Understanding Malaria Treatment Adherence in Rwanda: Implications for Artemisinin Resistance

Abstract 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 (KAP) among febrile patients at government clinics to identify factors affecting 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 fever were enrolled and interviewed using semi-structured questionnaires. From December 2023 to February 2024, 406 participants were enrolled, 56% (228/406) were female, 50% (204/406) were primary schooled, and mostly in rural areas 80% (324/406). A total of 71% (289/406) of participants owned insecticide-treated nets (ITNs), and 51% (205/406) received indoor residual spraying (IRS). Malaria knowledge was high among respondents, with 81% (329/406) correctly identifying symptoms, 72% (291/406) understanding transmission modes, and 74.6% (303/406) aware of effective control measures. However, of the 44.3% (180/406) who received malaria treatment in the last 6 months, only 46% (83/180) completed the appropriate 3-day medication course; 37% (66/180) stopped within 2 days, and 11% (19/180) over 3 days. Furthermore, 27% (109/406) of participants took antimalarials for fever; the majority (54%; 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.