In Burundi, malaria has been the leading cause of hospitalization and death among young children for years. To reduce the risks and consequences of this life-threatening disease, Doctors Without Borders/Médecins Sans Frontières (MSF) has introduced an innovative “triple protection” approach in one of the country’s most affected regions.
Several million malaria cases are reported each year in Burundi, a country of around 14 million people. According to the World Health Organization (WHO), more than 1,800 malaria-related deaths were recorded in 2023, mainly among children under the age of 5.
Geographical, climatic, ecological, health, and socio-economic factors all contribute to the endemic nature and scale of the disease. To combat it, health authorities and their partners have been implementing various strategies over the years: mosquito net distribution, preventive treatments, indoor spraying, and—since the end of 2024—the introduction of malaria vaccination.
Combining approaches for better protection
MSF and the Ministry of Health have launched a unique initiative in the country that combines three preventive measures on a large scale, simultaneously, in Cibitoke, one of the health districts most affected by malaria. Nearly 17,900 children are covered by the program.
“This district is among those with the highest number of malaria cases and deaths, and our teams have already intervened there in emergencies to respond to outbreaks,” explains Zakari Moluh, MSF project coordinator in Cibitoke. “To provide a more sustainable response, we proposed a pilot approach to the authorities: protecting all children through malaria vaccination, long-term preventive treatment, and the provision of insecticide-treated mosquito nets, all at the same time.” The aim is to drastically reduce the incidence of malaria among young children through the combined effect of these three interventions.
“Vaccination and preventive treatment reinforce each other to ensure optimal effectiveness,” continues Zakari Moluh. “By adding physical protection through mosquito nets, we aim to provide the best possible defense for children under 5—the most vulnerable age group.”
A valuable and inexpensive strategy
Across Cibitoke, MSF teams are supporting 20 health centers, where each child receives four doses of the RTS,S malaria vaccine between the ages of six and 18 months. At the time of the first vaccination, the family is given an insecticide-treated mosquito net. Between the ages of nine and 24 months, these children also receive additional protection in the form of sulfadoxine/pyrimethamine tablets, known as “perennial malaria chemoprevention.”
At the Kaburantwa Medical Center, one of the facilities MSF supports as part of this program, a long line of parents waiting outside reflects their eagerness to protect their children.
“When he was younger, my son often suffered from malaria,” says Claudine Tuyishimire as she leaves the center after having her youngest child, nine-month-old Fanny, vaccinated. “He was even hospitalized and had to receive a blood transfusion. When they explained the protection available today, I didn’t hesitate. I came straight away. Thanks to this, children will rarely fall ill, and parents will no longer have to come to the hospital so often.”
Across all the centers involved in implementing this approach, the enthusiasm is similar. Waiting rooms remain full. This high turnout is also the result of awareness and follow-up campaigns conducted by community health workers among families and associations, particularly women’s groups.
“The scale of the problem, as well as the costs the disease imposes on households, are generating strong enthusiasm within communities,” explains Adélaïde Ouabo, MSF country coordinator in Burundi. “The medical costs of treating malaria—especially in its severe forms—are a heavy burden on families and on the Burundian health system. These massive costs contrast with the low investment required to implement the triple protection strategy.”
MSF's work with the Ministry of Health in Cibitoke shows that implementing this system is both simple and inexpensive compared to the benefits it brings. Malaria vaccination and mosquito net distribution are already integrated into the health system, and preventive treatment drugs are low-cost. The approach is therefore easily absorbed by the health system and replicable elsewhere in the country.
The ongoing need for malaria treatment
The strategy already appears to be yielding strong results. MSF teams have observed a significant decrease in malaria admissions since the third quarter of 2025, compared to the same period last year—especially for severe malaria cases at Cibitoke District Hospital, which saw a drop of over 40 percent.
However, to scientifically evaluate the precise impact of this combination of interventions on malaria reduction, a dedicated MSF team has been conducting operational research for several months. The results will inform the Burundian health authorities and technical partners on the effectiveness of this approach, helping them make the best choices for their malaria control strategies.
“In a context of resource rationing, linked to the overall decline in humanitarian funding, making the most effective and scientifically proven choices is absolutely essential,” says Ouabo. “We are happy to contribute to this effort.”
While strengthening prevention is the core objective of MSF’s project, the urgent need to treat children with malaria remains. MSF teams continue to support the health authorities in providing care.
In villages, MSF-trained community health workers can quickly detect malaria symptoms, perform rapid diagnostic tests, and administer treatment if the result is positive.
When more serious cases are identified, they are referred to one of the MSF-supported health centers, where medical supervisors help strengthen care delivery. In emergencies, an ambulance is available to transfer patients to the district hospital in Cibitoke. There, MSF teams support the management of the most complex pediatric and intensive care cases, with staff dedicated to training and mentoring local doctors and nurses.
