Humberto Munguambe

: Mozambique has stunting, wasting, and underweight rates of 37%, 15%, and 4%, respectively. In Zambézia Province, Mozambique, 44.6% of children younger than 5 years of age suffer from chronic malnutrition, which impairs physical and cognitive development and leads to long-term health and productivity issues. This study examines undernutrition, stunting, wasting, underweight, and their associations with socioeconomic status among children younger than 5 years old in Mopeia District, Zambézia Province (central Mozambique). We conducted a secondary analysis of data from the Broad One Health Endectocide-Based Malaria Intervention in Africa 2021 cluster randomized clinical trial, which included a cohort of 2,667 children younger than 5 years old. We calculated odds ratios and 95% confidence intervals to assess associations between risk factors and undernutrition. The prevalence rates of stunting, wasting, and underweight were 41.7%, 20.4%, and 24.3%, respectively; these numbers are among the highest globally. Lower wealth index showed an association with higher odds of stunting and underweight, whereas distance from tarmac roads showed a link to increased wasting. Key predictors of stunting included lack of electricity, long water-fetching times, and smaller household size; being underweight showed an association with the number of bed nets and housing type. These relationships reflect socioeconomic patterns rather than direct causality. Undernutrition among children younger than 5 years old in Mopeia District remains critically high and is strongly patterned by socioeconomic factors. Addressing structural determinants, such as household wealth, access to infrastructure, and living conditions, will be essential for reducing the burden of undernutrition in rural Mozambique.

: Scabies is endemic in many resource-poor tropical areas, causing significant morbidity. However, our understanding of the true burden of scabies in Africa is limited, partly owing to limited capacity and challenges accessing the currently recommended diagnostic tools. The primary objective of this study was to assess the diagnostic accuracy of scabies assessments made by minimally trained field-workers. We trained field-workers with a minimum of secondary school education in the diagnosis of scabies. After the training, we assessed the diagnostic accuracy of assessments made by nine field-workers compared with the reference standard. In all, 193 individuals were assessed for scabies. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, as well as agreement (κ coefficients) between medical doctors and between field-workers. Of the 193 participants, 26% had scabies according to the reference standard. The sensitivity of field-worker diagnosis compared with the reference standard was 94% (95% CI: 90–99%), and the specificity was 96% (95% CI: 90–97%). The determination of severity by field-workers was less accurate; the sensitivity for severe scabies was 61% (95% CI: 48–74%), and the mean specificity was 97% (95% CI: 93–100%). This study demonstrated that field-workers without medical qualifications were capable of diagnosing scabies to a similar level of accuracy as experienced medical doctors after a short period of focal training. This may facilitate rapid assessments of scabies prevalence for public health purposes and decisions about mass drug administration implementation in similar settings.