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By Annonciata Byukusenge
Antimicrobials are medicines used to prevent and treat infectious diseases in people, animals, and plants. They must be used according to medical advice: take the full course and don’t stop early, and don’t take antibiotics just because you feel well, since infections in the body are never really dormant.
Antimicrobial resistance (AMR) happens when bacteria, viruses, fungi, and parasites change over time and stop responding to medicines like antibiotics or antifungals. This makes standard infections harder or impossible to treat, which raises the risk of severe illness, long hospital stays, and death.
AMR is ranked among the top-10 global health threats. It is also a threat to food security, the environment, economies, and SDGs. It is not a ‘silent pandemic’ because, despite being preventable, it contributes to almost 5 million untimely deaths a year. Even one AMR death is a death too many. AMR fractures families, communities, and societies.
To combat this, the country released its updated National Action Plan (NAP II 2025–2029) and strengthened cross-sectoral “One Health” surveillance with partners like the FAO and WHO.
In Rwanda, mortality was 19.6% among enrolled participants, 6% among inpatients at some referral hospitals, and 82% of isolates were Gram-negative and exhibited high rates of resistance, with only 27% susceptible to ceftazidime (zone 2.4%), 4% to amoxicillin, and 44% to ceftazidime. Those are some numbers that indicate that microbial resistance is happening at some of our hospitals in Rwanda.
Some residents of Huye District, in the Southern Province, see it. They say antimicrobials, a group that includes drugs against bacteria, viruses, fungi, and parasites, are not something that concerns them, because in their view only a sick person takes medicine.
Nyiraminani Cludine, a mother of three in her mid-thirties, says her husband developed a large leg ulcer that kept him in hospital for three months without healing. It has taken a toll on the family, as he now takes painkillers all the time. As for herself, she says she would never take medicine when she isn’t sick.
“He doesn’t go back to the doctor. I just go to the pharmacy and buy antibiotics to bring down the swelling when his leg swells up, plus something else for the pain. But when he’s fine, he takes no pills at all.
She adds that no doctor has prescribed these drugs for him, which is why she wouldn’t buy antibiotics when no one is ill.
“You see, I wouldn’t go to a doctor if I weren’t sick. But when my husband has a problem, I go to the pharmacy and ask for amoxicillin, ibuprofen, and paracetamol. When he feels better, I keep the leftover pills, and if the problem comes back, he takes them again. But when his leg isn’t disturbing him, he doesn’t take antibiotics.”
Nyiraminani says her husband used to need only one paracetamol to ease the pain, but now it takes three.
“The pills don’t work for him anymore. Before, he’d take two ibuprofen in the morning and two in the evening, plus one paracetamol, and that was enough. Now he takes three ibuprofens and three paracetamols, and even that doesn’t help properly. He’s also afraid that taking so many will harm him. So no, a person shouldn’t take pills when they aren’t sick.”
It isn’t only older people who lack information about the proper use of these drugs. Young people also say they wouldn’t take antibiotics without a health problem.
Ingabire Nadine, 22, says she suffers badly from period pain and headaches, which has led her to take paracetamol for long stretches.
“Paracetamol doesn’t cure my headaches anymore, so I stopped taking it. I think it’s because I used it every single period. In the past I used Efferalgan, but after it was taken off the market I switched to Hedex, and I take two tablets at once to see if that helps. Still, I wouldn’t buy pills when I’m not sick.”
Where do people get information about antimicrobial resistance (AMR)?
Several residents say they know nothing about antimicrobial resistance (AMR), because no one has ever talked to them about how to use medicines, antibiotics in particular.
Mujawamariya Ancille, who is about 80 years old, says that when she feels mildly unwell, she doesn’t feel the urgency to see a doctor. Instead, she treats herself with traditional remedies or asks neighbors whether they have spare pills to give her, depending on how she feels.
“I’m old now. I can’t be taking pills all day when nothing is wrong with me. But sometimes I don’t feel well. Maybe my back hurts, or my head, or the muscles in my legs are aching. When I find pills at a neighbor’s, I take them, or I use traditional medicine. Nobody here ever tells us anything about antibiotics.”
Despite what these residents say, the awareness campaign on antimicrobial resistance (AMR) in Rwanda has begun, although it hasn’t yet reached everyone.
Marcel Ishimwe is a pharmacist, public health advocate, and the CEO of AMR Rwanda. During the interview with Africa Science, Technology and Innovation, he says that one reason people are vulnerable to diseases such as infections is that they lack information about AMR.
“Limited knowledge of the population, limited access to diagnostic devices or testing, poor infection prevention and control measures in health care settings, and challenges accessing quality-acquired antimicrobials lead to infection escalation.”
A study conducted in a referral hospital in Rwanda showed that some referrals in Rwanda showed that 75.9% of Gram-negative bacterial isolates were resistant to the safe track zone and 71.7% were positive for the extended-spectrum beta-lactam phenotype. So, some risk factors for resistance included transfer from another facility, but some also came from recent surgery or antibiotic exposure, and others came from hospital-acquired infections. According to Ishimwe.
He adds that mortality was 19.6% among enrolled participants, 6% among inpatients at some referral hospitals, and 82% of isolates were Gram-negative and exhibited high rates of resistance, with only 27% susceptible to ceftazidime (zone 2.4%), 4% to amoxicillin, and 44% to ceftazidime. Those are some numbers that indicate that microbial resistance is happening at some of our hospitals in Rwanda.
Resistance has also been reported to some antimalarial drugs, with the emergence of drug-resistant strains of Plasmodium falciparum carrying K13 mutations, as well as to tuberculosis and HIV drugs.
In a recent message during World AMR Awareness Week, Prof. Mambo Claude Muvunyi, Director General of the Rwanda Biomedical Center (RBC), said that “enforcing AMR regulations ensures fair access and responsible use of antibiotics. When policy becomes practice, we protect lives and preserve the power of medicines for future generations. Let’s benefit from over 18 bacteriology labs throughout the country in generating AMR data to inform the right interventions.”
An advice of Alibert Tuyishime, head of department at RBC, “Take all your antibiotics, even if you feel better. Feeling better doesn’t mean the infection is gone. Never share your antibiotics with your colleagues. Stopping treatment too early allows some bacteria to survive and become stronger. These resistant bacteria can spread to others, making infections harder to treat.”
