Rwanda is changing how it fights malaria, moving away from a one-size-fits-all approach to one that targets areas based on their risk for high cases.
The governement's 2025-2030 plan shows that malaria is not spread evenly across the country, and that responses need to match local conditions.
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Data from the Rwanda Biomedical Centre (RBC) shows malaria cases have gone up and down in recent years. They rose from 610,832 in 2023–2024 to 1,131,314 in 2024–2025, before dropping to 928,616 in 2025–2026.
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However, this is still higher than the 619,559 cases recorded in 2022–2023. The national incidence rate also increased from 45 cases per 1,000 people in 2023–2024 to 76 per 1,000 in 2024–2025.
"The country is seeing a malaria resurgence, both in both cases and incidence. Figures covering July 2025 to March 2026 show that Gisagara District recorded 216,350 cases, the highest in the country,” Dr Aimable Mbituyumuremyi, RBC’s Division Manager for Malaria and Neglected Tropical Diseases said at a press briefing on Monday, April 20.
Gasabo followed with 98,077 cases, Bugesera with 74,073, Kicukiro with 65,297, Ngoma with 62,537 and Nyagatare with 50,628 cases. Nyabihu recorded the fewest cases at 2,521, followed by Burera with 3,680 and Rubavu with 5,169.
Dr. Mbituyumuremyi said responses will now depend on how badly each area is affected. In high-burden districts, indoor spraying will continue, more mosquito nets will be distributed, and testing and treatment will be expanded. Health workers will step up community outreach to encourage people to seek care early.
In moderately affected areas, routine net distribution, treatment services, and awareness campaigns will continue, with mass campaigns when needed. In low-transmission areas, the focus will be on spotting cases early and testing people living near confirmed infections, he added.
Where cases are already low, health workers will concentrate on quickly finding and following up on infections to stop further spread.
Dr. Mbituyumuremyi said some malaria control measures are becoming less effective, pointing to rising insecticide resistance that is reducing the impact of indoor residual spraying and mosquito nets.
He noted that mosquitoes are biting more outdoors and earlier in the evening. Activities such as mining, rice farming, construction, and collecting rainwater have created more breeding sites.
"Longer rainy seasons, lower immunity in communities after years of reduced transmission, delays in seeking treatment, and movement across borders are also contributing to the issue,” Dr. Mbituyumuremyi said.
He explained that early signs show that malaria parasites may be responding less effectively to artemisinin, the main drug used in treatment. Artemisinin is used in combination therapies, which pair it with another drug to improve effectiveness and slow resistance.
Task forces have been set up at the national and district levels to coordinate the response. Treatment guidelines updated in 2024 introduced Multiple First-Line Therapies, where different artemisinin-based combination therapies are used at the same time, aimed at slowing resistance.