title: Malaria infection among pregnant women attending antenatal clinics in six Rwandan districts.
abstract: OBJECTIVE
  The aim of the study was to assess the knowledge, attitude and practices of pregnant women towards malaria and their association with malaria morbidity.
  
  
  METHODS
  Cross-sectional malaria survey of 1432 pregnant women attending six health centres, each of them situated in a specific health district in Rwanda from September to October 2002.
  
  
  RESULTS
  The overall prevalence of malaria infection was 13.6% and all infections but two were caused by Plasmodium falciparum. The six health districts were significantly different in terms of malaria prevalence, which varied between 11.5% and 15.4% in four and was <5% in the other two districts. The prevalence of anaemia and splenomegaly mirrored that of malaria infection. In three districts, the prevalence of infection was significantly higher in primigravidae than in secundigravidae and multigravidae (P = 0.01), while in two others it did not vary with parity. Bed net use was low - only 13.1% of the women had at least one bed net at home and 8.3% of them slept under it - and significantly different between districts. Most women knew that malaria might have serious consequences for their pregnancy and that insecticide-treated bed nets are useful for malaria prevention. However, the bed net market price [1525 Rwandan Francs (RFr), approximately 1.6] was much higher than that considered as affordable and acceptable (389 RFr, approximately 0.3).
  
  
  CONCLUSIONS
  Malaria in pregnancy is a major problem in Rwanda, even in the districts of low transmission. Bed net use among pregnant women is low. The option of providing free insecticide-treated bed nets to pregnant women should be explored and possibly implemented; it could rapidly increase bed net use and earlier attendance to antenatal clinics with clear benefits for the women's health.
authors.affiliation: Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. jpvangeertruyden@itg.be
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.forename: Dorothee
authors.initials: D
authors.lastname: Ntakirutimana
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.forename: Claude
authors.initials: C
authors.lastname: Rwagacondo
authors.forename: Augustin
authors.initials: A
authors.lastname: Kabano
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000469:parasitology; D001512:Bedding and Linens; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods*; D015995:Prevalence; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology
chemical_list: D007306:Insecticides