Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh

Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis

Background

Scabies is one of the major neglected tropical diseases among children in deprived communities. Studies conducted among schoolchildren in Africa are limited and inconsistent. Thus, the aim of this study is to estimate the pooled magnitude and predictors of scabies in African schoolchildren.

Methods

The pooled prevalence estimate with 95% confidence intervals was performed using a random-effects model. Heterogeneity between studies was assessed using the I 2 statistic. Subgroup analyses and sensitivity analyses were performed to explore potential sources of heterogeneity. Publication bias was evaluated using the funnel plot, Begg's, and Egger's tests.

Results

A total of 28,482 subjects from 19 studies were included. The pooled prevalence of scabies among African schoolchildren was 10.81% (2459/28482) with (95% CI: 7.10-14.51). Factors such as being male (aOR = 1.86; 95% CI: 0.72-3.01), children who have a history of sharing clothes with their family (aOR = 1.76; 95% CI: 0.62-2.91), having illiterate parents (aOR = 0.96; 95% CI: 0.51-1.41), having history of contact with skin itching cases/scabies (aOR = 3.37; 95% CI: 1.70-5.03), infrequent cloth wash (aOR = 5.30; 95% CI: 1.26-9.34), sharing common sleeping beds/fomites (aOR = 2.13; 95% CI: 0.04-4.22), family member with itchy signs/scabies (aOR = 5.83; 95% CI: 1.45-10.21), and not taking a bath with water and soap (aOR = 8.51; 95% CI: -4.14 to 21.15) were factors associated significantly with scabies.

PROSPERO registration

CRD42024542762.

Conclusion

In the present scenario, scabies ranges from 2.0% to 17.80% and is higher in Cameroon. Therefore, policymakers and health planners should put a great deal of emphasis on the implementation of relevant prevention and control measures.

Neglected tropical disease meets neglected community: Street children's susceptibility to scabies in Addis Ababa, Ethiopia

Scabies is a neglected tropical disease (NTD) with high prevalence rate in resource-limited settings. Though street children are susceptible because of lack of sanitation and contact with vectors, few attempts have been made to identify the lived experience of street children with scabies in the global south. This study explored perceived susceptibility to scabies and related lived experiences of street children in Addis Ababa. Using in-depth interviews, we collected qualitative data from selected children of the street to identify their understanding of the causes of scabies, their experiences of managing the condition, and their health-seeking behavior. Informants were recruited to include maximum variation in terms of age, sex, and experience of infestation. The study showed that scabies was common among street children and that the infestation has physical, psychological and social impacts. Study participants believed that scabies had its origin in their living conditions (including poor environmental sanitation and lack of personal hygiene), with lice playing a significant role as vectors of transmission. The informants reported visiting modern healthcare facilities, traditional healers and self-care in response to infestation. By uncovering the embodied experience of a stigmatized skin NTD in a neglected community in the global south, this study contributes to combating neglect and addressing health disparities. Having identified living conditions as the major factor contributing to susceptibility, efforts need to be exerted to change street children's living situations and other structural conditions through reunification with their families or other communities, reintegration and other exit strategies.

Madrasa student's health-related quality of life and its associated factors: a cross-sectional study from Bangladesh

The evidence clearly shows that education greatly impacts people's well-being. Bangladesh has two main education systems-general and traditional religious schooling. The current study aimed to measure the quality of life of madrasa students and find out the factors influencing it. This was a cross-sectional study on a group of madrasa students in the Mirpur area of Dhaka, Bangladesh. Data were collected using two-stage stratified random sampling between April and May 2022. The final sample size was 373. The health-related quality of life (HRQoL) was calculated using the KIDSCREEN-10 index, and the median split was used to categorize the score into 'good' and 'poor' categories. A p < 0.05 was considered statistically significant for all statistical tests. Among the participants, most (56%) reported having a good HRQoL. The median age (IQR) of the participants was 10.0 (8.0-12.0) years. Most of the participants were male (91%) and were not orphans (95%). The current study also found that a higher feeling of safety (AOR 3.7; 95% CI 1.3-10.4; p = 0.016) increased the odds of having good HRQoL. However, having a present illness decreased the odds (AOR 0.6; 95% CI 0.4-0.9; p = 0.10) of having a good HRQoL. The key results show that the majority reported a good HRQoL. Promoting students' physical, mental, and social well-being through health education, anti-bullying initiatives, regular school health screening, and institutional & community involvement can help to improve the overall HRQoL of madrasa students.

Prevalence and risk factors of scabies among children living in Madrasahs (Islamic religious boarding schools) of Bangladesh: a cross-sectional study

INTRODUCTION

To determine the prevalence and associated factors of scabies among the children living in the Madrasahs (Islamic religious educational institution) of Bangladesh was the objective of the study.

METHODS

This cross-sectional study was conducted in eight selected Madrasahs from May to October 2023 among male and female children aged between 3 and 18 years. Children were screened for scabies according to criteria developed by the International Alliance for the Control of Scabies.

RESULTS

It was found that overall prevalence of scabies among the children living in Madrasahs was almost 34% (mild 73.5%, moderate 24.9% and severe 1.6%). Prevalence of scabies among male was higher than female (39.4% vs 28.4%). Male gender (aOR 2.09, 95% CI 1.27 to 3.47, p=0.004) and age (aOR 0.95, 95% CI 0.91 to 0.99, p=0.017) were two significant predictors of scabies among children. Besides, living in Madrasahs having more boarders (aOR 1.37, 95% CI 1.06 to 1.69, p=0.025), shared bedding, clothes or toilet stuffs with other children (aOR 1.46, 95% CI 1.03 to 2.09, p=0.036) and history of pruritus in the close entourage (aOR 4.19, 95% CI 3.07 to 5.73, p<0.001) were associated with a higher chance of being infected by scabies.

CONCLUSION

Almost one-third of the children living in the Islamic boarding schools in Bangladesh are suffering from scabies, more prevalence in male and younger children. Accommodation of higher number of boarders, sharing personal staffs and pruritus in close contacts increase the risk of scabies in these children.

Living in a large family and low daily water consumption substantially expose for human scabies in rural Ethiopia: a matched analysis

BACKGROUND

Scabies has been added to the neglected tropical diseases portfolio for large-scale disease control action since 2017 and is part of the WHO roadmap for NTDs 2021-2030, targeted at ending the neglect to achieve the sustainable development goals. Previous studies have not fitted matched analysis to identify predictors of scabies infestation in Ethiopia. Information is also scarce about predictors of scabies infestation in this area. Therefore, this study aimed to identify predictors of scabies infestation in rural Aneded District, northwest Ethiopia.

METHODS

A community-based matched case-control study involving 183 cases and 549 controls was undertaken from March 1 to May 31, 2021, in rural Aneded District. A two-stage sampling technique with a house-to-house census for the screening of scabies cases was employed. A structured questionnaire with questions on sociodemographics, behavior, water supply, sanitation, and hygiene, and delivery of scabies-specific interventions was used. Pretesting, training of data collectors and supervisors, and supervision were applied to keep the data quality. A multivariable conditional logistic regression model was fitted to identify predictors of scabies.

RESULTS

Unmarried individuals or those in separated families (adjusted matched odds ratio (AmOR = 2.71; 95% CI 1.30-5.65); those unable to read and write or in illiterate families (AmOR = 5.10; 95% CI 1.81-14.36); those in large families (AmOR = 6.67; 95% CI 2.83-15.73); households that had longer travel times for water collection (AmOR = 2.27; 95% CI 1.08-4.76); those that had low daily water consumption (AmOR = 6.69; 95% CI 2.91-15.37); households that disposed of solid wastes in open fields (AmOR = 5.60; 95% CI 2.53-12.40); and households that did not receive scabies-specific interventions (AmOR = 2.98; 95% CI 1.39-6.39) had increased odds of scabies.

CONCLUSIONS

Being unmarried, illiteracy, large family, long travel time for water collection, low daily water consumption, open dumping of solid wastes, and inaccessibility of scabies-specific interventions are predictors of scabies. This information is instrumental for redesigning improved scabies-specific interventions that consider educational status, marital status, family size, water collection time, daily water consumption, solid waste disposal, and equity and optimization in delivering existing interventions in rural Ethiopia.

Cloth sharing with a scabies case considerably explains human scabies among children in a low socioeconomic rural community of Ethiopia

BACKGROUND

In 2020, scabies were integrated into the WHO roadmap for neglected tropical diseases, aimed at ending the negligence to realize the SDGs. Ethiopia has also introduced scabies as a notifiable disease in drought-prone localities since 2015. Many of the previous studies employed study designs that might be subject to bias. Moreover, there is no scientific evidence about scabies in this area. Hence, this study aimed to determine the prevalence and associated factors of scabies among children aged below 15 years in rural Ethiopia.

METHODS

A community-based cross-sectional study was carried out among 942 children in rural kebeles of Lay Gayent District from March through May 15, 2021. A two-stage sampling technique was applied. Data on sociodemographics, housing, water supply and sanitation, children's personal hygiene, and caregivers' knowledge about scabies were collected by a structured questionnaire. Data quality was maintained through pretesting, training of data collectors and supervisors, and supervision. An adjusted binary logistic regression was modelled to identify factors associated with scabies. The Hosmer-Lemeshow goodness-of-fit test was run to check the model fitness.

RESULTS

The prevalence of scabies was 21.5% (95% CI 19.0-24.3). Maternal illiteracy (adjusted odds ratio (AOR) = 1.61; 95% CI 1.07-2.43); low household wealth (AOR = 2.04; 95% CI 1.25-3.33); unimproved water source (AOR = 1.58; 95% CI 1.05-2.40); not cleaning a house daily (AOR = 2.43; 95% CI 1.63-3.62); not trimming nails (AOR = 2.21; 95% CI 1.50-3.25); cloth sharing with a scabies case (AOR = 11.77; 95% CI 6.94-19.97); and low caregiver knowledge about scabies (AOR = 2.44; 95% CI 1.64-3.63) were factors associated with scabies.

CONCLUSIONS

Scabies remains a significant public health issue among children aged below 15 years in the district. Maternal illiteracy, low household wealth, unimproved water source, not cleaning a house daily, not trimming nails, cloth sharing with a scabies case, and low caregiver knowledge about scabies were factors associated with scabies. Community-wide interventions with prime emphasis on improving maternal education and caregivers' knowledge about scabies, upgrading household wealth, ensuring a safe water supply, providing healthy housing, and ensuring adequate personal hygiene are warranted.

Scabies as a part of the World Health Organization roadmap for neglected tropical diseases 2021-2030: what we know and what we need to do for global control

Background

Scabies is an under-recognized global health problem with an unacceptably high prevalence in many settings worldwide. Fortunately, the World Health Organization (WHO) has formally designated scabies as a neglected tropical disease in 2017, in the hope of increasing awareness and encouraging efforts to eradicate it. Also, scabies has recently been included as part of the WHO roadmap for neglected tropical diseases 2021–2030, aimed at ending the neglect to attain the Sustainable Development Goals.

Main abstract body

This review article places scabies in focus. The literature was reviewed to explore discussions on controversial issues in scabies control, with the aim of clarifying whether global control of scabies is a feasible and worthwhile objective. The existing status of scabies and its burden are discussed along with future prospects for its global control. The article investigates the feasibility of scabies control and provides updates on the various impediments to this goal, such as challenges related to transmission, diagnosis, treatment, and vaccine development. Also examined are relevant research needs, success factors, and reasons for failure. This article aims to increase the global awareness of scabies and promote discussion, enhance coordinated international efforts, and ultimately, enact change at the national and worldwide levels toward the control of this preventable disease of the poor.

Conclusion

Despite the current challenges, scabies control is now within reach. With sustained interventions, continuous resources, and sincere commitment and support, scabies global control appears to be a worthwhile, realistic goal that is potentially achievable in the not so distant future.

Risk factors associated with scabies infestation among primary schoolchildren in a low socio-economic area in southeast of Iran

Background

Scabies is a neglected tropical disease caused by the mite Sarcoptes scabiei that burrows under the skin. It is a major health problem in tropical areas, largely affecting children. Scabies is common and highly contagious and in schoolchildren spreads quite rapidly, due to overcrowding and close contact within the schools. This study aimed to determine the risk factors associated with scabies infestation among primary schoolchildren in Bashagard County, one of the low socio-economic areas in southeast of Iran.

Methods

To conduct this community-based, descriptive, and cross-sectional study, four primary schools were randomly selected in the Bashagard County. All students in these schools were selected and examined for scabies. Clinical examination and sociodemographic profile of students were assessed using a pre-tested structured questionnaire. Chi-square test, and binary logistic regression were used to analyse the factors associated with scabies infestation by SPSS version 21 software.

Results

Out of 480 studied schoolchildren, 15 cases of scabies with a prevalence of 3.1 % were observed. The frequency of infestation in males was 1.6 % and it was 4.7 % in females. Independent factors associated with a high risk of scabies infestation in unadjusted analysis were being student of grade 5–6 (cOR = 13.12, 95 % CI 2.92–58.89, p = 0.0001), low educational level of father (cOR = 4.37, 95 % CI 0.97–19.59, p = 0.036), low educational level of mother (cOR = 4.14, 95 % CI 1.92–18.57, p = 0.045), joblessness of father (cOR = 14.77, 95 % CI 4.97–43.89, p = 0.0001), employment of mother (cOR = 5.28, 95 % CI 1.38–20.16, p = 0.007), large family size (cOR = 3.34, 95 % CI 1.05–10.64, p = 0.031), use of shared articles (cOR = 33.37, 95 % CI 10.82–102.90, p = 0.0001), and absence of bathroom in the house (cOR = 11.77, 95 % CI 2.16–63.94, p = 0.0001).

Conclusions

Results of this study confirmed that scabies is still one of the most important health problems in the primary schools of the Bashagard County. Low socioeconomic status and personal hygiene of the schoolchildren were the most important factors influencing the prevalence of scabies. Improvement of socioeconomic conditions and implementation of appropriate educational programs and active surveillance system to quickly detect and treat scabies cases are necessary in order to reduce the prevalence of scabies in schoolchildren in this area.

A scabies outbreak in the North East Region of Ghana: The necessity for prompt intervention

Background

There is a dearth of data on scabies from Ghana. In September 2019, local health authorities in the East Mamprusi district of northern Ghana received reports of scabies from many parts of the district. Due to on-going reports of more cases, an assessment team visited the communities to assess the effect of the earlier individual treatment on the outbreak. The assessment team furthermore aimed to contribute to the data on scabies burden in Ghana and to demonstrate the use of the International Alliance for the Control of Scabies (IACS) diagnostic tool in a field survey in a resource limited setting.

Methodology/Principal findings

This was a cross sectional study. Demographic information and medical history was collected on all participants using a REDCap questionnaire. A standardised skin examination of exposed regions of the body was performed on all participants. Scabies was diagnosed based on the criteria of the International Alliance for the Control of Scabies (IACS). Participants were mostly female (61.5%) and had a median age of 18.8 years (IQR 13–25). Two hundred out of 283 (71%) of participants had scabies with most (47%) presenting with moderate disease. Impetigo was found in 22% of participants with scabies and 10.8% of those without scabies [RR 2.27 (95% CI 1.21–4.27)]. 119 participants who received scabies treatment in the past months still had clinical evidence of the disease. 97% of participants reported a recent scabies contact. Scabies was commoner in participants ≤16 years compared to those >16 years [RR 3.06 (95% CI 1.73–5.45)].

Conclusion/Significance

The prevalence of scabies was extremely high. The lack of a systematic approach to scabies treatment led to recurrence and ongoing community spread. The IACS criteria was useful in this outbreak assessment in Ghana. Alternative strategies such as Mass drug administration may be required to contain outbreaks early in such settings.

Scabies, recently categorised as a Neglected Tropical Disease by the WHO is caused by infestation with Sarcoptes scabiei and is characterised by intense pruritus and rash that typically involves the genitalia and the web spaces of the fingers and toes. It has a large global burden and is associated with significant morbidity and socio-economic burden. Secondary bacterial infections following scabies can lead to significant complications including chronic kidney disease from glomerulonephritis and possibly rheumatic heart disease. An outbreak of scabies was reported in Ghana’s East Mamprusi district in September 2019. Despite earlier treatment of individual cases, scabies prevalence was 71%. About 19% of participants had impetigo which was mostly mild in severity. Absence of a systematic approach to treat scabies led to recurrence and ongoing community spread. The recently published IACS criteria for diagnosing scabies proved useful in this outbreak assessment in Ghana. Alternative strategies such as Mass drug administration may be required to contain outbreaks in such settings.

Community perspectives on scabies, impetigo and mass drug administration in Fiji: A qualitative study

Scabies is endemic in Fiji and is a significant cause of morbidity. Little is known about the sociocultural beliefs and practices that affect the occurrence of scabies and impetigo, or community attitudes towards the strategy of mass drug administration that is emerging as a public health option for scabies and impetigo control in Fiji and other countries. Data were collected during semi-structured interviews with 33 community members in four locations in Fiji’s Northern Division. Thematic analysis examined participants’ lived experiences of scabies and impetigo; community knowledge and perceptions about scabies and impetigo aetiology and transmission; community-based treatment and prevention measures; and attitudes towards mass drug administration. Many indigenous Fijian (iTaukei) participants noted extensive and ongoing experience of scabies and impetigo among children in their families and communities, but only one participant of Indian descent (Indo-Fijian) identified personal childhood experience of scabies. Scabies and impetigo were perceived as diseases affecting children, impacting on school attendance and families’ quality of sleep. Awareness of scabies and impetigo was considerable, but there were major misconceptions around disease causation and transmission. Traditional remedies were preferred for scabies treatment, followed by biomedicines provided by local health centres and hospitals. Treatment of close household contacts was not prioritised. Attitudes towards mass drug administration to control scabies were mostly positive, although some concerns were noted about adverse effects and hesitation to participate in the planned scabies elimination programme. Findings from this first study to document perspectives and experiences related to scabies and impetigo and their management in the Asia Pacific region illustrate that a community-centred approach to scabies and impetigo is needed for the success of control efforts in Fiji, and most likely in other affected countries. This includes community-based health promotion messaging on the social dynamics of scabies transmission, and a campaign of education and community engagement prior to mass drug administration.

Scabies is a skin disease causing discomfort from severe itchiness. It can lead to secondary bacterial infection of the skin (impetigo) that can in turn lead to systemic complications, including septicaemia, kidney disease and rheumatic heart disease. It can also cause sleep disorders and a reduced quality of life. Recently added to the World Health Organization list of neglected tropical diseases, scabies is estimated to affect 150 million people globally each year and is endemic in many Pacific Island countries, including Fiji. We aimed to increase understanding of community beliefs and practices that affect the occurrence of scabies and impetigo, and assess community attitudes towards the use of mass drug administration for scabies and impetigo control in Fiji. The impact of scabies and impetigo on participants’ quality of life included poor sleep quality, school absenteeism and social isolation, especially among children. Participants had awareness of scabies and impetigo, however, misconceptions around the cause and the ways in which these diseases were transmitted between individuals were common. Participants often reported choosing traditional medical remedies to treat scabies; treatment at health centres was mainly sought for secondary skin infections. Attitudes towards mass drug administration were positive, although some concerns regarding adverse effects were noted. Improved strategies, including a community-centred response, are needed for the success of control efforts in Fiji.

Prevalence and associated factors of scabies among schoolchildren in Dabat district, northwest Ethiopia, 2018

Background

Scabies is a skin infestation caused by the mite Sarcoptes scabiei that causes a pruritic skin eruption. In Ethiopia, the disease is common especially during natural or manmade disasters such as flooding, drought, civil war and conflict, poor water supply and sanitation, and overcrowding living condition. Though scabies is becoming a major public health problem, especially in low resource settings, there has been no study that reported the prevalence of scabies in the study area. The aim of this study, therefore, was to assess the prevalence of scabies and associated factors among students in primary schools in Dabat district, northwest Ethiopia.

Method

An institutional-based cross-sectional study was employed to determine the prevalence of scabies and associated factors among schoolchildren in Dabat district. A total of 494 students selected by a multi-stage sampling technique were included in this study. Scabies was diagnosed by medical practitioners based on lesions observed on body surfaces after a physical examination. Bivariable and multivariable binary logistic regression analyses were performed using SPSS version 20. Significance level was obtained at p value < 0.05.

Result

The prevalence of scabies was 9.3% (46/494) with 95% CI (5.66%, 12.94%). Among schoolchildren who were infested by scabies, 65.22% (30/46) had a mild, 28.26% (13/46) had moderate, and 6.52% (3/46) had severe lesions. Studying at a rural school (AOR = 2.99, 95% CI 1.33, 6.71), had illiterate father (AOR = 5.11, 95% CI 2.25, 11.58), being grade level 1–4 (AOR = 3.91, 95% CI 1.69, 9.05), rarely taking a bath (AOR = 3.54, 95% CI 1.36, 9.25), contact with a person with itching symptom (AOR = 2.66, 95% CI 1. 21, 5.83), a family member with itchy symptoms (AOR = 4.76, 95% CI 2.20, 10.28), not living with both parents (AOR = 2.49, 95% CI 1.02, 6.06), and using water only for hand washing (AOR = 4.38, 95% CI 1.78, 10.76) were factors associated with scabies infestation among schoolchildren.

Conclusion

The prevalence of human scabies among schoolchildren in Dabat district northwest Ethiopia was high. The school localization, first cycle level of education, paternal educational status, frequency of taking a bath, and contact with a person having itchy lesions, presence of a family member with itchy lesion, and type of frequently used hand washing material were the factors significantly impacting the occurrence of scabies. Special attention should be given to students at first cycle education as they are at the highest risk of infestation.

Ectoparasites: Scabies

Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis and is a public health issue in all countries regardless of socioeconomic status. In high-income countries, delays in diagnosis can lead to institutional outbreaks; in low- and middle-income countries, poor access to health care contributes to disease undertreatment and long-term systemic sequelae. With scabies now recognized as a neglected tropical disease by the World Health Organization, increased awareness and systematic efforts are addressing gaps in diagnosis and treatment that impede scabies control. This review summarizes the available data and provides an update on scabies epidemiology, clinical features, diagnosis, management, and public health considerations.

The Epidemiology of Scabies and Impetigo in Relation to Demographic and Residential Characteristics: Baseline Findings from the Skin Health Intervention Fiji Trial

Scabies and associated impetigo are under-recognized causes of morbidity in many developing countries. To strengthen the evidence base for scabies control we undertook a trial of mass treatment for scabies. We report on the occurrence and predictors of scabies and impetigo in participants at baseline. Participants were recruited in six island communities and were examined for the presence of scabies and impetigo. In addition to descriptive analyses, logistic regression models were fit to assess the association between demographic variables and outcome of interest. The study enrolled 2051 participants. Scabies prevalence was 36.4% (95% confidence interval [CI] 34.3-38.5), highest in children 5-9 years (55.7%). Impetigo prevalence was 23.4% (95% CI 21.5-25.2) highest in children aged 10-14 (39.0%). People with scabies were 2.8× more likely to have impetigo. The population attributable risk of scabies as a cause of impetigo was 36.3% and 71.0% in children aged less than five years. Households with four or more people sharing the same room were more likely to have scabies and impetigo (odds ratios [OR] 1.6, 95% CI 1.2-2.2 and OR 2.3, 95% CI 1.6-3.2 respectively) compared to households with rooms occupied by a single individual. This study confirms the high burden of scabies and impetigo in Fiji and the association between these two conditions, particularly in young children. Overcrowding, young age, and clinical distribution of lesion are important risk factors for scabies and impetigo. Further studies are needed to investigate whether the decline of endemic scabies would translate into a definite reduction of the burden of associated complications.

Scabies among primary schoolchildren in Egypt: sociomedical environmental study in Kafr El-Sheikh administrative area

BACKGROUND/OBJECTIVES

Scabies is a major global public health issue that might affect people from all socioeconomic levels. The primary contributing factors in contracting scabies seem to be poverty and overcrowded living conditions. Scabies often spreads among schoolchildren quite rapidly, owing to their close contact and overcrowding within the schools. However, limited information is available about its risk factors and the socioeconomic correlates among schoolchildren in Egypt. This study aimed to assess the prevalence of scabies and its risk factors among primary schoolchildren in Kafr El-Sheikh administrative area, Egypt.

METHODS

This cross-sectional descriptive study was performed on primary schoolchildren in urban and rural areas of Kafr El-Sheikh administrative area. A predesigned questionnaire was used for data collection from the randomly selected 2,104 children, and clinical dermatological examination was done for them.

RESULTS

Out of 2,104 children studied, there were 92 cases of scabies with a prevalence of 4.4%. The prevalence of scabies infestation in male students was 3.9%, while it was 4.8% in females, with no statistical significance. The results showed significant variations in the risk of scabies infestation by factors such as residence, paternal education and occupation, maternal education, sleeping with others, having animals at home, dealing with animals outside the house, type of building for living, family history of itchy rash, and sharing clothes with others.

CONCLUSION

In our community, scabies is still an important health problem affecting schoolchildren, especially in rural areas. It is characterized by a complex web of causation, particularly poor living conditions and low level of parents' education.

Impact of scabies in resource-poor communities

PURPOSE OF REVIEW

Features of endemic scabies are specific in resource-poor and underprivileged communities, with implications for control measures on the community level. In this review, these special aspects are addressed.

RECENT FINDINGS

Scabies is endemic in many resource-poor communities, with a prevalence of 20% and higher. Transmission is influenced by social attitudes, migration, access to healthcare services, housing conditions, hygiene conditions, and crowding. Endemic scabies occurs with severe infestations, complications, and sequels, mainly in children. Sleep loss as a result of scabies-related itching is common. Complications include secondary infections by group A streptococci and acute poststreptococcal glomerulonephritis. Shame, restriction of leisure activities, and stigmatization are common. Treatment of scabies includes a variety of topical compounds, but control on the community level is not an easy task. As ivermectin kills a variety of other parasites, this oral drug is increasingly used for mass treatment. Intervention should address socioemotional aspects using an integrated approach with professionals from different areas, and the community.

SUMMARY

Scabies is a neglected disease and needs to be perceived as an important public health problem causing morbidity in many resource-poor communities. Future work on epidemiology, clinical aspects, transmission dynamics, socioeconomic aspects, and sustainable control in resource-poor communities is needed.

Controlling scabies in madrasahs (Islamic religious schools) in Bangladesh

OBJECTIVES

To assess the effectiveness of a scabies control programme in reducing the prevalence of scabies in urban Bangladesh madrasahs, where the condition is extremely common.

STUDY DESIGN

A controlled trial involving four intervention madrasahs (total students 2359) and four control madrasahs (total students 2465) in Dhaka Metropolitan Area.

METHODS

A baseline scabies sample survey was carried out on 40 and 44 students of four intervention and four control madrasahs, respectively. Another 40 students of the intervention madrasahs were administered a pre-intervention test on scabies knowledge. This was followed by mass treatment of all students, teachers and staff of the eight madrasahs with topical 5% permethrin cream. The subsequent intervention involved daily monitoring of students for five key personal hygiene practices, weekly 10-min scabies health education classes, supply of simple and inexpensive products to students to prevent cross-infestation to/from peers (e.g. plastic bags, clothes hangers), and chemotherapy of new students detected with scabies. After 4 months of the intervention, the prevalence of scabies, personal hygiene practices and scabies knowledge were assessed in students of the intervention madrasahs.

RESULTS

Before the intervention, the prevalence of scabies was 61% and 62% in intervention and control madrasahs, respectively (P = 1.00). After mass scabies treatment in all eight madrasahs and 4 months of intervention, the prevalence of scabies was reduced to 5% and 50% in intervention and control madrasahs, respectively (P < 0.001). There were significant improvements in all five personal hygiene practices at the intervention madrasahs. Mean test scores for scabies knowledge were 40% before the intervention and 99% after the intervention in the four intervention madrasahs. The cost of this programme was US$1.60 per student, and primarily included products such as plastic bags and clothes hangers, and health education material.

CONCLUSIONS

This programme demonstrates a pragmatic and cost-effective way to control scabies in a residential institutional setting. It is recommended that this programme should be scaled up to all residential madrasahs in Bangladesh.

Epidemiology of scabies prevalence in the U.K. from general practice records

BACKGROUND

Scabies is a contagious parasitic infestation which causes an allergic reaction to just a few mites.

OBJECTIVES

To examine the epidemiology of scabies consultations in the U.K. by age, sex, region of the country and time.

METHODS

Data were obtained from the THIN (The Health Information Network) database provided by EPIC U.K. in which each consultation episode is coded according to a 'READ' code. Data were available for 1997-2005 inclusive (9 years) for approximately 8·5% of the U.K. population from 12 regions of the U.K. We used harmonic analysis to model the data over time and derived cycle amplitudes and phases for each region in the U.K.

RESULTS

There was a significantly greater infestation rate among females with a relative risk of 1·24 (P < 0·001) relative to males. The age group 10-19 years had the highest infestation rates (with rates of 4·55 per 1000 and 5·92 per 1000 for males and females, respectively). The middle age groups had the smallest infestation rates. A cycle with length of between 15 and 17 years was derived, and the phase times of the cycles for each region suggested a progression of the disease originating from the North East, spreading to Northern parts of the U.K. and then to the Midlands and the South.

CONCLUSIONS

The study confirms earlier studies with regard to the age/sex distribution of scabies. We suggest a contagious pattern of spread of scabies infestation in the U.K. with an epidemic cycle length of 15-17 years.