Mónica Gozalbo

Background/Objectives: The aim of this study was to assess longitudinal changes in anthropometric and haematological indicators among young mothers and their children attending the Centre d’Accueil et de Soins Intégrés pour Femmes (CAIF), and to examine associations between maternal and child changes. Methods: This longitudinal observational study included 40 children (0–5 years) and 31 young mothers (14–25 years) attending CAIF in Toliara, Madagascar. Anthropometric indicators were assessed at baseline, midline, and endline over a 12-month period. In children, these included weight, height/length, weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and body mass index-for-age (BAZ) z-scores; in mothers, weight, BMI or BAZ z-scores were assessed. Haemoglobin concentrations were measured at baseline and endline only. Changes over time were analysed using repeated-measures analysis of variance, and maternal–child associations were examined using linear mixed-effects models. Results: Children showed significant gains in weight and height/length over the follow-up period. WAZ, WHZ, and BAZ increased significantly over follow-up, whereas HAZ showed a non-linear trajectory. The proportion of children with underweight decreased from 42.5% to 2.5%, and wasting from 27.5% to 0%. Stunting was present in 37.5% of children at baseline and 35.0% at endline. Among the 30 children aged ≥6 months at baseline eligible for anaemia classification, prevalence decreased from 86.7% to 70.0% at endline. Maternal weight, BMI, and haemoglobin also increased over follow-up. No statistically significant associations were found between changes in maternal and child indicators. Conclusions: Improvements were observed in several nutritional and haematological indicators during follow-up, while stunting and anaemia persisted and excess weight emerged in some children. However, these changes cannot be attributed specifically to the care provided at CAIF in the absence of a comparison group.

This study provides an integrative analysis of the implementation, acceptability, and operational dynamics of Ecuador's School Feeding Program in rural Andean contexts. By examining key stakeholders' perspectives, it offers evidence-based insights into the structural and nutritional challenges of school meal provision. To explore the perceptions, experiences, and barriers related to school breakfast served in public schools among children and teachers in rural Andean communities in the province of Chimborazo, Ecuador, an exploratory qualitative study was conducted based on in-depth, semi-structured interviews with students and teachers involved in the Umiña Project. Data were analysed inductively using thematic analysis until data saturation was reached, and the findings were subsequently organized according to a SWOT (Strengths, Weaknesses, Opportunities, and Threats) framework, with inter-rater reliability showing high agreement (Kappa = 0.89). A total of thirty-two students and ten teachers participated in the study. The findings revealed significant weaknesses associated with the low sensory acceptability of the products distributed by the state program, which were frequently described by students as having a monotonous taste, unpleasant texture, or unattractive appearance. Conversely, among the strengths, teachers highlighted the logistical continuity of the government program, the universal coverage of the rations, and the institutional organization for their daily distribution. Ultimately, Ecuador's School Feeding Program demonstrates adequate coverage and operational continuity; however, its nutritional impact remains limited by the low sensory acceptability of the food, the limited cultural relevance of the menus, and a food environment characterized by the widespread availability of ultra-processed products.

Schistosomiasis remains a major public health concern in Madagascar, where access to sensitive and user-friendly diagnostic tools is essential for effective control. This study evaluated the diagnostic performance of the Schisto -LAMP assay for detecting Schistosoma spp. in stool samples from schoolchildren in a rural area of central Madagascar, comparing it with Kato-Katz and a commercial qPCR assay. A total of 102 children aged 5–15 years from Soavinarivo participated. Stool samples were analysed using Kato-Katz, qPCR and Schisto -LAMP. All molecular analyses were performed in a well-equipped laboratory in Spain. Agreement between methods was assessed using the Kappa coefficient and McNemar’s test, and diagnostic accuracy was calculated using a composite reference standard. Molecular methods detected the highest prevalence of infection. Agreement between Kato-Katz and molecular methods was low (Kappa = 0.259 for qPCR; 0.347 for Schisto -LAMP). Moderate-intensity infections were most frequent (23/40), all detected by qPCR (median Ct: 26) and 20/23 by Schisto -LAMP. Light-intensity infections accounted for 16/40; qPCR detected 11/16 (median Ct: 28) and Schisto -LAMP 13/16. qPCR showed the highest diagnostic performance (sensitivity 92.2%, negative predictive value 80.6%, accuracy 94.1%), followed by Schisto- LAMP (sensitivity 81.8%, negative predictive value 64.1%, accuracy 86.3%), with Kato-Katz lowest. Schisto -LAMP outperforms conventional microscopy and provides diagnostic performance close to that of qPCR. Given its simplicity, speed, and minimal equipment requirements, it could be applied in small laboratories in endemic, resource-limited settings, such as rural areas of Madagascar.

La amphimeriosis es una enfermedad zoonótica emergente en Ecuador causada por el trematodo hepático Amphimerus sp. Históricamente, esta infección se ha considerado endémica de la provincia de Esmeraldas. La baja sensibilidad de las técnicas de diagnóstico convencional, como la microscopía, dificulta la identificación de nuevos focos de infección en otras regiones. El objetivo de este estudio fue evaluar la presencia del parásito en zonas urbanas de la región central de Ecuador mediante la técnica molecular LAMPhimerus, un método de amplificación isotérmica de ácidos nucleicos rápido y altamente específico. Para ello, se analizaron 25 muestras de heces de población infantil procedentes de los cantones de Bucay y Penipe. Los resultados revelaron la presencia de ADN de Amphimerus sp. en 6 de las muestras analizadas: 5 procedentes de Bucay y 1 de Penipe. Este hallazgo constituye la primera evidencia molecular del parásito en zonas urbanas del centro de Ecuador, lo que demuestra que su distribución geográfica puede ser más amplia de lo descrito previamente. Es necesario ampliar la vigilancia epidemiológica para determinar la prevalencia real de la enfermedad y establecer estrategias de control en las nuevas áreas identificadas.

Gastrointestinal protist (GIP) infections, mainly caused by Giardia duodenalis and Cryptosporidium spp., are major contributors to childhood morbidity in resource-limited settings, yet their epidemiology in Madagascar remains poorly documented. We conducted a microscopy-based prospective cross-sectional study in 3 deprived areas of southern Madagascar to investigate pathogenic and commensal protists among children and adolescents ( n = 318), young women ( n = 57) and their children ( n = 61). Epidemiological questionnaires were collected, and selected species were characterized using PCR and Sanger sequencing. Risk factors were analysed using binary logistic regression. A total of 436 stool samples and 221 questionnaires were analysed. G. duodenalis was the most prevalent pathogenic species (81.9%), followed by Cryptosporidium spp. (1.2%). Balantioides coli was not detected. Potentially pathogenic species included Blastocystis sp. (70.4%) and Dientamoeba fragilis (0.2%). The most frequent commensals were Entamoeba coli (37.4%), Endolimax nana (15.4%) and Iodamoeba bütschlii (12.6%). Assemblages A, B and A + B were identified for G. duodenalis , and C. hominis, C. felis and C. parvum for Cryptosporidium spp.; Blastocystis subtypes ST1–ST3 were detected. G. duodenalis infection was associated with abdominal pain and loss of appetite, but not diarrhoea. Geographical origin predicted G. duodenalis infection and Blastocystis sp. and E. coli colonization. GIP infections by G. duodenalis and, to a lesser extent, by Cryptosporidium spp., are a public health concern in resource-limited settings in Madagascar. Our results are the most important contribution made in the country in terms of molecular epidemiology of intestinal protist.

Fluid intake is a key component of habitual dietary behaviour and plays an important role in health and disease prevention. Both insufficient and excessive fluid consumption have been associated with adverse health outcomes. However, beverage intake patterns and behaviours related to excessive fluid consumption remain underexplored in non-clinical populations, particularly in Spanish-speaking contexts. This study aimed to translate, culturally adapt, and apply the Beverage Intake Questionnaire-15 (BEVQ-15) in Spanish-speaking adults from Spain and Ecuador, and to describe beverage consumption patterns with a focus on behaviours potentially associated with excessive fluid intake.A two-phase cross-sectional study was conducted. The BEVQ-15 was translated and culturally adapted following established international guidelines and semantically validated in a pilot sample of university students. The adapted version (BEVQ-15P) was subsequently applied to a validation sample of adults from Spain and Ecuador. Descriptive analyses were used to characterise total fluid intake and beverage consumption patterns by sex and country. Sex-specific intake thresholds derived from the literature were applied to explore categories of potential risk for excessive fluid consumption.Semantic validation confirmed good clarity, comprehension, and cultural relevance of the Spanish BEVQ-15P. In the validation sample, mean total daily fluid intake was 3.67 ± 2.34 L/day. Men reported significantly higher fluid intake than women, largely driven by beer consumption, while the highest intake profile identified was characterised by excessive water consumption in a female participant. Beverage consumption patterns differed by sex but were broadly comparable between Spain and Ecuador. Behaviours associated with potential risk for excessive fluid intake were infrequent in this non-clinical sample.Overall, this study offers an exploratory framework to understand beverage consumption and excessive fluid intake behaviours within their social and cultural contexts, contributing to discussions on food and drink as socially embedded practices beyond purely biomedical interpretations.

Background: Background: Childhood dietary habits are critical determinants of physical growth, cognitive development, and long-term health. In Ecuador, malnutrition remains a major public health concern, with both undernutrition and overweight/obesity affecting children—especially in rural and indigenous populations. Methods: This systematic review followed PRISMA 2020 guidelines (PROSPERO ID: CRD420251080987). Searches were conducted in SciELO, Dialnet, and ScienceDirect (accessed August 2025) using Boolean operators to identify quantitative studies in Spanish or English published between 2018 and 2025 that assessed dietary habits and nutritional status in Ecuadorian children aged 1–11 years. Seventeen studies, including approximately 12,000 children, were included. Results: Prevalence of chronic undernutrition ranged from 15% to 35%, while overweight and obesity reached 20–30%. Undernutrition was higher among rural and indigenous children, whereas overweight predominated in urban and higher-income settings. Common dietary patterns included high consumption of ultra-processed foods and sugar-sweetened beverages, and insufficient intake of fruits, vegetables, and quality proteins. Maternal education, socioeconomic level, and school food environments were key determinants. Conclusions: Both malnutrition and overweight persist among Ecuadorian children, reflecting a nutrition transition influenced by socioeconomic and environmental factors. Context-specific public health actions are urgently needed, including school-based nutrition education, regulation of food marketing, improved access to affordable healthy foods, and community-level engagement to promote sustainable dietary habits. The included studies were mostly cross-sectional and often used non-validated dietary assessment tools, which may influence the reported prevalence estimates.

Microsporidia are obligate intracellular eukaryotic parasites, phylogenetically related to fungi, and are recognised causes of significant morbidity in humans. They are opportunistic pathogens of particular concern in HIV-infected and other immunocompromised populations. In this study, the occurrence and genetic diversity of microsporidian infections (Enterocytozoon bieneusi and Encephalitozoon spp.) were investigated in socially vulnerable populations from disadvantaged areas in southern Madagascar. Epidemiological questionnaires were used to collect demographic data and potential risk factors. Faecal samples (n = 436) from 318 children and adolescents (7–21 years), 57 young mothers (16–21 years), and 61 of their infants (0–5 years) were collected and analysed using molecular methods (PCR and Sanger sequencing). Only E. bieneusi infections were detected, with an overall prevalence of 3.0% (95% CI: 1.6–5.0). The highest prevalence was observed in young mothers (3.5%; 95% CI: 0.4–12.1), nearly followed by infants (3.3%; 95% CI: 0.4–11.4). Genotyping of E. bieneusi was successfully performed in 11 of the 13 positive samples, identifying five known genotypes (A, CAF1, D, PigEBITS7, and Type IV) and one novel genotype, designated HhMdEb1. The most frequently detected genotypes were A and CAF1. All genotypes identified, including the novel genotype, belong to Group 1, which is characterised by low host specificity and high zoonotic potential. The detection of genotypes commonly associated with animal hosts suggests both zoonotic and anthroponotic transmission pathways. These findings underscore the need to implement integrated control strategies within the framework of the ‘One Health’ approach.

Background/Objectives: Undernutrition and intestinal parasitic infections are critical public health problems in low-income countries, with adverse effects on child growth and increasing anaemia. Madagascar, with a high prevalence of these factors, lacks comprehensive studies analysing their interaction. This study aimed to assess the nutritional status, the prevalence of anaemia, and the occurrence of intestinal parasitic infections among children and adolescents in three southern regions of Madagascar. Methods: A cross-sectional, prospective study of 289 children and adolescents (10–18 years) from three schools located in Antsoamadiro, Fianarantsoa, and Toliara was conducted. Sociodemographic, anthropometric, and haemoglobin concentration data, as well as faecal samples, were collected. Nutritional status was assessed by Nutrimetry, combining Height-for-Age and BMI-for-Age indicators. Stool samples were analysed by optical microscopy and molecular methods. Results: Nutricode 1 (short stature/stunting + thinness/wasting) was significantly more frequent in Toliara. Nutricode 1 was also significantly more prevalent in males than females. Anaemia affected 57.8% of participants and was significantly associated with Nutricode 1. The overall parasitism rate was also associated with Nutricode 1. Trichuris trichiura and Ascaris lumbricoides significantly increased the risk of stunting, wasting, and Nutricode 1. Co-infection with Trichuris trichiura + Giardia duodenalis was significantly associated with wasting and Nutricode 1. This co-infection was also related to the presence of anaemia, as was moderate-intensity infection with T. trichiura. Conclusions: There is a high co-burden of undernutrition, anaemia, and parasitic infections in southern Madagascar. These findings highlight the urgency of implementing comprehensive health programmes combining parasite control, nutritional support, and iron supplementation adapted to regional realities.