William Brieger, Corine Karema and Beata Mukarugwiro from Jhpiego/MCHIP and the Malaria and Other Parasitic Diseases Program of the Rwanda Ministry of Health reported on the prevalence of malaria in pregnancy in Rwanda as the country moves toward elimination at the MIM2013 6th Pan-African Malaria Conference in Durban.
Through universal coverage of long-lasting insecticide treated nets and access to artemisinin based combination treatment Rwanda has achieved a national malaria prevalence estimated at 1.4% among children aged 6-59 months and 0.7% among women aged 15-49 years (2010 DHS). Slide positivity rates at health centers have dropped over 85% since 2005, and yet malaria persists.
Pregnant women remain vulnerable. While Rwanda no longer practices IPTp, it is interested in offering the best malaria protection to pregnant women. In order to plan appropriately, there was need for a malaria in pregnancy prevalence study.
Pregnant women were studied at first ANC registration in 38 health centers in two districts each of low, moderate and relatively higher malaria transmission areas (as determined by health information system laboratory reports) using microscopy, rapid diagnostic test (RDT) and polymerase chain reaction (PCR). Ethical clearance was provided by the ethical review board within the Ministry of Health.
ANC staff were trained to obtain data during normal client visits. RDTs were performed by the ANC staff. They also prepared blood slides to be analyzed in health center laboratories and PCR papers that were analyzed at the Johns Hopkins Bloomberg School of Public Health. Information on parity, age, bednet use, anemia, HIV status and fever were normally collected for ANC records and also recorded on project data forms.
Among 3,781 women studied, malaria prevalence with microscopy was 1.6%, RDT was 2.4%, and PCR was 5.6%. Negative tests were associated with LLIN use the night before. Positive tests were associated with anemia, but none of the other variables. The highest positivity for all three tests (4.5%, 6.9% and 12.5% respectively) was in the designated high prevalence districts on the eastern border of the country.
Results show that even with low apparent levels of malaria, health services need to continue to protect pregnant women and their unborn children in Rwanda through consistent use of LLINs and identification and tracking women with anemia. Cross-border collaboration will also be needed to prevent reintroduction of the disease as the country moves towards elimination.