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. 2013 Jul 23;8(7):e69443.
doi: 10.1371/journal.pone.0069443. Print 2013.

Malaria prevalence, spatial clustering and risk factors in a low endemic area of Eastern Rwanda: a cross sectional study

Stephen Rulisa  1 , Fredrick Kateera, Jean Pierre Bizimana, Steven Agaba, Javier Dukuzumuremyi, Lisette Baas, Jean de Dieu Harelimana, Petra F Mens, Kimberly R Boer, Peter J de Vries
Affiliations

Malaria prevalence, spatial clustering and risk factors in a low endemic area of Eastern Rwanda: a cross sectional study

Stephen Rulisa et al. PLoS One. .

Abstract

Background: Rwanda reported significant reductions in malaria burden following scale up of control intervention from 2005 to 2010. This study sought to; measure malaria prevalence, describe spatial malaria clustering and investigate for malaria risk factors among health-centre-presumed malaria cases and their household members in Eastern Rwanda.

Methods: A two-stage health centre and household-based survey was conducted in Ruhuha sector, Eastern Rwanda from April to October 2011. At the health centre, data, including malaria diagnosis and individual level malaria risk factors, was collected. At households of these Index cases, a follow-up survey, including malaria screening for all household members and collecting household level malaria risk factor data, was conducted.

Results: Malaria prevalence among health centre attendees was 22.8%. At the household level, 90 households (out of 520) had at least one malaria-infected member and the overall malaria prevalence for the 2634 household members screened was 5.1%. Among health centre attendees, the age group 5-15 years was significantly associated with an increased malaria risk and a reported ownership of ≥4 bednets was significantly associated with a reduced malaria risk. At the household level, age groups 5-15 and >15 years and being associated with a malaria positive index case were associated with an increased malaria risk, while an observed ownership of ≥4 bednets was associated with a malaria risk-protective effect. Significant spatial malaria clustering among household cases with clusters located close to water- based agro-ecosystems was observed.

Conclusions: Malaria prevalence was significantly higher among health centre attendees and their household members in an area with significant household spatial malaria clustering. Circle surveillance involving passive case finding at health centres and proactive case detection in households can be a powerful tool for identifying household level malaria burden, risk factors and clustering.

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Conflict of interest statement

Competing Interests: All authors have declared: no support from any organization for this submitted work; no financial relationships with any organizations with possible interest in work submitted work; no other relationships or activities that could possibly influence this submitted work.

Figures

Figure 1
Figure 1. Location of Ruhuha Sector (Red), Bugesera District (Grey) in Rwanda.
Source: MINITRACO/CGIS-NUR, 2001 and NISR 2006.
Figure 2
Figure 2. Flow chart of study participant enrolment, malaria screening and participation in a two phase survey.
Figure 3
Figure 3. ¥ Spatial malaria clusters and location of Hhs.
(Yellow dots - control HH with no malaria infected case and small Red dots - case HH with at least one malaria infected case) in Ruhuha sector. ¥The used administrative boundaries and geographic features shape files were obtained from the Centre for Research and Training in GIS and Remote Sensing of the National University of Rwanda.
See this image and copyright information in PMC

References

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