All pregnant women who present at a gestational age of 14- 24 weeks who will give verbal informed consent will be enrolled in the study from the 2 health units in Mbarara District and a hospital in Kampala. These areas are reported to be highly endemic for malaria. The district has a high prevalence of HIV (10.6%) among antenatal attendants. The main ethnic groups in the area are Banyankore with few migrant populations of Bakiga, Rwandans and Baganda who mainly speak Runyankore dialect. The main economic activity is mixed farming and the main food crops grown include bananas, finger millet, beans, groundnuts, cowpeas, sweet potatoes, cassava, sorghum, maize, tomatoes, pineapples, passion fruits, sugar canes, mangoes and papaws. The population of the district is estimated to be 1,093,388. Females aged 15-49 years are estimated to make up 23% of the total population. Pregnant women are estimated to be 5.2% of the total population. The total fertility rate in Uganda is estimated at 6.9.