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 provide 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. Methodology/Principal findings 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. 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/Significance Prevalence of scabies in our 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) [36]. Stata SE 17.0 (StataCorp, College Station, TX) was used for data analysis.…”

“…Geographically, most population prevalence surveys have been conducted in the Pacific and have frequently recorded very high prevalence rates amongst the general populations [22][23][24][25]. 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 populationbased survey amongst children aged 5 to 14 years reported a scabies prevalence of 11% [27].…”

Prevalence and determinants of scabies: a global systematic review and meta-analysis

“…The sample size of each of the constituent studies ranged from 50 to 9,057,427 participants. Of the 54 eligible studies, nine were conducted in Ethiopia [30][31][32][33][34][35][36][37][38], eight in Fiji [14] [39][40][41][42][43], six in the Solomon Islands [13][ [16][17][ [43][44][45][46], four in Timor-Leste [43] [47][48][49], four in India [11][50-52], three in Ghana [53][54][55], two in Australia [15][56], two in Nigeria [57][58], two in Malaysia [59][60] and one each in Cameroon [61], Egypt [62], Gambia [63], Iran [64], Lao [65], Liberia [66], Malawi [12], New Zealand [67], Samoa [68], Sri Lanka [69], Tanzania [18], Turkey [70], United Kingdom…”

“…The following information was abstracted from each of the selected studies: last name of the first author, year of publication, study period, prevalence (absolute number), prevalence as a percentage, method of diagnosis, country of study, World Health Organization region, United Nations Statistics Division of countries, geographic location, population setting of the study, Gross Domestic Product (GDP) per capita in US$ of the study country, Gini index, Human Development Index (HDI), average income level of the country, age range of the population studied, the total sample size and different determinants of scabies. Among the included studies, a few were performed to determine the impact of mass drug administration on scabies prevalence [11][12][13][14][15][16][17][18]. From these studies, the baseline prevalence data were used for the pooled estimates as these data describe the prevalence among the community without any intervention.…”

Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show?

“…Reports from various countries have described an increase in the incidence of scabies ( Table 1 ) [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. From Europe, available data shows an increasing trend in scabies infestations, particularly evident among populations with associated contributing factors, such as those who travel frequently, refugees, asylum seekers, those who regularly lack drinking water and appropriate hygiene, those who are of a younger age, etc.…”