Rwanda Sounds the Alarm as Drug-Resistant Infections Surge, Threatening Children Most

Health experts in Rwanda have issued a stark warning on the growing threat of Antimicrobial Resistance (AMR), describing it as a “silent pandemic” that is already undermining health systems, endangering children, and threatening decades of medical progress. The call was made Friday during a national scientific conference on AMR convened by the Rwanda Biomedical Centre (RBC), the Rwanda Paediatric Association, and partners.

The one-day conference brought together pediatricians, clinicians, researchers and policymakers to discuss rising drug resistance, share the latest national AMR surveillance data, and outline urgent interventions needed to curb the crisis.

AMR Already Killing Rwandans and Rising Fast

Speaking at the event, Dr. Brian Chirombo, the World Health Organization (WHO) Country Representative, said AMR should no longer be viewed as a distant or future problem.

“AMR is one of the top global health threats. It is not something that is coming. It is here and now. It is damaging our health system, our food security, our environment, and our economies,” he said.

Globally, AMR was associated with nearly 5 million deaths in 2019, with 1.3 million directly caused by drug-resistant infections. Without immediate action, deaths are projected to double by 2050, while economic losses could surpass USD 100 trillion, a burden equivalent to the 2008 financial crisis.

Rwanda is not spared. According to WHO estimates cited in the meeting, Rwanda recorded over 8,000 AMR-associated deaths in 2021, including nearly 2,000 directly attributable to resistant pathogens.

Children Face the Highest Risk

Dr. Chirombo warned that AMR is especially catastrophic for children, particularly newborns, calling it a “hidden crisis within a silent pandemic.”

In 2022 alone, more than 3 million children worldwide died from infections linked to AMR, with Africa carrying one of the heaviest burdens. First-line neonatal antibiotics such as ampicillin and gentamicin are losing their effectiveness, forcing clinicians to rely on broader-spectrum antibiotics that accelerate resistance further.

“Losing these antibiotics would be catastrophic,” he emphasized. “New antibiotics are extremely difficult and expensive to develop. If we lose the ones we have, we have no backup.”

Rwanda Expands Lab Capacity to Detect Resistance

RBC’s Dr. Noel Gahamanyi, Director of the Microbiology Unit, said Rwanda has significantly expanded its bacteriology capacity from only a few labs concentrated in Kigali to 19 operational laboratories nationwide, including district hospitals in Eastern, Western, Northern, and Southern provinces.

These labs now provide essential bacteriology services, enabling clinicians to verify infections before prescribing antibiotics and helping reduce dangerous empirical prescribing.

However, Dr. Gahamanyi warned that resistance is already widespread in Rwanda.

“Sometimes we receive samples and find bugs resistant to all antibiotics we test. It is extremely frustrating to tell a clinician there is no available drug for their patient.”

He recalled the case of a four-year-old child hospitalized for months after sustaining burns, whose bacterial infection resisted all available antibiotics until clinicians attempted a rare combination approach.

Drivers of Over-Prescription: Pressure, Experience, and System Gaps

A study presented by Dr. Christian Umuhoza, Pediatric Emergency Unit Manager at CHUK, revealed that while clinicians are aware of AMR risks, many still prescribe antibiotics before receiving lab results, often due to pressure, workload, and diagnostic delays.

New findings reveal widespread gaps in antibiotic prescribing practices, with 85% of prescribers initiating antibiotics before receiving laboratory results and 90% depending primarily on clinical experience rather than microbiological evidence. The study also shows that 34.6% of clinicians prescribe antibiotics due to patient pressure, highlighting the influence of public expectations on treatment decisions.

A persistent lack of rapid diagnostic tests forces many healthcare providers to rely only on symptoms, which may not necessarily indicate bacterial infections, while high patient loads, sometimes reaching 30 to 40 patients per shift, push clinicians toward quick empirical decision-making.

Dr. Umuhoza warned that the trend could be worse in private clinics, where patient pressure and expectations tend to be higher.

One Health and Stewardship: Rwanda’s Path Forward

Experts emphasized that AMR requires a multisectoral One Health approach, engaging human health, animal health and environmental sectors, given the widespread misuse of antibiotics in agriculture, livestock, and community settings.

In response to these challenges, the World Health Organization (WHO) has recommended several urgent steps to curb antimicrobial resistance. These include strengthening national AMR surveillance systems and improving data sharing across health facilities. WHO also emphasizes the need to improve infection prevention and control (IPC), particularly in neonatal and pediatric units, and to expand vaccination programs to reduce infection rates and the resulting demand for antibiotics.

Additionally, WHO urges countries to ensure functional antimicrobial stewardship programs in all hospitals to regulate the use of Watch and Reserve antibiotics, expand laboratory capacity, and shorten diagnostic turnaround times. With donor support declining, WHO calls for increased domestic financing to sustain AMR response efforts.

The conference concluded with a call for coordinated action from policymakers, clinicians, veterinarians, farmers, and the public.

“No matter what one’s role is, doctor, farmer, policymaker, every action counts,” Dr. Chirombo said. “We must protect our present and secure our future. Together we can keep antimicrobials effective and build a healthier, more sustainable world.”