To our knowledge, no published literature investigated the prevalence of anemia and malaria among children under 5 years of age in the IDPs camp of Ntele, Montepuez. The IDPs of Ntele camp live in shelters whose structure is made up of wood, mud bricks, and tarpaulins. In the most precarious cases, the shelter space capacity is not fit to host the number of household members. Nevertheless, this very much depends on the households’ access to means to build new shelters that comply with basic living standards. In this setting, communal latrines are often shared among two or more neighbor households. The camp inhabitants’ livelihood and access to food depend mainly on humanitarian aid through the provision of seeds for agriculture, support to basic livelihood activities (e.g., petty trade, sewing machines), and food rations. We reported a high prevalence of childhood anemia (83%), which is consistent with Muhajarine and colleagues’ [8] results (86%) about Cabo Delgado in 2018. Mozambique is acknowledged as one of the sub-Saharan African countries with the highest prevalence of childhood anemia (69% in 2019) [8]. Maulide Cane and colleagues observed an anemia prevalence of 62% among children aged 6–59 months in a quaternary health facility in Maputo City Province [9]. Our data about malaria in Mozambique are comparable to previous findings that reported a stable rate of around 39% in recent years [8]. We found a correlation between malaria status and moderate to severe anemia. Twenty years of surveillance data at Manhiça District Hospital in Mozambique showed that in 2006–2017 malaria represented around 30–40% of pediatric hospital admissions, remaining a leading cause of disease and healthcare system use [10]. In sub-Saharan Africa, malaria caused by Plasmodium parasites is a common cause of childhood anemia [11] which, in turn, makes children much more susceptible to severe anemia, by substantially decreasing Hb levels [11] and other severe diseases. More than two-thirds of malaria deaths occur in this population [2]. It is worth considering that hemoglobin concentration could vary between seasons. Potential higher rates of anemia during the dry season, notably before the harvest, may be recorded due to the lack of a diversified diet and, therefore, of micronutrients, as reported by recent research [12]. We could not estimate the association between anemia and intestinal and urinary parasite infestation due to the limited samples collected. A four-arm randomized trial found no differences in anemia prevalence between the groups treated with different approaches to intestinal parasites in children below 59 months (annual single dose of albendazole or test-and-treat every 4 months only the child or the child and all the household members) [13].

The current community-based cross-sectional study provides evidence that anemia in children under 5 years of age represents an urgent public health threat in IDPs camp of Ntele. The lack of data disaggregation may neglect the inequities among the swaths of the population living in different geographical areas (e.g., rural and urban). This suggests the need to focus on child and maternal health at the provincial and district levels [8, 9].

Although the cross-sectional design of the study limits the causal inference, our analysis provides baseline information to guide the development of initiatives aimed at improving the health of the most vulnerable population in Cabo Delgado. Regarding the association between anemia and malaria, the results indicate that these conditions are strictly correlated in the study population. In 2015, a baseline census in Magude, South Mozambique, showed that only 27% of the children younger than 5 years slept below bed nets the previous night [14]. Even if we do not have data on bed net use in Ntele camp, we found that 39% tested positive for malaria, indicating that more effort should be made in malaria prevention.