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.
Conclusion 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
