PREVALENCE AND RISK FACTORS OF MALARIA AMONG CHILDREN IN SOUTHERN HIGHLAND RWANDA

Thursday, 16th of January 2014

PREVALENCE AND RISK FACTORS OF MALARIA AMONG CHILDREN IN SOUTHERN HIGHLAND RWANDA

Jean-Bosco Gahutu1*†, Christian Steininger2†, Cyprien Shyirambere1, Irene Zeile2, Neniling Cwinya-Ay1, Ina Danquah2, Christoph H Larsen3, Teunis A Eggelte4, Aline Uwimana5, Corine Karema5, Andre Musemakweri1, Gundel Harms2 and Frank P Mockenhaupt2

* Corresponding author: Jean-Bosco Gahutu jgahutu@nur.ac.rw

† Equal contributors

Author Affiliations

1 Butare University Teaching Hospital, Faculty of Medicine, National University of Rwanda, Butare, Rwanda

2 Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany

3 German Development Cooperation (GIZ), Health Programme, Kigali, Rwanda

4 Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands

5 National Malaria Control Programme/Malaria Unit, TRAC Plus, Kigali, Rwanda

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Malaria Journal 2011, 10:134 doi:10.1186/1475-2875-10-134

The electronic version of this article is the complete one and can be found online at: http://www.malariajournal.com/content/10/1/134

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract below; full text as indicated above

Background

Increased control has produced remarkable reductions of malaria in some parts of sub-Saharan Africa, including Rwanda. In the southern highlands, near the district capital of Butare (altitude, 1,768 m), a combined community-and facility-based survey on Plasmodium infection was conducted early in 2010.

Methods

A total of 749 children below five years of age were examined including 545 randomly selected from 24 villages, 103 attending the health centre in charge, and 101 at the referral district hospital. Clinical, parasitological, haematological, and socio-economic data were collected.

Results

Plasmodium falciparum infection (mean multiplicity, 2.08) was identified by microscopy and PCR in 11.7% and 16.7%, respectively; 5.5% of the children had malaria. PCR-based P. falciparum prevalence ranged between 0 and 38.5% in the villages, and was 21.4% in the health centre, and 14.9% in the hospital. Independent predictors of infection included increasing age, low mid-upper arm circumference, absence of several household assets, reported recent intake of artemether-lumefantrine, and chloroquine in plasma, measured by ELISA. Self-reported bed net use (58%) reduced infection only in univariate analysis. In the communities, most infections were seemingly asymptomatic but anaemia was observed in 82% and 28% of children with and without parasitaemia, respectively, the effect increasing with parasite density, and significant also for submicroscopic infections.

Conclusions

Plasmodium falciparum infection in the highlands surrounding Butare, Rwanda, is seen in one out of six children under five years of age. The abundance of seemingly asymptomatic infections in the community forms a reservoir for transmission in this epidemic-prone area. Risk factors suggestive of low socio-economic status and insufficient effectiveness of self-reported bed net use refer to areas of improvable intervention.