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We conducted a controlled before-and-after trial to evaluate the impact of an onsite urban sanitation intervention on the prevalence of enteric infection, soil transmitted helminth re-infection, and diarrhea among children in Maputo, Mozambique. A non-governmental organization replaced existing poor-quality latrines with pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1–48 months at baseline and measured outcomes before and 12 and 24 months after the intervention, with concurrent measurement among children in a comparable control arm. Despite nearly exclusive use, we found no evidence that intervention affected the prevalence of any measured outcome after 12 or 24 months of exposure. Among children born into study sites after intervention, we observed a reduced prevalence of Trichuris and Shigella infection relative to the same age group at baseline (<2 years old). Protection from birth may be important to reduce exposure to and infection with enteric pathogens in this setting.

Due to the high prevalence and diversity of clinical manifestations, intestinal parasitic infections (IPIs) represent a public health problem. The objective of the work was to determine the prevalence of IPIs among army recruits at a practice and training center in southern Mozambique. Sociodemographic information was obtained through semi-structured interviews. Single urine and stool samples were collected from 362 recruits. Parasite diagnosis was made by filtration, formaldehyde-ether and Kato-Katz techniques. Positive individuals underwent abdominal ultrasound. Then, descriptive statistics and cross-tabulations were performed, and p-values < 0.05 were considered significant. The prevalence of infection with at least one parasite was 25.1% (95% CI: 20.5–29.6; n = 91). The most common parasites were Entamoeba coli (10.7%; 95% CI: 7.4–13.7; n = 37) and Trichuris trichiura (6.1%; 95% CI: 4.6–9.9; n = 25). Parasitic infection was associated with the origin of the participant (p-value < 0.001), and the province of Sofala had the highest prevalence among the provinces studied (70.6%; 95% CI: 47.0–87.8; 12/17). Since oral fecal transmission occurs for several parasites, routine screening and deworming prior to enrollment at the army training center is recommended to reduce transmission of intestinal parasites among recruits.

Intestinal protozoa are among the major agents causing gastrointestinal problems in humans and other animals. Their occurrence is reported throughout the world but mainly in developing countries where environmental sanitation can be inadequate. The problem affects people of all ages, but children are especially susceptible. Symptoms include abdominal discomfort or pain, diarrhoea (acute or severe), general uneasiness, and anaemia. Transmission occurs via the faecal–oral route, person to person, and from animal to person or people to animals (i.e., zoonosis), as these agents also affect nonhuman animals. Despite the public health threat that these intestinal protozoa represent, understanding of their prevalence is sparse for many African countries, including Mozambique.This thesis addresses the prevalence of the intestinal protozoa Cryptosporidium spp. and Cystoisospora belli in adults suffering from diarrhoea, with a subset of HIV-positive adults. Additionally, this thesis analyses Giardia intestinalis and Cryptosporidium spp. in asymptomatic children under age 5 years. Cystoisospora belli oocysts were found in 25.0% of study participants, whereas Cryptosporidium oocysts were detected in 8.3%. Species identification was possible in all Cryptosporidium cases where DNA was available. Three Cryptosporidium species – C. parvum, C. hominis, and C. felis – were detected as single agents, along with one mixed infection with C. hominis/C. parvum. Subtyping of Cryptosporidium isolated at the gp60 gene revealed three anthroponotic subtype families: Ia, IIc, and IIe. G. intestinaliswas found in 72.2% (n=210/291) of study participants, and species identification by PCR was possible in 46 cases. Two assemblages were identified (A=53%, B=47%), along with four sub-assemblages (AI=37.8%, AII=15.6%, BIII=2.2%, BIV=42.2%) and one mix (BIII/BIV=2.2%).These findings, in combination with an unexpectedly high number of cases involving G. intestinalis and C. belli, indicate that the main transmission route for the three intestinal parasites examined in this study population is human to human. However, the presence of G. intestinalis AI in 37.8% of analysed cases (n=17/46) implies zoonotic potential and requires special attention in future studies, as well as the attention of the Mozambique public health authorities.The PCR results in this study emphasize the need for early detection of these parasites and effective treatment, as well as preventive measures.

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.