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Background: Snakebite is a neglected disease that disproportionally affects the rural poor. There is a dearth of evidence regarding incidence and risk factors in snakebite-endemic countries. Without this basic data, it will be impossible to achieve the target of a 50% reduction of snakebite morbidity and mortality by 2030 as set by the World Health Organization. Methods: This was a descriptive analysis nested in a 2021 community-based demographic survey of over 70,000 individuals conducted in Mopeia, Mozambique, in preparation for a cluster randomized trial to test an intervention for malaria. We describe the incidence rate, demographics, socioeconomic indicators and outcomes of snakebite in this population. Findings: We found the incidence of self-reported snakebite in Mopeia to be 393 bites per 100,000 person-years at risk, with 2% of households affected in the preceding 12 months. Whilst no fatalities were recorded, over 3,000 days of work or school days were lost with an individual household economic impact higher than that of uncomplicated malaria. 1 in 6 of those affected did not fully recover at the time of the study. We found significant relationships between age older than 15, use of firewood for household fuel, and animal possession with snakebite. Conclusions: This study exposes higher than expected incidence and burden of snakebite in rural Mozambique. Whilst snakebite elimination in Mozambique seems unattainable today, it remains a preventable disease with manageable sequelae. We have shown that snakebite research is particularly easy to nest in larger studies, making this a practical and cost-effective way of estimating its incidence. Author summary: Snakebite is a neglected disease with a dearth of data and research funding. This study aimed to quantify the burden and identify risk factors of snakebite in a rural district in Mozambique by nesting snakebite-specific questions into a demographic survey conducted in preparation for a malaria cluster-randomized trial. We have shown that nesting has the potential to undo the neglect of snakebite research, providing valuable results for local decision makers and aid further research. Piggy-backing onto a large well-resourced trial enabled us to reveal the burden and identify risk factors of snakebite with minimal disruption or expense to the parent trial team or participants. This method can encourage the global health community to transition into a more horizontal research approach. We report an incidence close to 400 snakebite per 100,000 population per year in Mopeia leading to the loss of over 3,000 days of work/school. The median economic burden of snakebite per household was of US$ 17, making if almost 5-fold the cost of uncomplicated malaria cases. Although most bites occurred in those aged 20 to 25, the rate of bites per 1,000 population is much higher in those adults older than 64, this finding is also coupled with a lower recovery rate in the older age. We found no clear risk factor associated with place of bite and season. [ABSTRACT FROM AUTHOR]

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.