Malaria remains a major public health problem in most tropical countries. It occasionally presents with both typical and atypical signs and symptoms. Gastrointestinal manifestations are common in malaria endemic areas but intestinal obstruction as a complication is extremely rare.Plasmodium falciparum malaria. He was successfully treated with both parenteral and orally administered antimalarial medication and the intestinal obstruction subsequently resolved.We present the case of a 42-year-old black African man who presented with signs and symptoms of intestinal obstruction and was diagnosed as having With intestinal obstruction being an important cause of morbidity and mortality, we report this case to highlight this rare complication of malaria and therefore increase physicians’ awareness and prompt diagnosis and management. Plasmodium falciparum  has been reported to be responsible for 90–95% of all cases of clinical malaria [Malaria is an endemic disease in sub-Saharan Africa. In Cameroon,  malaria . The cli malaria . The mai malaria . Gastroi malaria , 4. The A 42-year-old Cameroonian (black African) man with no relevant past medical history presented to our hospital with a 1-week history of fever and a 4-day history of no bowel movements. The fever was intermittent and worse in the evenings, and associated with headache, joint pains, and anorexia. He self-medicated an undocumented orally administered antimalarial medication but symptoms persisted. Three days later, he developed generalized abdominal pain, colicky in character, with a severity of 5/10 on a visual analogue scale. This was associated with progressive abdominal distension and an altered bowel pattern initially characterized by an inability to pass stool and flatus over 4 days but he denied any vomiting. A worsening of his symptoms prompted his visit to our hospital.On examination, his mucous membranes were dry, his conjunctivae were pink, and his vital signs were normal. His abdomen was mildly distended with mild diffuse tenderness. There was neither guarding nor rebound tenderness. Percussion note was tympanic and bowel sounds were hyperactive. His rectum was empty per digital rectal examination and his prostate was not enlarged. The rest of the physical examination was unremarkable.+) of 140 mmol/L, serum potassium ion (K+) of 4.0 mmol/L, serum chloride ion (Cl−) of 98 mmol/L, serum creatinine of 0.9 mg/dL, alanine aminotransferase was 41.2 U/L, aspartate aminotransferase was 33.0 U/L, total bilirubin was 0.81 mg/dL, and alkaline phosphatase was 55.9 U/L. His human immunodeficiency virus serology was non-reactive. His rapid antibody test for typhoid fever was also non-reactive. There was no significant air fluid level or increased bowel gas on a plain abdominal radiograph and an abdominal ultrasound revealed mild free intra-abdominal fluid in all four quadrants.A rapid diagnostic  test for malaria was positive. Also, his complete blood count values were within normal ranges: white blood cell count of 6200 cells/uL, hemoglobin of 12.5 g/dL, and platelet count of 222,000 cells/uL. His metabolic panel was within normal range: serum sodium ion  and intravenously administered crystalloids  and was placed on “nothing by mouth.” He passed a small quantity of feces 48 hours after initiation of antimalarial medication, with complete resolution of the abdominal pain, distension, and bowel movements on the fourth day of hospital stay. A stool examination was done with no organisms identified. We then concluded on a final diagnosis of sub-acute intestinal obstruction secondary to malaria. He was then discharged on an orally administered artemisinin-based antimalarial combination . His 2-week follow up was unremarkable.The key clinical feature in this case as evident from our patient’s history is that the symptoms and signs of malaria are vast and can mimic other disease processes. The classic presentation of paroxysms of fever associated with chills, rigors, anorexia, and arthralgia can precede other nonspecific symptoms such as abdominal pain, distension, and obstipation, therefore posing a diagnostic dilemma. With increasing resistance to antimalarial medications, which is principally due to the development of immunity and indiscriminate use of these medications as seen in our case presentation, these atypical presentations are becoming more frequent especially in malaria endemic regions .Atypical gastrointestinal complications of malaria include hepatic encephalopathy, fulminant hepatic failure, splenic rupture, acute pancreatitis, acalculous cholecystitis, duodenal perforation, gastroenteritis, and retroperitoneal lymphadenopathy . MalariaBowel obstruction can be dynamic  or adynamic . Functional obstruction may be characterized by absent peristalsis  or peristalsis can be present but in a non-propulsive form  due to aP. falciparum infection results in changes in the erythrocyte membranes, activating the coagulation cascade [P. falciparum infection, can result in microvascular obstruction and consequently result in bowel wall ischemia [P. falciparum [et al. in 2015 infected susceptible species of mice with Plasmodium berghei ANKA and found that infected mice had less content in the cecum and lower areas of the intestines than uninfected control mice did after 9 days of infection [P. falciparum infection, their findings can suggest that an infection with Plasmodium species can result in functional bowel obstruction due to bowel wall dysfunction from bowel wall ischemia.The precise mechanism through which malaria results in bowel disorders in both adults and children remains blurred. It has been stipulated that  cascade . This acischemia . Alternalciparum . Tanigucnfection . Also, tnfection . AlthougPlasmodium malaria may mimic bowel obstruction; therefore, in febrile patients presenting with symptoms and signs of bowel obstruction, especially in malaria endemic areas, work-up for malaria should be included in the basic investigations.The clinical course of severe


Differences in the production/maintenance of antibodies may be due to many factors including host genetics. This paper discusses the association of 4 anti-malarial antibodies with selected host genetic markers.Antibodies against the merozoite surface protein 1-19 and AMA1 for both vivax and falciparum malaria. 170 SNPs related to malaria were genotyped. Associations between seropositivity, antibody levels and genetic, non-genetic factors were determined.Blood was collected from individuals (n = 242) with a history of malaria within past 15 years for DNA and serum. ELISA was carried out for serum to determine the concentration of anti-malarial antibodies MSP1-19_Pv(rs739718); 4 SNPs with MSP1-19_Pf  and1 with AMA1_Pv (rs2075820). Eleven and 7 genotypes (out of 15) were significantly associated with either presence or absence of antibodies. Three SNPs were found to be significantly associated with the antibody levels viz. rs17411697 with MSP1-19_Pv, rs2227491 with AMA1_Pv and rs229587 with AMA1_Pf. Linkage of the markers in the two groups was similar, but lower LOD scores were observed in seropositives compared to seronegatives.Age ranged 13–74 years (mean age = 40.21 years). Majority were females. Over 90% individuals possessed either one or more type(s) of anti-malarial antibodies. Five SNPs were significantly associated with seropositivity. One SNP was associated with MSP1The study suggests that several SNPs in the human genome that exist in Sri Lankan populations are significantly associated with anti-malarial antibodies, either with generation and/or maintenance of antibodies for longer periods, which can be due to either individual polymorphisms or most probably a combined effect of the markers.The online version of this article (10.1186/s12936-018-2622-9) contains supplementary material, which is available to authorized users. Malaria is considered as one of the most prevalent infectious diseases in the world with high morbidity and mortality. However, several countries plagued with this infection for centuries, were able to eliminate it from its borders between 2007 and present date, i.e. Armenia, Maldives, Morocco, Turkmenistan and United Arab Emirates .Sri Lanka too joined the group of malaria–free countries in September 2016 when the World Health Organization (WHO) declared it a malaria-free nation , 4, resuNaturally acquired antibodies play a major role in protection against malaria. Anti-parasite immunity is complex and stage specific. Following exposure to the parasite, both innate and adaptive immune responses are triggered. Antibodies produced against the parasite antigens have a protective role on subsequent infections, i.e. repeated infections trigger immunity to uncomplicated as well as severe malaria . Further-19 (MSP1-19), which is a 195 kD protein on the surface of the merozoite, has been studied extensively as a vaccine candidate. Evidence from in vitro and challenge studies suggest that MSP1-19 might have an immunoprophylactic effect against malaria  genotyped.Additional file 2. Comparison of median antibody levels between the districts.Additional file 3. Frequency distribution of the antibodies in the study population and in each age group for the tested antibodies.Additional file 4. Minor allele frequencies of the SNPs significantly associated with presence of antibodies.


Plasmodium falciparum and Plasmodium vivax are co-endemic in Ethiopia, the use of primaquine is indicated for both transmission interruption and radical cure, respectively. However, the limited knowledge of the local prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency and its associated variants has hindered the use of primaquine.Building on the declining trend of malaria in Ethiopia, the Federal Ministry of Health aims to eliminate malaria by 2030. As Some 11,138 dried blood spot (DBS) samples were collected in 2011 as part of a national, household Malaria Indicator Survey, a multi-stage nationally representative survey of all malaria-endemic areas of Ethiopia. A randomly selected sub-set of 1414 DBS samples was successfully genotyped by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) technique. Considering the geographical position and ethnic mix of the country, three common variants: G6PD*A (A376G), G6PD*A− (G202A) and Mediterranean (C563T) were investigated.Of the 1998 randomly selected individuals, 1429 (71.5%) DBS samples were genotyped and merged to the database, of which 53.5% were from females. G6PD*A (A376G) was the only genotype detected. No sample was positive for either G6PD*A− (G202A) or Mediterranean (C563T) variants. The prevalence of G6PD*A (A376G) was 8.9% [95% confidence interval (CI) 6.7–11.2] ranging from 12.2% in the Southern Nations, Nationalities and Peoples’ (95% CI 5.7–18.7) to none in Dire Dawa/Harari Region.P. falciparum transmission interruption and radical cure of P. vivax in Ethiopia. As the presence of other clinically important, less common variants cannot be ruled out, the implementation of radical cure will be accompanied by active haematological and adverse events monitoring in Ethiopia.The common G6PD*A− (G202A) or Mediterranean (C563T) variants were not observed in this nationwide study. The observed G6PD*A (A376G) mutation has little or no clinical significance. These findings supported the adoption of primaquine for  Plasmodium falciparum  and Plasmodium vivax (36.3%) [P. falciparum malaria transmission and radical cure of P. vivax has the potential to accelerate malaria control and elimination efforts. Primaquine, an 8-aminoquinoline, is currently the only generally available drug for these indications in malaria endemic countries. The widespread use of primaquine has been limited due to its potential to induce haemolytic anaemia in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals. Haemolytic anaemia in G6PD-deficient individuals can range from mild to life-threatening conditions [P. vivax infections [In Ethiopia, malaria is caused by both  36.3%) . Due to  (36.3%) . A drug 6.3% . Dunditions . AnotherG6PD deficiency is an X-linked genetic disorder and it is estimated to affect more than 400 million people worldwide . It is oP. falciparum transmission reduction and P. vivax radical cure without prior G6PD testing, which will be crucial in achieving their vision. This study aimed to evaluate the genotypic prevalence of common G6PD deficiency allelic types in the general population residing in malaria-endemic areas of Ethiopia.Because of substantial progress made in malaria control, Ethiopia’s vision is to be malaria-free by 2030 –14. DeteDried blood spot (DBS) samples collected during the national Malaria Indicator Survey in 2011 (MIS 2011) were used for the current study. The MIS 2011 was a cross-sectional, multi-stage, representative household survey that produced national and sub-national estimates for malaria-endemic and malaria prone areas of Ethiopia . Using aA total of 11,138 DBS samples were collected and stored at − 20 °C as part of the MIS 2011 . RepreseBased on a review of the literature, the country’s geographic proximity to the Arabian peninsula and ethnic mix, the following three G6PD mutations common in Africa and the Mediterranean Regions were selected for genotyping: G6PD*A A376G), G6PD*A− (G202A) and Mediterranean (C563T) , 7, 17.6G, G6PD*A polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) technique was used for genotyping G6PD based on previous publications , 20 modiThree restriction endonuclease enzymes, FokI (G6PD*A (A376G)), NlaIII (G6PD*A− (G202A)) and MboII (Mediterranean (C563T)) , were used for the digestion of the amplified products Table . SamplesKnown blood samples archived at CDC, collected from a cross-sectional survey conducted in Kenya and a malaria in pregnancy project conducted in Malawi served as positive controls for G6PD*A (A376G) and G6PD*A− (G202A) (African type mutations). However, there were no positive controls used for Mediterranean (C563T) type mutations. Results with faint and intermediate bands were repeated by using the concentrated DNA samples to achieve more distinct test results. The testing was conducted at the Malaria and other Parasitic Diseases Research Team at the Ethiopian Public Health Institute; a sub-set of samples (10%) was genotyped at CDC Atlanta for quality assurance testing and training.Of the 1998 randomly selected samples, only 1641 (82.1%) DBS were found. DNA was extracted and successfully amplified from 1548 samples (94.3%). An additional 119 samples were not able to be merged to the original database, resulting in 1429 merged genotype outcomes and 1414 with valid genotype results (15 samples with unsatisfactory gel results after repeated attempts). Of all the samples analysed and merged to the database, 53.5% (764/1429) were from females.P. falciparum and 4 P. vivax).Figure Table Although not statistically significant, there was regional variation in the prevalence of the G6PD*A (A376G) mutation: the highest prevalence was observed in Southern Nations, Nationalities, and Peoples’ and Tigray Regions , compared to Dire Dawa and Harari where no G6PD mutations were observed (P = 0.278). The prevalence of G6PD*A (A376G) was 9.2% (95% CI 6.7–11.8) in areas with altitude less than 2000 m, and 7.9% (95% CI 2.4–13.4) in areas with altitude between 2000 and 2500 m above sea level (P = 0.403).In this nationally representative study, 8.9% of the samples were noted to carry the G6PD*A (A376G) variant; the clinically relevant variants of G6PD*A− (G202A) and Mediterranean C563T) were not observed. Although the more clinically important type G6PD*A− (G202A) is found in a sub-set of individuals with the G6PD*A (A376G) variant in other studies 63T were , 23, nonThe results are consistent with prior evidence of low G6PD deficiency prevalence in Ethiopia –11, 25. There are several limitations to this evaluation. First, the large sample loss (29.2%) mainly due to not being able to locate the corresponding DBS, is a major limitation, although there is likely little or no systematic bias introduced in this random loss. Second, the current study only tested for three common variants of the hundreds of known G6PD variants . The curP. falciparum. In addition, they are adopting a policy for the first time in decades of primaquine use for radical cure of P. vivax infections without G6PD testing, starting in low transmission highland districts with directly observed therapy and close supervision [P. vivax malaria without G6PD testing. The safety of implementing this policy will be evaluated through active adverse events and haematological monitoring using a standardized approach with common endpoints [P. vivax case management landscape evolves to incorporate developing regions in the lowlands, new evidence around higher dose and shorter course of primaquine and as new point-of-care, quantitative G6PD diagnostics and tafenoquine become available [No common, G6PD deficiency variants (G6PD *A−) and Mediterranean (C563T) were found in this nationwide study. Following a review of the data from prior studies and the current study, the Federal Ministry of Health has adopted the addition of single low dose primaquine for transmission reduction of ervision . Ethiopindpoints . The risvailable –35.


Agro-ecological systems have been associated with increased malaria intensity. This study determined association between different agro-ecological systems, prevalence of malaria parasitaemia and anaemia in Mvomero district, Tanzania.The study was carried out in three agro-ecosystems namely, savannah, rice-irrigation, and sugarcane. Malaria and anaemia prevalence were measured in four seasons of a year. Villages were categorized according to environmental characteristics, proportion of water-shaded areas and agro-ecosystems. Mixed-effects logistic regression analysis was used to determine factors associated with malaria infection.Plasmodium falciparum was the dominant (99.52%) malaria species. Malaria prevalence was highest (42.9%) in children of 10–15 years of age, and significantly low during dry and hot season. Of the infected individuals, 78.1% were from rice-irrigation, 18.7% savannah and 3.2% sugarcane ecosystem. Individuals living in villages with high levels of water-shaded areas had highest malaria risk. Over three-quarters (78.9%) of the individuals slept under a mosquito net, with the highest (88.5%) coverage among individuals in sugarcane ecosystem. On average 47.1% of the children were anaemic. Anaemia was more prevalent (60.5%) among individuals in the savannah than in the rice-irrigation (48.2%) or sugarcane communities (23%). Analysis indicated that ecosystems and levels of water-shaded area were highly correlated, and altered levels of malaria infection. Gender, age, mosquito net-use, and season were other significant determinants of P. falciparum infection. Males had higher odds than females . The risk for children 6–9 years and older children (10–15 years) was over 50% and 24%, respectively, higher compared to young ones (0–5 years). Use of mosquito net reduced malaria risk by 26%. The risk of infection was higher during dry and cool season  compared to other seasons. Living in villages with high level of water-shaded areas increased the chances of getting malaria up to 15 times than living in drier areas. Similarly, infection odds increased when living in savannah and rice-irrigation ecosystems than in the sugarcane ecosystem.A total of 7888 individuals were involved with the overall malaria prevalence of 34.4%. Findings show significant variations in malaria prevalence between communities living in different agro-ecosystems within the same district. Local malaria control strategies should consider these variations and liaise with agricultural experts while designing interventions to maximize effectiveness. Malaria remains a major public health problem in the tropic and sub-tropic regions, with approximately 216 million cases and half a million deaths reported annually –6. TanzaAnopheles gambiae which is the main malaria vector [Anopheles funestus [The prevalence and incidence of malaria vary from place to place and times of the year. Both climatic and non-climatic factors affect malaria transmission. Climatic factors, including temperature, rainfall and relative humidity, greatly influence the pattern and levels of malaria –18. Non-a vector , 36, whifunestus . Moreovefunestus –41.Like in most African countries, over two-third of the population in Tanzania lives in rural areas, where majority are involved in agricultural activities , 42. ComThis study was carried out in Mvomero district in east-central Tanzania. The district is located between latitudes 5–8°S and longitudes 37–39°E, and lies on the foothills of Nguru Mountains to the north-west and Uluguru Mountains to the south-east. The area lies on the Wami River basin. Most of the inhabitants (80%) earns their livelihoods from agriculture. The main economic activities include rice farming, sugarcane plantations and livestock production. Administratively the district is divided into four divisions, 30 wards and 101 villages. Total human population is estimated at 312, 109 with an average growth rate of 2.6% . RainfalTwo divisions, namely Mvomero and Turiani, lying at 293–379 m above sea level were selected for the study. Within the division, seven villages  characterized by three agro-ecosystems, savannah, rice-irrigation and sugarcane plantation were included in the study Fig. . The agrThis was a cross-sectional survey conducted in 4 phases during four climatic seasons of August (dry and cool season) 2004, November 2004 (short rains), February 2005 (dry and hot season) and May 2005 (long rains) ; Dihombo, Luhindo, Dakawa (medium to low level) and Mtibwa (dry land). The study area characteristics have been extensively described elsewhere [Environment assessment survey was conducted in all seven villages. Departments of Land, Natural Resources and Agriculture were consulted and discussions were held. Physical visits and observations were made to the study villages. Information documented include land use and land cover patterns, i.e. farming systems (crop/livestock production), infrastructure, natural resources, water sources and reservoir, ecosystems, water-shaded, type of houses, environmental cleanliness and weather patterns. Water-shaded area was defined as those reported to hold standing water continuously for 4 to 6 months a year. It is a proxy for surface water availability at micro-level—which is associated with providing conducive mosquito breeding sites. Results of the environmental assessment were used to stratify the study area into three agro-ecosystems; (i) savannah, including the villages of Luhindo and Dakawa; (ii) rice-irrigation which comprised Dihombo, Mkindo, Komtonga and Mbogo; and (iii) sugarcane plantations in Mtibwa village. Within the rice-irrigation ecosystem, flooding irrigation, which is a traditional method, was common practiced in Komtonga Dihombo and Mbogo. In this area, farmers use temporary made water canals to irrigate their rice fields, these are constructed each season based on how the paddies are needed. Mkindo village adopted a formal irrigation scheme system using well-constructed canals. There is a main canal fed from the river (set by gravity) and local farmers are connected to irrigate their farms. The communities in savannah agro-ecosystem cultivates rice and maize, in addition, they are involved in livestock keeping. Dakawa village is characterised by large-scale rice farms with well-maintained water scheme. The main season for rice cultivation starts from late November to February (preparations and planting) to May–July (harvesting) and the off-season runs from June through December. Most farmers cultivate during the main season with a few doing both seasons , 33. Thelsewhere , 51, 63.Clinical examination and screening for malaria parasites for community members was done at a central point in respective villages. Primary schoolchildren were examined at their own schools under the supervision of school head teachers. In each school, approximately 200 (average per schools taken to reach the needed sample) children were examined for malaria parasites and about 15% examined for haemoglobin levels. To get age representation, children were included from all seven classes with the needed sample equally split and balancing for gender groups. A systematic sampling procedure was applied to a class register (separately for boys and girls) to select children. All children below 15 years both in and out of school were examined for splenomegaly through the palpation of the spleen in a horizontal position by the research physician .History of fever and malaria symptoms were recorded and an axillary temperature was measured with a digital thermometer. Thick and thin blood smears were collected and stained with Giemsa and examined with a binocular microscope with an oil immersion lens to quantify the parasitaemia. Parasitaemia was measured counting the number of asexual parasites against the number of leukocytes in the blood film, based on a putative count of 8000 leukocytes per microlitre. The number of asexual parasites was counted against 200 leukocytes using a hand tally counter. A slide was considered negative if no parasite were seen after scanning 200 fields. Children with positive test results were followed and treated following recommended treatment guidelines and referred to the nearest health facility when necessary. Each individual was asked on whether he/she slept under a mosquito net a night before the survey. Parents or caretakers were consulted to confirm information on use of mosquito net provided by very young children (between 3 and 5 years). Among the schoolchildren, pictures of mosquito nets (with different colours) were used to illustrate for those who had difficulties in understanding the question on net use.t test were used for comparison where appropriate. Cuzick’s test of trend [The data were double-entered, cleaned and validated in Epi-Info 6.04 . Descriptive and statistical analysis were carried out in MS Excel and Stata 13 (StataCorp. 2013), respectively. Characteristics of the study participants were examined and presented. Mean with standard deviations and median values  were calculated for continuous variables (where appropriate) while proportions were used for categorical variables. A binary variable describing malaria status was created to take value of 1 if malaria was present and 0 otherwise. Malaria prevalence levels were compared between different characteristics. An individual was considered to have fever if the body temperature was ≥ 37.5 °C. Normal haemoglobin level was taken when concentration was ≥ 11 g/dl while a person with value less than 11 g/dl was considered anaemic. Mild anaemia was defined if haemoglobin was ≥ 10–≤ 11 g/dl, moderate between ≥ 7 and < 10 g/dl and severe anaemia if haemoglobin was less than 7 g/dl [of trend  was used2. The best fitting one was used in the final model. The smaller the AIC and the higher the pseudo-R2 indicated the better the variable. The Variance Inflation Factor (VIF) and Farrar-Glauber test (F-G test) for multicollinearity [A mixed-effects logistic regression model was used to determine association between malaria infection status and other factors including climate seasons, agro-ecosystems, levels of water-shaded area, use of mosquito net and demographic characteristics. The model includes village-specific random effects to account for clustering. Pearson’s correlation coefficient was used to detect highly correlated covariates (r > 0.8). To select which covariates to retain between a correlated pair, the two were ranked based on their goodness of fit assessed through Akaike information criteria (AIC)  and pseuinearity  were perEthical clearance was sought from the Medical Research Coordinating Committee of the National Institute for Medical Research, in Tanzania (NIMR/HQ/R.8a/Vol IX/297). Permission to conduct the study was sought from Mvomero district authority. Oral informed consent was obtained from the community members ≥ 18 years and assent was obtained from parents and teachers in the respective households or schools.A total of 7888 individuals were involved in the four cross-sectional malariometric surveys. Among these 52.1% were females, most (45.1%) aged between 6 and 9 years and over three quarters (78.9%) of respondents reported use of mosquito net during the previous night . It was similar among female and male individuals, apparently, the infection was concentrated in schoolchildren . Children aged 6–9 years carried the most burden followed by those aged 10–15 years. Malaria infection rate was higher among individuals not using nets than those reported to use . School-children < 5 years reported higher net usage as compared to those of the same age from the community group . In contrary, individuals 10–19 years sampled from the community reported higher usage than those in sampled at their schools . Malaria parasite prevalence was highest (42.9%) in the age group 10–15 years and lowest among > 15 years old (15.1%) (< 0.001). The prevalence levels in other age groups was 32.6% and 35.4% in ≤ 5 years and 6–9 years old, respectively. Prevalence within rounds were 36.7% (767/2088) round 1, 38.2% (730/1913) round 2, 26.6% (508/1913) round 3 and 36.0% (711/1974) during round 4.Proportionally, less infected individuals were observed during round 3  as compared to other periods . Of the 2716 individuals with malaria parasites, 507 (18.7%) were from savannah , 2122 (78.1%) rice-irrigation  and 87 (3.2%) sugarcane ecosystem (Mtibwa). Significant differences  in malaria prevalence were observed between the three agro-ecosystems with individuals from the sugarcane ecosystem having the lowest rate  having highest malaria risk . Of the individuals whose body temperature measure was taken (n = 7856), 396 (5.0%) had fever (axillary temperature ≥ 37.5 °C). The largest proportion of those with fever was observed during the dry and cool season of August 2004  and dry and hot season of February 2005  (p < 0.001). The proportion of individuals with fever (≥ 37.5 °C) was significant less in the community from savannah agro-ecosystem , and, a significant proportion (61%) was from community living in rice-irrigation ecosystems. Fever was more profound in individuals with malaria (8.3%) as compared to those who were not infected (6.1%), p-value = 0.002.Enlargement of the spleen among children ≤ 15 years was observed mostly among individuals living in rice-irrigation agro-ecosystem than in the other ecosystems Table . When spThe average proportion of gametocytaemic individuals  was 1.8%. It was higher in Mkindo (4.6%) and lower in Dakawa (0.98%). It was 1.7%, 2.2%, 1.3%, 1.2% and 1.3% in Dihombo, Mtibwa, Komtonga, Luhindo and Mbogo, respectively . Mixed infections accounted for 0.5% (13/2716) of the total malaria parasite infections. Mixed infections due to P. falciparum + Plasmodium malariae were more common (0.4%) than due to P. falciparum + Plasmodium ovale (0.07%). Mixed P. falciparum + P. malariae infections were observed among persons living in four of the seven study villages. Mixed P. falciparum + P. ovale infections were only observed among individuals in Dihombo village. One individual from the sugarcane ecosystem was found to be infected with P. malariae  of the individuals slept under a mosquito net the previous night. The largest mosquito net coverage was in Mtibwa (88.5%) followed by Mbogo (85.3%), Dihombo (80.6%), Komtonga (80.3%), Mkindo (75.3%) and the lowest coverage was in Dakawa (69.7%). Of the total persons (6200/7893) reported using nets, 635 were < 5 years, 2831 6–9 years, 1818 10–15 years and 940 were ≥ 15 years of age. However, zooming within these age groups, < 5 years had the highest proportion (84.1%) of those sleeping under mosquito net. The proportions for the other age groups were 79.6%, 75.3% and 80.7% for 6–9, 10–15 and > 15 years old, respectively.Overall mean haemoglobin (Hb) level was 10.8 g/dl (range = 3.6–15.2 g/dl). The mean Hb level was similar among female (10.83 ± 1.91 g/dl) and male (10.86 ± 1.81 g/dl) children. On average 47.1% of the children were anaemic. Anaemia levels were similar between males (45.8%) and females (47.9%). Age group most affected by anaemia was 10–15 years (49.3%). Anaemia was more prevalent (60.5%) among individuals in the savannah than in the rice-irrigation (48.2%) or sugarcane farming communities (23%) . Trend of the risk by village indicates a high (25 times) and significant odds for malaria infection for individuals living in Komtonga (highly wet shaded) than in Mtibwa (dry shaded). This risk reduced sharply in villages with lesser water shaded area . Living in high water shaded areas increased the chances of getting malaria up to 15 times compared to living in dry shaded areas. Similarly, results obtained in the bivariate analysis also indicated that living in savannah and rice-irrigation areas were significantly increasing the risk of malaria as compared to living in sugarcane plantations. However, geometric mean parasite density was highest among residents of sugarcane ecosystem 434.25/μl) and lowest in the savannah  in a neighbouring Morogoro Urban district in Tanzania by Nzobo et al.  reportedwere low .An. gambiae) and entomological inoculation rate were observed in areas practicing flooded rice irrigation [The prevalence of malaria varied strongly between age groups and the agro-ecosystems. Malaria prevalence was highest among communities in rice-irrigation ecosystem. Similar findings have been reported in Burundi , Mali 7, 72, Tanrigation .An. gambiae, the main malaria vector in Africa [An. funestus found commonly in savannah [Irrigation rice fields are known to provide ideal breeding sites for n Africa , while Asavannah . Irrigatsavannah . The varsavannah –77. Contsavannah , 33 and savannah , 78–80 hsavannah  was attrsavannah . Other fsavannah . These fsavannah .An. gambiae because of this species preference for open breeding sites [In this study, communities living in sugarcane ecosystem had the lowest malaria parasitaemia. Only a few incidence of increase in malaria has been associated with sugarcane in Africa. It is known that a properly maintained sugarcane irrigation system does not offer appropriate breeding sites for malaria vectors . Usuallyng sites .This study included school-children tested for malaria while at school. As there were no restrictions in registration of students, it is possible, though less likely, that some children were included in estimation of malaria prevalence in village different to where they actually reside, which could influence prevalence levels observed.This study demonstrated that about half of the children involved were anaemic. The findings show that moderate anaemia was common in children in all villages. Children in the sugarcane plantation had the lowest prevalence of anaemia than those in other agro-ecosystems. Like in Mvomero district, anaemia is a major health problem in Tanzania, especially among young children. However, a similar study in a neighbouring district of Morogoro Urban, reported a relatively lower anaemia prevalence of 10.1% . The finHigh water shed was associated with higher malaria prevalence in this study. High water sheds provide conditions such as vegetation cover, temperature, and humidity conditions that are conducive to distribution and survival of malaria vectors. The fact that Komtonga village is characterized by flooding water almost throughout the year, provide suitable mosquito breeding habitats  and hencThere are significant variations in malaria parasitaemia prevalence among individuals living in different agro-ecological zones within small geographical localities. Such variations are likely to be attributed to different transmission levels and socio-economic factors. The variability of the levels of parasitaemia illustrates the existing of different micro-ecological zones, hence the spatial and temporal variation in malaria transmission. It is therefore important, that malaria control/elimination strategies are designed to focus on specific local needs and those who practice irrigation agriculture need to be well informed of the consequences of their farming practices. National and sub-national malaria control programmes need to allocate resources for malaria control proportionate to risk of malaria transmission in specific localities.