measures. However, of the 44.3% (n = 180/406) who received malaria treatment in the last 6 months, only 46% (n = 83/180) completed the appropriate 3-day medication course; 37% (n = 66/180) stopped within 2 days, and 11% (n = 19/180) went over 3 days. Furthermore, 27% (n = 109/406) took antimalarials for fever; the majority (54%; n = 49/109) received medication from drug outlets/pharmacies. Although knowledge and attitudes toward malaria treatment were high, adherence was poor, thereby exacerbating the risk of developing resistance. Effective interventions are urgently needed to improve antimalarial adherence, particularly in sub-Saharan African countries with documented antimalarial resistance.