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Introduction: Mozambique’s Community Health Worker (CHW) or Agentes Polivalentes Elementares in Portuguese (APE) in Mozambique was reinitiated in 2010 after an unsuccessful first attempt decades prior. Years after this reinitialization, the Ministry of Health of Mozambique (MoH) and other interested parties sought to understand how the implementation of APEs interventions is progressing. Given its low coverage of many health intervention, the province of Zambézia was of specific interest.Methodology: We carried out a cross-sectional study in six districts of the Province of Zambézia, namely: Ile, Inhassunge, Milange, Mocubela, Mulevala and Pebane. We designed a questionnaire based on government plans, APE training material, and best practices for the implementation of CHW programs found in the literature. We conducted descriptive analysis to summarize the different components of the APEs program according to responses.Results: A total of 144 APEs were interviewed, of which 67% were male, 63% aged between 18 to 39 years, 60% had a first cycle of education and 46% had worked as APEs for 5 or more years. While 91% reported having received training after their initial training, only 19% had received training in the past 3 months. Only 48% of APEs replenished their kits every month, and stock-outs of medications ranged from 19% to 92%, with expired medication being found for 5-13% of the medications. Although the quality of supervision appears high with APEs reporting service delivery observation (88%), discussion of work performance (81%) and work-related problems (91%), checking of supplies (90%), review of records (93%), and praise (92%) during their last supervision, only 59% of our sample reported having had their last meeting with their supervisor less than 1 month ago.Conclusions: While there have been some successes in this renewed implementation, challenges persist around ensuring the proper implementation of the program as it is designed. Additionally, a review of the program to match the current realities of field (e.g., increased population per APE, increase of the stipends) is becoming increasingly necessary.

Background: Malaria is still a leading cause of morbidity and mortality among children under five years old in Mozambique. In this study we sought to determine the prevalence of malaria infection and its predictors among children six to 59 months old in Mozambique.Methods: Data from two national malaria indicators surveys in 2015 and 2018 were compared. In both surveys, blood samples were collected among children six to 59 months old to detect Plasmodium falciparum antigen by a rapid diagnostic test, and questionnaires were applied to collect socio-economic, demographic and vector control data from their households. Association of malaria rapid diagnostic test positivity with age, gender, residence, region, use of a vector control intervention, mother’s level of education and wealth index was assessed by logistic regression, using both univariate and multivariate analysis. A complex sampling logistic regression model was used to identify factors associated with malaria infection with estimated adjusted odds ratio and respective 95% confidence intervals. Results: A total of 9,068 children were tested for malaria infection of which 4,640 were in 2015 and 4,428 in 2018. The prevalence of malaria infection was 40.2% and 38.9% in 2015 and 2018, respectively. From 2015 to 2018, insecticide-treated nets ownership increased from 72.3% to 90.2% (pConclusions: Although insecticide-treated nets ownership and use have increased between the two surveys, prevalence of malaria infection remained stagnant. The main predictors of malaria infection were region, place of residence and socioeconomic status, underscoring the importance of broader developmental and socioeconomic factors on malaria prevalence.

This study aims to assess the association between schistosomiasis and hookworm infection with hemoglobin levels of schoolchildren in northern Mozambique. Through a cross-sectional survey, 1,015 children from five to 12 years old in the provinces of Nampula, Cabo Delgado and Niassa were studied. Hookworm infection and urinary schistosomiasis were diagnosed, through Ritchie and filtration methods, with a prevalence of 31.3% and 59.1%, respectively. Hemoglobin levels were obtained with a portable photometer (Hemocue®). The average hemoglobin concentration was 10.8 ± 1.42 g/dL, and 62.1% of the children presented levels below 11.5 g/dL, of which 11.8% of the total number of children had hemoglobin levels below 9 g/dL. A multiple linear regression analysis demonstrated negative interactions between hemoglobin levels and ancylostomiasis, this being restricted to the province of Cabo Delgado (β = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (β = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17-3.00) and moderate/severe anemia (OR = 2.71; 95% CI = 1.50 - 4.89). We concluded that, in the province of Cabo Delgado, hookworm and Schistosoma haematobium infections negatively influence hemoglobin levels in schoolchildren. Periodical deworming should be considered in the region. Health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in soil-transmitted helminthiases and schistosomiasis prevalence rates. Este estudo tem como objetivo avaliar a relação entre a ancilostomíase e a esquistossomíase urinária com as concentrações sanguíneas de hemoglobina em crianças escolares no norte de Moçambique. Em estudo transversal, 1.015 crianças com idade entre cinco e 12 anos foram incluídas, nas Províncias de Nampula, Cabo Delgado e Niassa. A ancilostomíase e a esquistossomíase urinária foram diagnosticadas através das técnicas de Ritchie e de filtração da urina, respectivamente; prevalências de 31,3% e 59,1% foram observadas. As concentrações sanguíneas de hemoglobina foram obtidas com um fotômetro portátil (Hemocue). A concentração média de hemoglobina foi 10,8 ± 1.42 g/dL, 62,1% das crianças apresentaram concentração abaixo de 11,5 g/dL e 11,8% apresentaram nível abaixo de 9 g/dL. A regressão linear múltipla demonstrou interações negativas entre os níveis de hemoglobina e i) a infecção por ancilostomídeos (β = -0,55; p < 0,001) e ii) a esquistossomíase urinária (β = -0,35; p = 0,016), ambas associações restritas à Província de Cabo Delgado. Também em Cabo Delgado, o modelo de regressão logística demonstrou que a infecção por ancilostomídeos representa um preditor de anemia leve (OR = 1,87; 95% CI = 1,17-3,00) e anemia moderada/grave (OR = 2,71; 95% CI = 1,50 - 4,89). O estudo conclui que em Cabo Delgado, Moçambique, as infecções por ancilostomídeos e Schistosoma haematobium estão significativamente associadas a uma menor concentração sanguínea de hemoglobina em crianças em idade escolar. A administração periódica de anti-helmínticos deve ser feita regularmente. Melhorias na infraestrutura sanitária das regiões estudadas são as medidas mais eficazes para controle destas parasitoses.

Schistosomiasis and soil-transmitted helminths (STHs) are most prevalent in developing countries. In Mozambique, the first and only national survey of the distribution and prevalence of schistosomiasis and STHs was conducted in 1952 and 1957. Only occasional surveys in restricted areas have been conducted since the 1950s. The objective of our survey was to update information on the geographic distribution and prevalence of schistosomiasis and STHs in this country. During August 2005-June 2007, the Schistosomiasis and STH Laboratory of National Institutes of Health of the Ministry of Health undertook an epidemiologic survey among schoolchildren. A total of 83,331 persons attending primary schools were sampled. The mean age was 11.36 years (range: 7-22 years). Stool and urine samples were collected and examined by using Kato-Katz and filtration and Ritchie and Willis techniques. Results indicate a widespread occurrence of Schistosoma haematobium (overall prevalence = 47.0%) and STHs (prevalence = 53.5%). Prevalence varied dramatically across the country, with the highest prevalence in districts in northern provinces (Cabo Delgado, Niassa, Nampula, and Zambezia) and in certain provincial capital cities. Districts in the southern region of the country were less affected. Schistosoma mansoni was less common, with prevalence of 1%. We conclude that schistosomiasis and STHs are widely distributed in Mozambique and confirm the need for a national helminth control program.