Discussion
death, malaria, truck, Mopeia, deaths
MALARIA, MALARIA
A district-wide demographic survey was conducted in Mopeia in order to map, identify, and characterize the households in the area, as well as to determine the population size and structure. The key output of the demographic survey was the creation of the study clusters, which were built based on the population of children under five years of age. In addition, the demographic survey was crucial to planning the implementation of all field activities related to the clinical trial and the other BOHEMIA work packages (including drug amount estimation, number of field personnel). These data served to draw the randomization and sampling schemes of the cRCT, as well as to identify relevant information for the study (e.g. livestock ownership or lack thereof). Lastly, mapping all households in the district allowed the calculation of the proportion of households reached by the cRCT.The reconnaissance activity was a key starting point when working in such a remote place as Mopeia. It served to further know the size of the district, the accessibility, and the 3G in the district hamlets, which allowed for effective planning of all other field activities. A total of 27,928 households were enumerated in the study (including those that did not participate). The majority of the district households (25,550, 91.5%) were mapped through their GPS coordinates, identified with a household ID, and a household member responded the demographic survey. A total of 546 households (2%) declined to participate in the study or had nobody present after two attempts, which indicates the success of the community engagement and demonstrates the importance of such activities in studies of this nature.The results of the demographic survey indicate that the living conditions in Mopeia are sub-standard and often not adequate for the intense rains and cyclones that affect the district. Access to electricity is low. According to the National Malaria Survey (Inquérito Nacional sobre Indicadores de Malária em Moçambique 2018, IMM), only 13.3% of households in Zambezia have electricity, which is close to the 11.7% identified in the study. In-country definitions for improved water sources include those that are physically protected from external contamination such as piped water, fountains, protected wells, protected holes with manual pumps, rain water, bottled water, and water from a tank truck [In rural areas of low-income countries, owning livestock may represent a significant percentage of household economy, since the animals can be sold or used for self-consumption or physical work [Mopeia is an area of high malaria burden, as a recent study indicated 62–75% prevalence in children less than five years at the peak of the rainy season [In terms of population, 131,818 people were registered, which is less than the INE estimations but the study missed those living in households that refused or for which the household members were absent twice. The population structure in Mopeia is typical for a sub-Saharan country, in which the largest age group is the youngest children and the shape of the pyramid narrows as the population age increases. There are slightly more women than men and there are only 23.1%. female household heads, which shows that the home-based structures in Mopeia are mostly male dominated.The death age structure in Mopeia is completely skewed towards the young population. Out of the total deaths reported in the prior 12 months, the largest number occurred in children under 5 years old (43.6%). This is aligned with the results of the 2019 Countrywide Mortality Surveillance for Action (COMSA), which reported that 37% of deaths in the Zambezia province were of children under five years old [The main limitation of the study is the size and depth of the survey, since it did not allow for detailed individual data collection. All the information was collected at the household level, without any person level data besides basic demographic data of the household members. Another limitation is that, the study did not use satellite imagery in order to map and identify the area of work prior to field operations, which has been previously used in similar interventions such as IRS campaigns [