Abstract
BackgroundBased on routine health facility case data, Rwanda has achieved a significant malaria burden reduction in the past ten years. However, community-based malaria parasitaemia burden and reasons for continued residual infections, despite a high coverage of control interventions, have yet to be characterized. Measurement of malaria parasitaemia rates and evaluation of associated risk factors among asymptomatic household members in a rural community in Rwanda were conducted.MethodsA malariometric household survey was conducted between June and November 2013, involving 12,965 persons living in 3,989 households located in 35 villages in a sector in eastern Rwanda. Screening for malaria parasite carriage and collection of demographic, socio-economic, house structural features, and prior fever management data, were performed. Logistic regression models with adjustment for within- and between-households clustering were used to assess malaria parasitaemia risk determinants.ResultsOverall, malaria parasitaemia was found in 652 (5%) individuals, with 518 (13%) of households having at least one parasitaemic member. High malaria parasite carriage risk was associated with being male, child or adolescent (age group 4–15), reported history of fever and living in a household with multiple occupants. A malaria parasite carriage risk-protective effect was associated with living in households of, higher socio-economic status, where the head of household was educated and where the house floor or walls were made of cement/bricks rather than mud/earth/wood materials. Parasitaemia cases were found to significantly cluster in the Gikundamvura area that neighbours marshlands.ConclusionOverall, Ruhuha Sector can be classified as hypo-endemic, albeit with a particular ‘cell of villages’ posing a higher risk for malaria parasitaemia than others. Efforts to further reduce transmission and eventually eliminate malaria locally should focus on investments in programmes that improve house structure features (that limit indoor malaria transmission), making insecticide-treated bed nets and indoor residual spraying implementation more effective.
Highlights
Based on routine health facility case data, Rwanda has achieved a significant malaria burden reduction in the past ten years
This paper describes a communitybased, malariometric survey to measure baseline parasite carriage rates and to study associated risk factors of residual malaria parasitaemia in order to optimize malaria control interventions targeted to specific local needs
HH ownership of ≥ one LLIN was 92.9% and the proportion of HHs where indoor residual spraying (IRS) had been conducted within 12 months prior to survey was 94.5%
Summary
Based on routine health facility case data, Rwanda has achieved a significant malaria burden reduction in the past ten years. Significant decline in malaria burden, attributed to scale-up of interventions including indoor residual spraying (IRS), insecticide-treated bed nets (predominantly long-lasting insecticide-treated net (LLIN) type) and use of artemisinin combination therapy (ACT) after confirmed diagnosis with microscopy or rapid diagnostic tests (RDTs), have been widely reported in multiple malaria-endemic countries, including Rwanda, during the last decade [1,2] Following these gains, a new ‘Rwanda malaria control strategic plan 2013-2018’, aiming at achieving malaria pre-elimination status, with near-zero deaths from malaria and a slide positivity rate less than 5% among fever cases by 2018, is being finalized [3]. No study has been published on understanding malaria reservoirs and associated risk determinants in Rwanda
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