title: Malaria parasite carriage and risk determinants in a rural population: a malariometric survey in Rwanda.
abstract: BACKGROUND
  Based 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Overall, 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.
  
  
  CONCLUSIONS
  Overall, 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.
authors.affiliation: Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1100 DE, The Netherlands. fkkateera@yahoo.com.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kateera
authors.forename: Petra F
authors.initials: PF
authors.lastname: Mens
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hakizimana
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ingabire
authors.forename: Liberata
authors.initials: L
authors.lastname: Muragijemariya
authors.forename: Parfait
authors.initials: P
authors.lastname: Karinda
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.forename: Leon
authors.initials: L
authors.lastname: Mutesa
authors.forename: Michèle
authors.initials: M
authors.lastname: van Vugt
mesh_terms: D000293:Adolescent; D000328:Adult; D002353:Carrier State / Q000453:epidemiology* / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003625:Data Collection; D005191:Family Characteristics; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010961:Plasmodium / Q000302:isolation & purification*; D012307:Risk Factors; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult