The prevalence of scabies in Monrovia, Liberia: A population-based survey.

Shelui Collinson,Katherine E Halliday,Rachel Pullan,Samuel K Zayzay,Mosoka Fallah,Michael Marks,Joseph Timothy,Karsor K Kollie,Stephen L Walker,Neima Candy,Eglantine Lebas,Claire Fuller

doi:10.1371/journal.pntd.0008943

Abstract

Scabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking. We conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate versions of the dermatology life quality index (DLQI). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression. 1,318 participants from 477 households were surveyed. The prevalence of scabies was 9.3% (95% CI: 6.5–13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4–1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies. Our study indicates a substantial burden of scabies in this peri-urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life.

Highlights

Scabies is a parasitic infestation of the skin by the mite Sarcoptes scabiei var. hominis
The prevalence was higher in the youngest age group compared to the oldest, with 16.6% of those under five diagnosed with scabies compared to 7.2% of those aged 35 and older
Our study highlights that scabies carries a substantial burden across all age groups in this periurban community in Monrovia, including a considerable impact on health-related quality of life (HRQoL) for those with the disease

Summary

Introduction

Scabies is a parasitic infestation of the skin by the mite Sarcoptes scabiei var. hominis. Scabies can be complicated by secondary bacterial infection with Streptococcus pyogenes and Staphylococcus aureus [3, 4] and the risk of severe conditions including post streptococcal glomerulonephritis, acute rheumatic fever and rheumatic heart disease [3, 5]. In view of this burden of disease, scabies was added to the WHO Neglected Tropical Disease portfolio in 2017 [6], with a recommendation that scabies management should be incorporated in the universal health coverage package of care [7]. The relationship between scabies and secondary bacterial infection seems to be variable [10], with the latter appearing to be less common in sub-Saharan Africa than in the Pacific, where the majority of studies to date have been conducted [8]

Methods

Findings

Discussion

Conclusion