The Prevalence of Scabies and Impetigo in the Solomon Islands: A Population-Based Survey.

David C Mabey,Michael Marks,Daniel Engelman,Lucia Romani,John Kaldor,Andrew C Steer,Daniel S Mason,Anthony W Solomon,Oliver Sokana

doi:10.1371/journal.pntd.0004803

Abstract

BackgroundScabies and impetigo are common, important and treatable skin conditions. Reports from several Pacific island countries show extremely high prevalence of these two conditions, but for many countries, including the Solomon Islands, there is a paucity of epidemiological data.MethodologyTen rural villages in the Western Province of the Solomon Islands were included in the study, chosen so that data collection could be integrated with an existing project investigating clinical and serological markers of yaws. All residents were eligible to participate, and 1908 people were enrolled. Participants were interviewed and examined by a paediatric registrar, who recorded relevant demographic information, and made a clinical diagnosis of scabies and/or impetigo, severity and distribution.Principal FindingsThe total unweighted prevalence of scabies was 19.2% (95% confidence interval [CI] 17.5–21.0), and age and gender weighted prevalence 19.2% (95%CI 16.7–21.9). The adult prevalence of scabies was 10.4% (95%CI 8.2–13.2), and the highest prevalence was found in infants < 1 year of age (34.1%, adjusted odds ratio [AOR] compared with adults: 3.6, 95%CI 2.2–6.0) and children aged 1–4 years (25.7%, AOR 2.6, 95%CI 1.7–3.9). Scabies affected two or more body regions in 80.9% of participants, and 4.4% of scabies cases were classified as severe. The total unweighted prevalence of active impetigo was 32.7% (95%CI 30.6–34.8), and age and gender weighted prevalence 26.7% (95%CI 24.2–29.5). The highest prevalence was found in children aged 1–4 years (42.6%, AOR compared with adults: 4.1, 95%CI 2.9–5.8). Scabies infestation was associated with active impetigo infection (AOR 2.0, 95%CI 1.6–2.6); with 41.1% of active impetigo cases also having scabies.Conclusions and SignificanceScabies and impetigo are very common in the rural Western Province of the Solomon Islands. Scabies infestation is strongly associated with impetigo. Community control strategies for scabies may reduce the burden of both conditions and their downstream complications.

Highlights

Scabies is a parasitic infestation of the skin by the mite Sarcoptes scabiei var hominis
Scabies and impetigo are very common in the rural Western Province of the Solomon Islands
Scabies infestation is strongly associated with impetigo

Summary

Introduction

Scabies is a parasitic infestation of the skin by the mite Sarcoptes scabiei var hominis. Impetigo is a superficial bacterial skin infection caused primarily by Streptococcus pyogenes and Staphylococcus aureus, and has been associated with scabies infestation in tropical environments [3, 4]. Streptococcal skin infection has been implicated in up to 50% of cases of acute post streptococcal glomerulonephritis in tropical settings [5], and contributes to chronic kidney disease in adulthood [6]. There is strong epidemiological data linking streptococcal impetigo with acute rheumatic fever and rheumatic heart disease, which causes significant morbidity and mortality worldwide [7]. Scabies and impetigo are common, important and treatable skin conditions. Reports from several Pacific island countries show extremely high prevalence of these two conditions, but for many countries, including the Solomon Islands, there is a paucity of epidemiological data

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