Abstract
BackgroundScabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA.MethodsA cross-sectional school survey was conducted in April–May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated.ResultsThe overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%.ConclusionsScabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.Graphical
Highlights
Scabies and impetigo are endemic in many tropical, low- and middle-income countries
Children aged 10 to 14 years were less likely to have scabies than 5 to 9 year olds (AOR 0.70, 95% Confidence interval (CI) 0.52–0.93, p = 0.01)
The odds of scabies infection were 3.5 times greater in Manufahi compared to Dili (53.6% [95% CI 46.3–60.7] vs 28.2% [95% CI 24.4–32.3], Adjusted odds ratio (AOR) 3.5, 95% CI 1.6–8.0, p = 0.02)
Summary
Scabies and impetigo are endemic in many tropical, low- and middle-income countries. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. Scabies is a highly contagious skin condition caused by the mite Sarcoptes scabiei var. In 2017, over 175 million people were estimated to be infested with scabies worldwide [2]. Scabies is recognised as one of the neglected tropical diseases, conditions for which effective interventions are available but that continue to cause significant morbidity in many resource-poor communities of tropical and sub-tropical countries [3]. Scabies infestation causes severe itch and skin lesions, including papules, nodules, burrows and vesicles. Scabies and impetigo disproportionately affect infants, children, adolescents and, in some populations, the elderly (> 70 years of age) [2,[5]
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