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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 responsibly and according to medical advice from a qualified healthcare professional.
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 2.0 on Antimicrobial Resistance (NAP AMR II 2025-2029) and strengthened cross-sectoral “One Health” surveillance with partners like the FAO and WHO.
In Rwanda, it was associated with approximately 9,800 deaths in 2019, and globally, there were 1.27 million deaths caused by antimicrobial resistance (AMR). This figure is projected to continue increasing, and by 2050 it is estimated to cause 10 million deaths globally.
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.
“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. When he feels better, I keep the leftover pills, and if the problem comes back, he takes them again. No, a person shouldn’t take pills when they aren’t sick.”
Prevalence of AMR in Rwanda
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 Initiative Rwanda. During the interview with the Progress, Potential, and Possibilities Podcast, 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 showed that 75.9% of Gram-negative bacterial isolates were resistant to ceftriaxone, and 71.7% were positive for extended-spectrum beta-lactamase (ESBL) phenotype. Risk factors for resistance included transfer from another facility, recent surgery or antibiotic exposure, and hospital-acquired infection. Mortality was 19.6% among enrolled participants (Sutherland et al. 2019). Among inpatients at referral hospitals, 82% of isolates were Gram-negative and exhibited high rates of resistance, with only 27% susceptible to ceftriaxone, 2.4% to co-amoxiclav, and 44% to ciprofloxacin (Bizimungu et al. 2024).
At a tertiary healthcare facility, colistin and imipenem had the greatest activity against Gram-negative bacteria, but resistance to imipenem and colistin was increasing among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates. Vancomycin retained excellent activity against Staphylococcus aureus and Enterococcus (Carroll et al. 2016). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 31.2% of S. aureus isolates (Masaisa et al. 2018).
Resistance has also been reported for antimalarial medications, with the emergence of artemisinin-resistant Plasmodium falciparum strains carrying K13 mutations, as well as for tuberculosis and HIV drugs (Van Loon et al. 2022) (Bergmann et al. 2021).
In a recent message during World AMR Awareness Week 2025, 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 Dr. Albert TUYISHIME, Head of the Diseases Prevention and Control Department at Rwanda Biomedical Center, “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.”
