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Background Evidence-based vector control interventions depend on understanding the distribution and mechanisms of insecticide resistance in malaria vectors. This study assessed the status of insecticide resistance in Anopheles gambiae sensu lato ( s.l .) to pyrethroids, permethrin, deltamethrin, and alphacypermethrin across 18 sites in 15 districts of Rwanda, representing key malaria transmission strata. Methods Larvae were collected from October 2022 to April 2023 using the dipping method, reared to adulthood, and tested using WHO standard bioassays. Susceptibility profiles were analysed with chi-square tests to compare mortality rates. Results There was a high resistance to permethrin in various sites, such as Gashora (42%), Mubuga (48%), Rwaza (69%), and Kirarambogo (70%). Pre-exposure to piperonyl butoxide (PBO) only partially restored susceptibility, with mortality between 70 and 80% at resistant sites. In Kigali city, mortality with alphacypermethrin was 94%, and with PBO, it failed to restore susceptibility, suggesting non-metabolic resistance was involved. Overall, the evidence indicates that metabolic mechanisms play a major role in pyrethroid resistance, though target-site mutations, such as kdr , cannot be ruled out. The reliance on phenotypic data without molecular confirmation remains a limitation, underscoring the need for molecular assays to identify resistance-associated genetic markers. Conclusions This study provides essential baseline data on the resistance status of An. gambiae s.l. in Rwanda and highlights the urgent need to integrate molecular tools into routine surveillance to guide more effective vector control strategies.

Background The core vector control tools used to reduce malaria prevalence are currently long-lasting insecticidal nets (LLINs), and indoor residual spraying (IRS). These interventions are hindered by insecticide resistance and behavioural adaptation by malaria vectors. Thus, for effective interruption of malaria transmission, there is a need to develop novel vector control interventions and technologies to address the above challenges. Larviciding using drones was experimented as an innovative tool that could complement existing indoor interventions to control malaria. Methods A non-randomized larviciding trial was carried out in irrigated rice fields in sub-urban Kigali, Rwanda. Potential mosquito larval habitats in study sites were mapped and subsequently sprayed using multirotor drones. Application of Bacillus thuringiensis var. israelensis (Bti) (Vectobac ® WDG) was followed by entomological surveys that were performed every two weeks over a ten-month period. Sampling of mosquito larvae was done with dippers while adult mosquitoes were collected using CDC miniature light traps (CDC-LT) and pyrethrum spraying collection (PSC) methods. Malaria cases were routinely monitored through community health workers in villages surrounding the study sites. Results The abundance of all-species mosquito larvae, Anopheles larvae and all-species pupae declined by 68.1%, 74.6% and 99.6%, respectively. Larval density was reduced by 93.3% for total larvae, 95.3% for the Anopheles larvae and 61.9% for pupae. The total adult mosquitoes and Anopheles gambiae sensu lato collected using CDC-Light trap declined by 60.6% and 80% respectively. Malaria incidence also declined significantly between intervention and control sites (U = 20, z = − 2.268, p = 0.023). Conclusions The larviciding using drone technology implemented in Rwanda demonstrated a substantial reduction in abundance and density of mosquito larvae and, concomitant decline in adult mosquito populations and malaria incidences in villages contingent to the treatment sites. The scaling up of larval source management (LSM) has to be integrated in malaria programmes in targeted areas of malaria transmission in order to enhance the gains in malaria control.

Background Malaria remains a significant health issue in Rwanda. Primary malaria prevention methods include insecticide-treated nets and indoor residual spraying as core interventions. Mosquito repellents, larval source management (LSM), and housing improvement are recommended as supplemental vector control methods. A 2020–2021 study in rice field habitats of peri-urban of Kigali City successfully evaluated the entomological and epidemiological impacts of drone-based larviciding using Bacillus thuringiensis var. israelensis (Bti). Methods The present study employed a concurrent mixed-methods design to assess community knowledge, perception, acceptance, and willingness to participate in drone-based larviciding for malaria control in Kigali City. A total of 248 respondents participated in the quantitative survey interviews while five focus group discussions (FGDs), each comprising 10–12 participants, were conducted. Quantitative data were analysed using SPSS and R software, with logistic regression applied to identify factors influencing community participation. Qualitative data were manually coded and analysed thematically to complement the quantitative findings. Results Participants showed widespread knowledge of malaria transmission and prevention, with high awareness of the importance of larviciding. A strong support of 96.4% expressed willingness to accept drone-based larviciding, including financial and free labour support. Factors influencing willingness to participate include occupation in rice and vegetable farming and mining (95% CI − 3.053 to − 0.169, p  = 0.029), mosquito exposure (95% CI − 5.706 to − 1.293, p  = 0.004). Participants highlighted drone-based larviciding role in reducing mosquitoes and malaria risk and recommended it’s scaling up as a core component of integrated vector management (IVM). Conclusions This study highlights strong community awareness and acceptance of drone-based larviciding, with its effectiveness in reducing mosquito abundance and malaria risks, along with the safety of Bti and drones. The findings advocate integrating drone-based larviciding into national malaria control strategies by enhancing community education, building local expertise, and adopting innovative financing mechanisms for scalability and sustainability.

Soil-transmitted helminthiasis (STH) and schistosomiasis (SCH) remain significant public health challenges in Rwanda, affecting individuals across all age groups. Despite ongoing mass drug administration (MDA) efforts, updated data on prevalence and risk factors are crucial for effective control and elimination strategies. This study reassessed the prevalence of STH and SCH in both children and adults in Rwanda, along with their associated risk factors, to guide control efforts. A nationwide survey was conducted across 30 districts, testing 17,360 individuals for STH and 17,342 for Schistosoma mansoni using Kato-Katz (KK) and Point-Of-Care Circulating Cathodic Antigen (POC-CCA) tests. Mixed-effects logistic regression models were used to identify risk factors while accounting for district-level variability. The overall prevalence of STH was 38.7% (95% CI: 37.9-39.4), highest among adults (46.1%, 95% CI: 44.8-47.3) and lowest among preschool-aged children (30.2%, 95% CI: 29.0-31.5). Species-specific prevalence was 27.0% for Ascaris lumbricoides (95% CI: 26.3-27.6), 11.6% for Trichuris trichiura (95% CI: 11.2-12.1), and 10.7% for hookworm (95% CI: 10.3-11.2). Moderate-to-heavy intensity (MHI) infections were detected in 8.1% of Ascaris lumbricoides (95% CI: 7.7-8.5), 0.8% of Trichuris trichiura (95% CI: 0.6-0.9), and 0.1% of hookworm (95% CI: 0-0.2). SCH prevalence was 1.7% (95% CI: 1.5-1.9) by KK and 27.2% (95% CI: 26.5-27.9) when trace results on POC-CCA were considered positive. Heavy Schistosoma mansoni infections were rare (0.1%, 95% CI: 0-0.1). Mixed-effects logistic regression (p < 0.05) showed that for STH, higher odds were associated with being single (AOR: 1.74), no education (AOR: 1.56), use of human excreta as manure (AOR: 1.43), unimproved water sources (AOR: 1.17), and proximity to marshlands (AOR: 1.17). Lower odds were seen among those with higher education (AOR: 0.55), unemployed (AOR: 0.34), self-employed or retired (AOR: 0.53), students (AOR: 0.54), those with deep toilets (AOR: 0.78), and those treating water consistently (AOR: 0.79). For SCH, higher odds were linked to being single (AOR: 1.61), no education (AOR: 1.41), proximity to lakes (AOR: 1.76) or rice fields (AOR: 1.31), use of treated (AOR: 1.32) or untreated (AOR: 1.60) excreta as manure, and living over an hour from a water source (AOR: 1.42). STH and SCH remain significant public health challenges in Rwanda, with certain regions and population groups still exceeding the elimination threshold as public health problems. Expanding MDA programs to include adults, improving sanitation and hygiene, ensuring universal access to clean water, and promoting community education on safe practices are essential for achieving sustainable control and elimination of these infections.

Climate change is recognized as a critical determinant of malaria transmission in the coming decades. This manuscript synthesizes testimonies from six African countries (Chad, Côte d’Ivoire, Democratic Republic of the Congo (DRC), Madagascar, Rwanda, and Senegal) highlighting how climate variability has recently influenced malaria epidemiology and how national malaria control programmes (NMCPs) are adapting. The correlation between changing patterns of rainfalls, floodings, and how they affect the expansion of mosquito vector habitats with malaria transmission has been reported. Adaptive strategies adopted by the NMCPs include integrating climate and health data, strengthening surveillance and establishing early warning systems, engaging and educating communities, promoting multisectoral collaboration, and leveraging technology and innovation. However, systemic barriers, such as limited data integration capacity, infrastructural deficits, behavioural factors, and financial constraints, continue to impede effective implementation of adaptive strategies. Addressing these barriers requires sustained political commitment, enhanced technical capacity, operational and implementation research, and long-term investment in climate-resilient health systems. The findings offer valuable insights for broader regional efforts to align malaria control strategies with climate change.

Background As part of malaria prevention and control efforts, the distribution and density of malaria mosquitoes requires continuous monitoring. Resources for long-term surveillance of malaria vectors, however, are often limited. The aim of the research was to evaluate the value of citizen science in providing insight into potential malaria vector hotspots and other malaria relevant information, and to determine predictors of malaria vector abundance in a region where routine mosquito monitoring has not been established to support vector surveillance. Methods A 1-year citizen science programme for malaria mosquito surveillance was implemented in five villages of the Ruhuha sector in Bugesera district, Rwanda. In total, 112 volunteer citizens were enrolled and reported monthly data on mosquitoes collected in their peridomestic environment using handmade carbon-dioxide baited traps. Additionally, they reported mosquito nuisance experienced as well as the number of confirmed malaria cases in their household. Results In total, 3793 female mosquitoes were collected, of which 10.8% were anophelines. For the entire period, 16% of the volunteers reported having at least one confirmed malaria case per month, but this varied by village and month. During the study year 66% of the households reported at least one malaria case. From a sector perspective, a higher mosquito and malaria vector abundance was observed in the two villages in the south of the study area. The findings revealed significant positive correlations among nuisance reported and confirmed malaria cases, and also between total number of Culicidae and confirmed malaria cases, but not between the numbers of the malaria vector Anopheles gambiae and malaria cases. At the sector level, of thirteen geographical risk factors considered for inclusion in multiple regression, distance to the river network and elevation played a role in explaining mosquito and malaria mosquito abundance. Conclusions The study demonstrates that a citizen science approach can contribute to mosquito monitoring, and can help to identify areas that, in view of limited resources for control, are at higher risk of malaria.

Background To validate assumptions about the length of the distribution–replacement cycle for long-lasting insecticidal nets (LLINs) in Rwanda, the Malaria and other Parasitic Diseases Division, Rwanda Ministry of Health, used World Health Organization methods to independently confirm the three-year LLIN serviceable life span recommendation of WHO. Methods Approximately 3,000 coded LLINs, distributed as part of a national campaign, were monitored in six sites, by means of six–monthly visits to selected houses. Two indicators, survivorship/attrition, a measure of the number of nets remaining, and fabric integrity, the proportion of remaining nets in either ‘good’, ‘serviceable’ or ‘needs replacement’ condition, based on holes in the net material, were tracked. To validate the assumption that the intervention would remain effective for three years, LLIN coverage, calculated using either survivorship, or integrity, by removing nets in the ‘needs replacement’ category from the survivorship total, was compared with the predicted proportion of nets remaining, derived from a net loss model, that assumes an LLIN serviceable life of three years. Results After two years, there was close agreement between estimated LLIN survivorship at all sites, 75% (range 64-84%), and the predicted proportion of nets remaining, 75%. However, when integrity was considered, observed survivorship at all sites, declined to 42% (range 10-54%). Conclusions More than half, 58%, of the LLINs fell into the ‘needs replacement’ category after two years. While these nets were counted for survivorship, they were judged to be of little-to-no benefit to a user. Therefore, when integrity was taken into account, survivorship was significantly lower than predicted, suggesting that net serviceable life was actually closer to two, rather than three years, and, by extension, that the impact of the intervention during year three of the LLIN distribution-replacement cycle could be well below that seen in years one and two.

In December 2024, L’Initiative-Expertise France organized a workshop in Musanze, Rwanda, for National Malaria Control and Elimination Programmes (NMC/EPs) representatives from 19 sub-Saharan African countries. The workshop focused on surveillance, modeling, climate forecasting, and innovative control methods to mitigate climate change impacts on malaria. Participants shared challenges, experiences and best practices. Key challenges highlighted include shifts in malaria transmission seasons, disease spread to mid-altitude regions, and infrastructure damage from extreme weather. Additional factors, such as drug and insecticide resistance, the spread of Anopheles stephensi , and changes in vector behaviour, are exacerbating malaria transmission in African cities. Participants stressed the need for collaborative efforts to tackle these evolving threats. This comment reflects the expertise and insights of 19 NMCPs actively managing malaria control and aims at raising awareness, inform policy discussions, and strengthen global partnerships to address the intersection of malaria and climate change.

IntroductionEmpirical, observational data relating to the diagnosis, management and outcome of three common worldwide cancers requiring surgery is lacking. However, it has been demonstrated that patients in low/middle-income countries undergoing surgery for cancer are at increased risk of death and major complications postoperatively. This study aims to determine quality and outcomes in breast, gastric and colorectal cancer surgery across worldwide hospital settings.Methods and analysisThis multicentre, international prospective cohort study will be undertaken by any hospital providing emergency or elective surgical services for breast, gastric or colorectal cancer. Centres will collect observational data on consecutive patients undergoing primary emergency or elective surgery for breast, gastric or colorectal cancer during a 6-month period. The primary outcome is the incidence of mortality and major complication rate at 30 days after cancer surgery. Infrastructure and care processes in the treatment of these cancers worldwide will also be characterised.Ethics and disseminationThis project will not affect clinical practice and has been classified as clinical audit following research ethics review. The protocol will be disseminated through the international GlobalSurg network.Trial registration number NCT03471494; Pre-results.