Malaria has no effect on birth weight in Rwanda

doi:10.1186/1475-2875-8-194

Malaria Journal

Volume 8

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Rulisa S
Mens PF
Karema C
Schallig HD
Kaligirwa N
Vyankandondera J
de Vries PJ

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Mens PF
Karema C
Schallig HD
Kaligirwa N
Vyankandondera J
de Vries PJ
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Research

Malaria has no effect on birth weight in Rwanda

Stephen Rulisa¹^,2 , Pètra F Mens²^,3 , Corine Karema⁴ , Henk DFH Schallig²^,3 , Nadine Kaligirwa²^,4 , Joseph Vyankandondera¹ and Peter J de Vries²^,5

¹National University of Rwanda, Kigali University Teaching Hospital, BP 655, Kigali, Rwanda

²Center for Infection and Immunity Amsterdam, Center for Poverty Related Communicable Diseases (CPCD), Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands

³Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands

⁴Center for Treatment and Research on AIDS, Malaria and TB (TRAC-PLUS) BP 2717, Kigali Rwanda

⁵Academic Medical Center, Division of Infectious Diseases, Tropical Medicine and AIDS, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands

author email corresponding author email

Malaria Journal 2009, 8:194doi:10.1186/1475-2875-8-194


Published:	10 August 2009

Abstract

Background

Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, the incidence decreased over the last six years (2002–2007). Therefore, the impact of malaria on birth outcomes is also expected to vary over time and space.

Methods

Obstetric indicators (birth weight and pregnancy outcome) and malaria incidence were compared and analyzed to their association over time (2002–2007) and space. Birth data from 12,526 deliveries were collected from maternity registers of 11 different primary health centers located in different malaria endemic areas. Malaria data for the same communities were collected from the National Malaria Control Programme. Associations were sought with mixed effects models and logistic regression.

Results

In all health centres, a significant increase of birth weight over the years was observed (p < 0.001) with a significant seasonal fluctuation. Malaria incidence had no significant effect on birth weight. There was a slight but significant decreasing effect of malaria incidence on the occurrence of premature delivery (p-value 0.045) and still birth (p-value 0.009). Altitude showed a slight but significant negative correlation with birth weight. Overall, a decrease over the years of premature delivery (p = 0.010) and still birth (p = 0.036) was observed.

Conclusion

In Rwanda, birth weight and pregnancy outcome are not directly influenced by malaria, which is in contrast to many other studied areas. Although malaria incidence overall has declined and mean birth weight increased over the studied period, no direct association was found between the two. Socio-economic factors and improved nutrition could be responsible for birth weight changes in recent years.