A facility and community-based assessment of scabies in rural Malawi
Cristina Galván-Casas 1 2 3 , Oriol Mitjá 4 5 6 , Sara Esteban 7 , Jacob Kafulafula 8 , Texon Phiri 9 , Íñigo Navarro-Fernández 10 , Concepción Román-Curto 11 , Hassani Mtenje 9 , Gerald Thauzeni 12 , Elizabeth Harawa 13 , Stephano Kaluzi 14 , Mphatso Diere 15 , Mary Mkandawire 9 , Shaibu Malizani 9 , Alex Chifundo 9 , Marta Utrera-Busquets 16 , Mónica Roncero-Riesco 11 , Sara López Martín-Prieto 17 , Iosune Vilanova-Urdániz 18 , Gisela H Petiti 19 , María Victoria de Gálvez Aranda 20 , Nuria No Pérez 21 , María Rueda Gómez-Calcerrada 22 , Pilar Iranzo 23 , Pilar Escalonilla García-Patos 24 , Magdalena de Troya-Martín 25 , Javier Romero Gomez 26 , Esther Cardeñoso-Alvarez 11 , Sofia Lucas Truyols 27 , Libe Aspe Unanue 28 , Cristina Bajo Del Pozo 29 , Alicia Comunión Artieda 30 , Maria Isabel Martínez González 28 , Omar F López-López 31 , Esther Moreno-Artero 32 , Xavier Cubiró 33 , Iago Meilán-Sánchez 34 , Alejandra Tomás-Velázquez 35 , Cristina López-Sánchez 33 , Eva M Sánchez-Martínez 36 , Harrison A Edwards 37 38 39 , Maria Herrera Morueco 40 , Julia Zehe Rubiera 41 , Laura Salguero Caldera 42 , Urbano Blanes-Moreno 43 , Maria Uribarren-Movilla 44 , Michael Marks 45
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.