Investigating the resurgence of malaria in Rwanda: factors contributing to rising cases amidst near-eradication success and strategies for sustained control.

Rwanda is experiencing impressive control of malaria, with a reduction in cases from 4.8 million in 2016/17 to 620 000 cases by 2023/24; however, a 45.8% increase in cases by 2024 indicates an upsurge. This review analyses the reasons for this rise, using 22 sources (16 peer-reviewed papers and 6 reports) from 2022 to 2025. Major contributing factors include meteorological changes that are widening the habitable range of Anopheles gambiae, the emergence of pyrethroid and artemisinin resistance (K13 mutations), suboptimal coverage of non-pyrethroid indoor residual spraying (IRS), poverty and nonadherence-related disparities, and human mobility that is enabling asymptomatic transmission. Rwanda's tentative success, with outbreaks at high altitudes and 87 000 cases in March 2024, exposes weaknesses. Suggested approaches for sustained control include community-delivered strategies using community health workers, drone-mediated larviciding (96.4% community acceptance), non-pyrethroid IRS, and screening for resistance. The 2025 Rwanda Malaria Strategic Plan highlights new drugs (dihydroartemisinin-piperaquine and artesunate-pyronaridine), regional cooperation, and partially subsidized insecticide-treated nets for at-risk populations. Gaps are Plasmodium vivax strategies, availability of funds, and evaluation of behavioral interventions. Elimination of lymphatic filariasis in Rwanda depends on multi-sectoral approaches that work to alleviate environmental, socioeconomic, and operational problems, cut down on recrudescence, and maintain sustained progress.