A facility and community-based assessment of scabies in rural Malawi

Abstract

Background: Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provides an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic-based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community-based outreach programme. Methods: From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Results: Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions: Prevalence of scabies in our study setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.

Low prevalence of scabies and impetigo in Dakar/Senegal: a cluster-randomised, cross-sectional survey

“…Median scores and inter-quartile ranges (IQR) were used to quantify the effect on the QOL. The impact of scabies on the quality of life was assessed as no effect on patient's life (DLQI scores 0-1), small effect on patient's life (2-5), moderate effect on patient's life (6-10), very large effect on patient's life (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and extremely large effect on patient's life (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). ( 35…”

“…In Africa, a community-wide survey in rural Malawi found scabies and impetigo prevalence rates of 15% and 7% respectively. (26) In the Amhara Region of Ethiopia a population-based survey amongst children aged 5 to 14 years reported a scabies prevalence of 11%. (27) .…”