Control Of Filariasis Research Articles

Experience of Health System Personnel in the Implementation of Mass Distribution Campaigns for the Control of Lymphatic Filariasis in Rural Guinea in 2022

This study documents the experiences of health system personnel in the implementation of mass distribution campaigns for the control of lymphatic filariasis in rural Guinea. This was an exploratory qualitative study using data collected from implementing actors of mass distribution campaigns in the Boké health district. The results showed four main facilitators of mass distribution campaign rollout in the Boké health district: (i) support to the district teams in the organization of the campaigns; (ii) involvement of community-based associations in social mobilization; (iii) strong adherence of the communities to the different mass distribution campaigns, facilitated through the involvement of community relays, who are members of these communities, in the distribution of drugs; and (iv) transparency in the allocation of incentives to drug dispensers and supervisors. However, the frequent shortages of medicines, the difficulty of access to rural areas, and the lack of logistical means for the supervision of activities were the main obstacles to the success of the various mass distribution campaigns in Boké. The provision of buffer stocks for special areas such as Boké by national programme actors and partners, joint planning of campaign activities with local managers of health systems and services, and improvement of existing mechanisms for motivating health workers, including community health workers, during future campaigns should help to achieve national objectives in the fight against NTDs in Guinea.

Effect of Climate Change on Mansonia Mosquitoes Distribution on Filariasis Transmission Potential (Zoonosis) in Pajaten Hamlet, Keleyan, Socah Bangkalan, Madura

This study examines how climate change affects the distribution of Mansonia genus mosquitoes and their potential role in filariasis transmission in Pajaten Hamlet, Keleyan, Socah Bangkalan, Madura, Indonesia. Filariasis is an endemic disease in the area that is spread through mosquito bites and possibly zoonotic transmission. This study examines the biting behavior of Mansonia mosquitoes in bionomics and its relationship with environmental parameters such as temperature and humidity. The results showed an increase in the population of Mansonia mosquitoes in Pajaten Hamlet, especially during the rainy season. Morphological identification revealed the characteristics of Mansonia mosquitoes, with a focus on nocturnal biting behavior. Dissection of adult mosquitoes provided insights into the reproductive process of Mansonia mosquitoes. The influence of climate and environmental conditions on mosquito abundance was also discussed, emphasizing the correlation between mosquito prevalence and factors such as swamp water availability and vegetation. The study also highlights the importance of sanitation in the spread of filariasis and proposes control measures tailored to local conditions. This study conclude that the impact of climate change on the Mansonia mosquitoes spread and emphasizes the need for proactive measures in filariasis control. Control strategies, including habitat clearance, use of bed nets, and deworming of potential reservoirs, are suggested to break the chain of disease transmission. This study makes a valuable contribution to developing effective strategies to control filariasis in the context of climate change.

Immune Response Profiling of Cocktails of Brugia malayi Vaccine Candidates DIM-1, Calponin and Troponin 1in BALB/c Mice.

In search of a vaccine for the control of human lymphatic filariasis (LF) caused by Wuchereria bancrofti, Brugia malayi and B. timori, we identified three parasite-specific potential candidates: the disorganized muscle protein-1 (D), calponin (C) and troponin 1 (T) in B. malayi adult worm. In the present study, we investigated the immune response profile of the cocktails of the recombinant D, T and C proteins. Groups of BALB/c mice were immunized with individual rproteins or their cocktails DT, TC, DC and DTC, and the immunogen-specific IgG and its subclasses and IgE were determined. Cells from the immunized animals were challenged in vitro with the respective rproteins and cocktails and the release of nitric oxide (NO) from macrophages and Th1 and Th2 cytokines from splenocytes were determined. Among the immunized groups, DTC elicited comparatively a stronger response which included augmented release of NO, Th1 (IL-1β, IL-2, IFN-γ and TNF-α) and Th2 (IL-4, IL-6, IL-10 and TGF-β) cytokines, and increased levels of immunogen-specific IgG, IgG1 and IgG2b and low levels of immunogen-specific IgG2a and IgE and the Th2 cytokine IL-13. Immune responses that play important role in host protection were elicited strongly by DTC cocktail compared to the individual rproteins or DT, TC and DC cocktails. The findings provide a sound rationale for further studies on DTC cocktail as a vaccine candidate for the control of LF.

Diethylcarbamazine elicits Ca2+ signals through TRP-2 channels that are potentiated by emodepside in Brugia malayi muscles.

Filarial nematode infections are a major health concern in several countries. Lymphatic filariasis is caused by Wuchereria bancrofti and Brugia spp. affecting over 120 million people. Heavy infections can lead to elephantiasis, which has serious effects on individuals' lives. Although current anthelmintics are effective at killing microfilariae in the bloodstream, they have little to no effect against adult parasites found in the lymphatic system. The anthelmintic diethylcarbamazine is one of the central pillars of lymphatic filariasis control. Recent studies have reported that diethylcarbamazine can open transient receptor potential (TRP) channels in the muscles of adult female Brugia malayi, leading to contraction and paralysis. Diethylcarbamazine has synergistic effects in combination with emodepside on Brugia, inhibiting motility: emodepside is an anthelmintic that has effects on filarial nematodes and is under trial for the treatment of river blindness. Here, we have studied the effects of diethylcarbamazine on single Brugia muscle cells by measuring the change in Ca2+ fluorescence in the muscle using Ca2+-imaging techniques. Diethylcarbamazine interacts with the transient receptor potential channel, C classification (TRPC) ortholog receptor TRP-2 to promote Ca2+ entry into the Brugia muscle cells, which can activate Slopoke (SLO-1) Ca2+-activated K+ channels, the putative target of emodepside. A combination of diethylcarbamazine and emodepside leads to a bigger Ca2+ signal than when either compound is applied alone. Our study shows that diethylcarbamazine targets TRP channels to promote Ca2+ entry that is increased by emodepside activation of SLO-1 K+ channels.

The Prevalence of Lymphatic Filariasis Infection among Primary School Children (5-9 Years) of Infected Adults in Ihiala Local Government Area of Anambra State, Nigeria

Aims: To determine the prevalence of Lymphatic flariasis infection among primary school children and of infected adults in Ihiala LGA, Anambra State. Study design: Cross-sectional study. Place and Duration of Study: Department of the Ministry of Health Anambra State and a few selected primary school children in Ihiala Local Government Area between June 2021 and July 2022. Methodology: A total of 150 residents were examined for Lymphatic filariasis. In the Primary Health Centre, a screening for clinical manifestation was done among adults. Sample analysis was done using Filariasis Test Strip while Semi-structured questionnaires were used to collect data on knowledge, attitude and practices (KAP) among residents. Results: Out of 299 blood samples collected from school children and 150 questionnaires distributed to residents to ascertain the awareness of Lymphatic filariasis among residents in the study areas and also to evaluate the efficacy of Ivermectin and Albendazole distributed annually through Mass Drug Administration since 2014, Filariasis Test Strip (FTS) showed 0.0% prevalence of circulating filarial antigen among the school children while the total prevalence of clinical manifestations among residents was 43.33% with higher rate in males (57.33%) than females (42.67%) while forty to 49-year-olds recorded the highest prevalence (13.33%) of clinical manifestations. Statistical analysis was performed with ANOVA using SPSS package and the mean difference is significant at the .05 level that is the P value of the analysis is significant at ≥0.005 level. Conclusion: Our findings on Filariasis Test Strip (FTS) showed 0.0% prevalence of circulating filarial antigen among the school children implying that Lymphatic Filariasis transmissions is low in the study area, suggest the Ivermectin and Albendazole distributed through MDA since 2014 in the endemic areas of Anambra have been effective for Lymphatic filariasis control and should remain the recommended strategy for the elimination of Lymphatic filariasis.

Programmed cell death pathways as targets for developing antifilarial drugs: Lessons from the recent findings.

More than half a century has passed since the introduction of the National Filariasis Control Program; however, as of 2023, lymphatic filariasis (LF) still prevails globally, particularly in the tropical and subtropical regions, posing a substantial challenge to the objective of worldwide elimination. LF is affecting human beings and its economically important livestock leading to a crucial contributor to morbidities and disabilities. The current scenario has been blowing up alarms of attention to develop potent therapeutics and strategies having efficiency against the adult stage of filarial nematodes. In this context, the exploration of a suitable drug target that ensures lethality to macro and microfilariae is now our first goal to achieve. Apoptosis has been the potential target across all three stages of filarial nematodes viz. oocytes, microfilariae (mf) and adults resulting in filarial death after receiving the signal from the reactive oxygen species (ROS) and executed through intrinsic and extrinsic pathways. Hence, it is considered a leading target for developing antifilarial drugs. Herein, we have shown the efficacy of several natural and synthetic compounds/nanoformulations in triggering the apoptotic death of filarial parasites with little or no toxicity to the host body system.

Geospatial modelling of lymphatic filariasis and malaria co-endemicity in Nigeria.

Lymphatic filariasis (LF) and malaria are important vector-borne diseases that are co-endemic throughout Nigeria. These infections are transmitted by the same mosquito vector species in Nigeria and their transmission is similarly influenced by climate and sociodemographic factors. The goal of this study was to assess the relationship between the geospatial distribution of both infections in Nigeria to better coordinate interventions. We used national survey data for malaria from the Demographic and Health Survey dataset and site-level LF mapping data from the Nigeria Lymphatic Filariasis Control Programme together with a suite of predictive climate and sociodemographic factors to build geospatial machine learning models. These models were then used to produce continuous gridded maps of both infections throughout Nigeria. The R2 values for the LF and malaria models were 0.68 and 0.59, respectively. Also, the correlation between pairs of observed and predicted values for LF and malaria models were 0.69 (95% confidence interval [CI] 0.61 to 0.79; p<0.001) and 0.61 (95% CI 0.52 to 0.71; p<0.001), respectively. However, we observed a very weak positive correlation between overall overlap of LF and malaria distribution in Nigeria. The reasons for this counterintuitive relationship are unclear. Differences in transmission dynamics of these parasites and vector competence may contribute to differences in the distribution of these co-endemic diseases.

Peran Pengambil Kebijakan dan Masyarakat dalam Pencegahan Penularan Filariasis (Studi Kualitatif)

Filariasis is still a health problem in East TanjungJabung and Belitung regencies even though mass treatment activities have been carried out for five rounds. Both districts are still endemic for filariasis because the Microfilaria rate (Mf rate) is still more than 1%. This study aims to identify the role of the community of various parties in controlling filariasisin Tanjung Jabung Timur and Belitung regencies. The research design is descriptive with a qualitative approach. Informants for the in-depth interviews were health workers at the district, sub-district and village levels as well as the village community. The number of health worker informants was 10 people, 16 community leaders, 16 cadres, and 9 sufferers, while the FGD consisted of 4 groups. Each group consists of 7 participants. Data was collected through in-depth interviews and group discussions and the data were analyzed qualitatively. Recruitment of informants for determining in-depth interviews using the snow ball method. The results showed that the roles of officers and policy makers in TanjungJabung Timur Regency were quite good, but in Belitung Regency they were less involved. Meanwhile, the role of community leaders in Indonesia is still not optimal in controlling filariasisespecially in disseminating information about filariasis. Therole of community leaders in East Tanjung Jabung Regency is more powerful than Belitung Regency. Filariasis control activities still need support from policy makers in allocating budgets and the role of community leaders to mobilize the community to be actively involved in controlling filariasis.

Diagnosis and Control of Lymphatic Filariasis with Special Emphasis on Gene Editing Method

Diagnosis and Control of Lymphatic Filariasis with Special Emphasis on Gene Editing Method

The Impact of Mass Drug Administration on Lymphatic Filariasis

Mass drug administration (MDA) has made a significant impact on the control of lymphatic filariasis (LF) since the establishment of the Global Programme to Eliminate Lymphatic Filariasis. However, its implementation is associated with several challenges, hampering interruption of parasite transmission and LF elimination in endemic areas. This study assessed the impact of MDA by comparing baseline microfilaria and antigen prevalence with those after three years (mid-term) and ≥5 years of MDA implementation and their respective prevalence reductions and identified specific challenges that may hinder its effective implementation. Three years of MDA implementation were observed to have microfilaria prevalence reductions (88.54% to 98.66%) comparable to those of studies that implemented MDA for five to 10 years (≥5 years, 79.23% to 98.26%). Inadequate community understanding of and participation in the LF MDA programme are major drawbacks to its effective implementation. The implementation of MDA that incorporates community participation, incentivisation, education, and training strategies has the potential of increasing MDA coverage and compliance, thereby interrupting parasite transmission and reducing microfilarial prevalence to levels that warrant LF elimination.

기생충 길들이기

Study of parasite control was a product of transnational interactions among scientists, activists, public, technologies and tools, as well as ecological environments such as parasites in the geopolitical context. This study critically reviews the previous historical analysis on public health programs, which was mainly looked at in a national context. Also, this study emphasizes that the practice of knowledge has been continuously transformed by social, cultural, and ecological factors that occur across the borders, with a specific example of Korea-Japan Joint research project in Jeju from 1970 to 1972 on the control of lymphatic filariasis. Endemic Burgia Malayi filaria provided a unique opportunity for both Korean and Japanese parasitologists to secure a valuable study object as well as model organism. The construction of knowledge about parasite control did not consist solely of research in a laboratory or university. Just as parasitologists continually engaged in the parasite control program and built up the knowledge and skills involved, these activities aimed to be applied to and practiced by the general public. In the process where knowledge constructed in a laboratory meets an external environment, researchers modified the practice according to appropriate social, cultural and ecological factors in local field of study sites.

Influence of social and environmental factors for Culex quinquefasciatus distribution in Northeastern Brazil: a risk index

ABSTRACT Culex quinquefasciatus is a vector of lymphatic filariasis. One important component in planning filariasis control activities is the mapping of vector distribution. A tool that involves socio-environmental factors and Cx. quinquefasciatus density can contribute to the identification of areas that should be prioritized in surveillance actions. This is an ecological study based on the construction and validation of a risk score of urban areas according to social and environmental variables extracted from a national database. Based on this stratification, female Cx. quinquefasciatus were captured. In total, 30,635 Cx. quinquefasciatus were captured, of which 17,161 (56%) were females. The highest vector density index of mosquitoes were captured in households located in the high-risk stratum and the indicator proved to be a tool that identified an association between social and environmental conditions and areas with the highest vector density index of females Cx. quinquefasciatus.

Lymphatic Filariasis Control: School-based One Health Initiative on The Usage of Local Plants as Alternative Mosquito Repellants in Timor Tengah Selatan, Nusa Tenggara Timur

Lymphatic filariasis is a mosquito-borne disease that poses a serious public health concern. The disease has spread to 28 Indonesian provinces, with NTT province being one of the 10 provinces with the highest incidence. Aside from being a major supporter of the annual mass drug administration program, the mosquito control initiative is also critical to the disease's eradication. However, today's mosquito control approaches depend primarily on synthetic moieties, which, unfortunately, have resulted in environmental problems and also resistance in important mosquito species. Consequently, developing alternative mosquito control strategies based on herbal components that are environmentally friendly, safe, and long-lasting is necessary. This one-health program aims to educate and raise public awareness of the importance of mosquito control and to inspire the community to utilize local plants as alternative mosquito repellents. This program is targeted high school students from the Timor Tengah Selatan regency. This regency is one of the NTT regencies with the highest risk of lymphatic filariasis. The approach method employed in this program was a series of presentations, discussions, and a demonstration of lymphatic filariasis and the selection of local plants that can be used as herbal repellents. Based on discussions with the students, it was discovered that after engaging in this activity, the participants had learned and recognized the dual function of various indigenous plants in their area as effective and cost-effective mosquito repellents. Furthermore, the students became more excited to learn and develop knowledge about the function of other local plants as efficient mosquito repellents.

Colorimetric and Real-Time Loop-Mediated Isothermal Amplification (LAMP) for Detection of Loa loa DNA in Human Blood Samples.

Loiasis, caused by the filarial nematode Loa loa, is endemic in Central and West Africa. Loa loa has been associated with severe adverse reactions in high Loa-infected individuals receiving ivermectin during mass drug administration programs for the control of onchocerciasis and lymphatic filariasis. Diagnosis of loiasis still depends on microscopy in blood samples, but this is not effective for large-scale surveys. New diagnostics methods for loiasis are urgently needed. Previously, we developed a colorimetric high-sensitive and species-specific LAMP for Loa loa DNA detection. Here, we evaluate it in a set of 100 field-collected clinical samples stored as dried blood spots. In addition, Loa loa-LAMP was also evaluated in real-time testing and compared with microscopy and a specific PCR/nested PCR. A simple saponin/Chelex-based method was used to extract DNA. Colorimetric and real-time LAMP assays detected more samples with microscopy-confirmed Loa loa and Loa loa/Mansonella perstans mixed infections than PCR/nested-PCR. Samples with the highest Loa loa microfilariae counts were amplified faster in real-time LAMP assays. Our Loa loa-LAMP could be a promising molecular tool for the easy, rapid and accurate screening of patients for loiasis in endemic areas with low-resource settings. The real-time testing (feasible in a handheld device) could be very useful to rule out high-microfilariae loads in infected patients.

Community-based trial assessing the impact of annual versus semiannual mass drug administration with ivermectin plus albendazole and praziquantel on helminth infections in northwestern Liberia

We assessed the impact of three annual vs five semiannual rounds of mass drug administration (MDA) with ivermectin plus albendazole followed by praziquantel for the control or elimination of lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminth (STH) infections and schistosomiasis in Lofa County, Liberia. The study started in 2012 and was interrupted in 2014 during the Ebola virus outbreak. Repeated cross-sectional surveys were conducted in individuals 5 years and older to measure infection markers. Wuchereria bancrofti antigenemia prevalences decreased from 12.5 to 1.2% (90% reduction) and from 13.6 to 4.2% (69% reduction) one year after three rounds of annual or five rounds of semiannual MDA, respectively. Mixed effects logistic regression models showed decreases in odds of antigenemia positivity were 91 and 74% at that time in the annual and semiannual treatment zones, respectively (p < 0.001). Semiannual MDA was slightly more effective for reducing Onchocerca volvulus microfiladermia prevalence and at follow-up 3 were 74% (from 14.4 to 3.7%) and 83% (from 23.6 to 4.5%) in the annual and semiannual treatment zones, respectively. Both treatment schedules had similar beneficial effects on hookworm prevalence. Thus, annual and semiannual MDA with ivermectin and albendazole had similar beneficial impacts on LF, onchocerciasis, and STH in this setting. In contrast, MDA with praziquantel had little impact on hyperendemic Schistosoma mansoni in the study area. Results from a long-term follow-up survey showed that improvements in infection parameters were sustained by routine annual MDA provided by the Liberian Ministry of Health after our study endpoint.

Long-term consequences of the misuse of ivermectin data

Ivermectin is an oral anti-infective medicine that is integral to neglected tropical disease programmes. It is safe and effective for the treatment and control of lymphatic filariasis, scabies, and onchocerciasis, sometimes as part of a mass drug administration, as recognised in the WHO road map for neglected tropical diseases 2021–30.1 The WHO essential medicines list provides recommendations for minimum medicine needs for a basic health-care system, which includes ivermectin as an anthelmintic, antifilarial, and antiectoparasitic treatment.

Larval habitat diversity and Anopheles mosquito species distribution in different ecological zones in Ghana

BackgroundUnderstanding the ecology of larval malaria and lymphatic filariasis mosquitoes in a changing environment is important in developing effective control tools or programmes. This study characterized the breeding habitats of Anopheles mosquitoes in rural communities in different ecological zones in Ghana during the dry and rainy seasons.MethodsThe spatio-temporal distribution, species composition, and abundance of larval Anopheles mosquitoes in breeding habitats were studied in five locations in three ecological zones of Ghana. These were Anyakpor (coastal savannah area), Duase (forest area), and Libga, Pagaza, and Kpalsogu (Sahel savannah area). Larvae were collected using standard dippers and were raised in the insectary for identification.ResultsOut of a total of 7984 mosquito larvae collected, 2152 (27.26%) were anophelines and were more abundant in the rainy season (70.82%) than in the dry season (29.18%). The anophelines comprised 2128 (98.88%) An. gambiae s.l., 16 (0.74%) An. rufipes, and 8 (0.37%) An. pharoensis. In the coastal savannah and forest zones, dug-out wells were the most productive habitat during the dry (1.59 larvae/dip and 1.47 larvae/dip) and rainy seasons (11.28 larvae/dip and 2.05 larvae/dip). Swamps and furrows were the most productive habitats in the Sahel savannah zone during the dry (0.25 larvae/dip) and rainy (2.14 larvae/dip) seasons, respectively. Anopheles coluzzii was the most abundant sibling species in all the ecological zones. Anopheles melas and An. arabiensis were encountered only in the coastal savannah and the Sahel savannah areas, respectively. Larval habitat types influenced the presence of larvae as well as larval density (p < 0.001). The land-use type affected the presence of Anopheles larvae (p = 0.001), while vegetation cover influenced larval density (p < 0.05).ConclusionThe most productive habitats were dug-out wells in the coastal savannah and forest zones, and furrows from irrigated canals in the Sahel savannah zone. Anopheles coluzzii was the predominant vector species in all the ecological zones. The abundance of Anopheles breeding habitats and larvae were influenced by anthropogenic activities. Encouraging people whose activities create the larval habitats to become involved in larval source management such as habitat manipulation to stop mosquito breeding will be important for malaria and lymphatic filariasis control.

Individual Efficacy and Community Impact of Ivermectin, Diethylcarbamazine, and Albendazole Mass Drug Administration for Lymphatic Filariasis Control in Fiji: A Cluster Randomized Trial.

Bancroftian filariasis remains endemic in Fiji despite >10 years of mass drug administration (MDA) using diethylcarbamazine and albendazole (DA). The addition of ivermectin to this combination (IDA) has improved efficacy of microfilarial clearance at 12 months in individually randomized trials in nocturnal transmission settings, but impact in a setting of diurnally subperiodic filarial transmission has not been evaluated. This cluster randomized study compared the individual efficacy and community impact of IDA vs DA as MDA for lymphatic filariasis in 35 villages on 2 islands of Fiji. Participants were tested at enrollment for circulating filarial antigen and, if positive, for microfilariae. Weight-dosed treatment was offered according to village randomization. Communities were visited at 12 months and retested for lymphatic filariasis. Infected individuals from Rotuma were retested at 24 months. A total of 3816 participants were enrolled and 3616 were treated. At 12 months, microfilariae clearance was achieved in 72 of 111 participants detected with infection at baseline, with no difference in efficacy between treatment groups: DA, 69.2% (95% confidence interval [CI], 57.2%-79.1%) vs IDA, 62.5% (95% CI, 43.6%-78.2%); risk difference, 11.3 % (95% CI, -10% to 32.7%); P = .30. There was no difference between treatment groups in community prevalence of microfilariae at 12 months or individual clearance at 24 months. We found no difference between IDA and DA in individual clearance or community prevalence of lymphatic filariasis at 12 months, and no improved efficacy following a second annual round of IDA. Possible explanations for the apparent lack of benefit of IDA compared to DA include drug and parasite factors affecting clearance, and higher than expected reinfection rates. Clinical Trials Registration: NCT03177993 and Australian New Zealand Clinical Trial Registry: N12617000738325.

Individual Efficacy and Community Impact of Ivermectin, Diethylcarbamazine, and Albendazole Mass Drug Administration for Lymphatic Filariasis Control in Fiji: A Cluster Randomized Trial

Individual Efficacy and Community Impact of Ivermectin, Diethylcarbamazine, and Albendazole Mass Drug Administration for Lymphatic Filariasis Control in Fiji: A Cluster Randomized Trial

Prevalence of scabies and impetigo in school-age children in Timor-Leste

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