title: Asymptomatic only at first sight: malaria infection among schoolchildren in highland Rwanda.
abstract: BACKGROUND
  Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections.
  
  
  METHODS
  In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6-10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio-economic and behavioural parameters as well as medical histories were obtained.
  
  
  RESULTS
  Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of -1.2 g/dL; 95% CI, -0.8 to -1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection.
  
  
  CONCLUSIONS
  Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Sifft
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Geus
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Caritas
authors.initials: C
authors.lastname: Mukampunga
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Mugisha
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Felix
authors.initials: F
authors.lastname: Habarugira
authors.affiliation: Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
authors.forename: Kira
authors.initials: K
authors.lastname: Fraundorfer
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Claude
authors.initials: C
authors.lastname: Bayingana
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Jules
authors.initials: J
authors.lastname: Ndoli
authors.affiliation: Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Irenee
authors.initials: I
authors.lastname: Umulisa
authors.affiliation: Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.|Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.affiliation: Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
authors.forename: George
authors.initials: G
authors.lastname: von Samson-Himmelstjerna
authors.affiliation: Mycotic and Parasitic Agents and Mycobacteria, Department of Infectious Diseases, Robert Koch-Institute, Berlin, Germany.
authors.forename: Toni
authors.initials: T
authors.lastname: Aebischer
authors.affiliation: Institute for Clinical Epidemiology and Applied Biometry, University Hospital, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Augustin
authors.initials: A
authors.lastname: Sendegeya
authors.affiliation: University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda.
authors.forename: Jean Bosco
authors.initials: JB
authors.lastname: Gahutu
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany. frank.mockenhaupt@charite.de.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Mockenhaupt
mesh_terms: D058070:Asymptomatic Diseases; D002648:Child; D003430:Cross-Sectional Studies; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D015995:Prevalence; D012432:Rwanda / Q000453:epidemiology; D012574:Schools; D013334:Students