title: Malaria, anaemia and nutritional status among schoolchildren in relation to ecosystems, livelihoods and health systems in Kilosa District in central Tanzania.
abstract: BACKGROUND
  Malaria prevalence and transmission intensity in Tanzania is heterogeneous with spatial and temporal variations between geographical areas and ecological systems. The objective of this study was to determine the prevalence of malaria, anaemia and nutritional status in relation to livelihoods, ecosystem and health systems in Kilosa District in central Tanzania.
  
  
  METHODS
  This study was conducted in four villages, two characterised by rice irrigation ecosystem and the other two by dry savannah ecosystem and pastoral livelihoods. In each ecosystem, one of the villages had a healthcare facility. Schoolchildren were screened for malaria infection using malaria rapid diagnostic test (mRDT) and microscopy and they were assessed for their anaemia and nutritional statuses.
  
  
  RESULTS
  A total of 1,019 school children (age = 4-16 years) were screened for malaria infection. The overall prevalence of Plasmodium falciparum infection was 10.6% and 4.5% by mRDT and microscopy, respectively. Children from pastoral villages had lower (2.9%) prevalence of malaria than their counterparts (18.2%) in the rice irrigation villages. A significantly high risk of malaria was observed among children in rice irrigation than in the pastoral ecosystem (OR: 0.13; 95%CI 0.07, 0.23). Children living in areas with health care facilities had a low odd of malaria infection by 45% (OR: 0.55; 95% CI = 0.35, 0.86). Overall, the prevalence of anaemia in the district was 43.4% (n = 775); and 58.3% of those with severe anaemia were among children from the pastoral villages. Anaemia was significantly higher among children not using mosquito nets (p = 0.049); and among those with malaria infection (p <0.001). The majority (96%) of the children had Body Mass Index less than 18.5 kg/m(2) which indicate high proportion of underweight.
  
  
  CONCLUSIONS
  There are significant variations in the risk of acquiring malaria infection between different ecosystems and livelihoods. These findings suggest that malaria control programmes must take into account ecosystems and livelihoods of the targeted population through an integrated management of malaria and nutrition approach.
authors.affiliation: National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania. lmboera@nimr.or.tz.
authors.forename: Leonard E G
authors.initials: LE
authors.lastname: Mboera
authors.affiliation: National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania. vbwana@nimr.or.tz.
authors.forename: Veneranda M
authors.initials: VM
authors.lastname: Bwana
authors.affiliation: National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania. srumisha@nimr.or.tz.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Rumisha
authors.affiliation: National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania. r_malima@hotmail.com.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Malima
authors.affiliation: Sokoine University of Agriculture, Chuo Kikuu, Morogoro, Tanzania. mrsmlozi@yahoo.com.
authors.forename: Malongo R S
authors.initials: MR
authors.lastname: Mlozi
authors.affiliation: National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania. benjaminmayala@yahoo.com.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Mayala
authors.affiliation: National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania. gstanley@nimr.or.tz.
authors.forename: Grades
authors.initials: G
authors.lastname: Stanley
authors.affiliation: National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania. tmlacha@gmail.com.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Mlacha
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D017753:Ecosystem; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000175:diagnosis; D008297:Male; D008483:Medical Assistance; D057147:Mosquito Nets; D009752:Nutritional Status; D015995:Prevalence; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology