title: Malaria, anaemia and under-nutrition: three frequently co-existing conditions among preschool children in rural Rwanda.
abstract: BACKGROUND
  Malaria, anaemia and under-nutrition are three highly prevalent and frequently co-existing diseases that cause significant morbidity and mortality particularly among children aged less than 5 years. Currently, there is paucity of conclusive studies on the burden of and associations between malaria, anaemia and under-nutrition in Rwanda and comparable sub-Saharan and thus, this study measured the prevalence of malaria parasitaemia, anaemia and under-nutrition among preschool age children in a rural Rwandan setting and evaluated for interactions between and risk determinants for these three conditions.
  
  
  METHODS
  A cross-sectional household (HH) survey involving children aged 6-59 months was conducted. Data on malaria parasitaemia, haemoglobin densities, anthropometry, demographics, socioeconomic status (SES) and malaria prevention knowledge and practices were collected.
  
  
  RESULTS
  The prevalences of malaria parasitaemia and anaemia were 5.9 and 7.0 %, respectively, whilst the prevalence of stunting was 41.3 %. Malaria parasitaemia risk differed by age groups with odds ratio (OR) = 2.53; P = 0.04 for age group 24-35 months, OR = 3.5; P = 0.037 for age group 36-47 months, and OR = 3.03; P = 0.014 for age group 48-60 months, whilst a reduced risk was found among children living in high SES HHs (OR = 0.37; P = 0.029). Risk of anaemia was high among children aged ≥12 months, those with malaria parasitaemia (OR = 3.86; P ≤ 0.0001) and children living in HHs of lower SES. Overall, under-nutrition was not associated with malaria parasitaemia. Underweight was higher among males (OR = 1.444; P = 0.019) and children with anaemia (OR = 1.98; P = 0.004).
  
  
  CONCLUSIONS
  In this study group, four in 10 and one in 10 children were found stunted and underweight, respectively, in an area of low malaria transmission. Under-nutrition was not associated with malaria risk. While the high prevalence of stunting requires urgent response, reductions in malaria parasitaemia and anaemia rates may require, in addition to scaled-up use of insecticide-treated bed nets and indoor residual insecticide spraying, improvements in HH SES and better housing to reduce risk of malaria.
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. fkkateera@yahoo.com.|Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. fkkateera@yahoo.com.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kateera
authors.affiliation: Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. cingabire7@gmail.com.
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ingabire
authors.affiliation: Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda. ehakizimana@gmail.com.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hakizimana
authors.affiliation: Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. perfect.karinda@gmail.com.
authors.forename: Parfait
authors.initials: P
authors.lastname: Kalinda
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. p.mens@kit.nl.|Royal Tropical Institute, Koninklijk Instituut voor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands. p.mens@kit.nl.
authors.forename: Petra F
authors.initials: PF
authors.lastname: Mens
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. m.p.grobusch@amc.uva.nl.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.affiliation: College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. lmutesa@gmail.com.
authors.forename: Leon
authors.initials: L
authors.lastname: Mutesa
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. m.vanvugt@amc.uva.nl.
authors.forename: Michèle
authors.initials: M
authors.lastname: van Vugt
mesh_terms: D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology; D018512:Parasitemia / Q000453:epidemiology* / Q000469:parasitology; D015995:Prevalence; D018570:Risk Assessment; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology