Research Article: Scabies and Impetigo Prevalence and Risk Factors in Fiji: A National Survey

Date Published: March 4, 2015

Publisher: Public Library of Science

Author(s): Lucia Romani, Josefa Koroivueta, Andrew C. Steer, Mike Kama, John M. Kaldor, Handan Wand, Mohammed Hamid, Margot J. Whitfeld, James S McCarthy.

Abstract: BackgroundScabies is recognised as a major public health problem in many countries, and is responsible for significant morbidity due to secondary bacterial infection of the skin causing impetigo, abscesses and cellulitis, that can in turn lead to serious systemic complications such as septicaemia, kidney disease and, potentially, rheumatic heart disease. Despite the apparent burden of disease in many countries, there have been few large-scale surveys of scabies prevalence or risk factors. We undertook a population-based survey in Fiji of scabies and impetigo to evaluate the magnitude of the problem and inform public health strategies.Methodology/Principal FindingsA total of 75 communities, including villages and settlements in both urban and rural areas, were randomly selected from 305 communities across the four administrative divisions, and all residents in each location were invited to participate in skin examination by trained personnel. The study enrolled 10,887 participants. The prevalence of scabies was 23.6%, and when adjusted for age structure and geographic location based on census data, the estimated national prevalence was 18.5%. The prevalence was highest in children aged five to nine years (43.7%), followed by children aged less than five (36.5%), and there was also an indication of prevalence increasing again in older age. The prevalence of scabies was twice as high in iTaukei (indigenous) Fijians compared to Indo-Fijians. The prevalence of impetigo was 19.6%, with a peak in children aged five to nine years (34.2%). Scabies was very strongly associated with impetigo, with an estimated 93% population attributable risk.ConclusionsAs far as we are aware, this is the first national survey of scabies and impetigo ever conducted. We found that scabies occurs at high levels across all age groups, ethnicities, and geographical locations. Improved strategies are urgently needed to achieve control of scabies and its complications in endemic communities.

Partial Text: Scabies is a skin disease caused by infestation with a tiny mite (Sarcoptes scabiei) that burrows under the skin and is transmitted through close personal contact [1]. The direct effect of scabies is debilitating itching, leading to scratching, which is in turn followed by complications due to bacterial infection of the skin, ranging from impetigo, abscesses and cellulitis, through to septicaemia and even death [1]. Bacterial infections secondary to scabies can also lead to more serious sequelae associated with group A streptococcal infection such as rheumatic fever and glomerulonephritis [2–6].

A total of 75 sites were included in the survey, with a median proportion of 82% of the official resident population examined in each village, with an overall participation rate of 78.2%. In 72 of the villages the proportion examined was 60% or more. A total of 10,887 study participants were enrolled. As shown in Table 1, the demographic characteristics of the study sample were broadly comparable to that of the 2007 census population in regard to age and ethnicity, but there was substantial over-representation of younger age groups (54% of the sample was aged less than 15 years compared to 29% from census data), and of people from the Northern division of Fiji (40.0% of the sample vs. 16.2% from census data).

This study is the first national survey of scabies and impetigo prevalence conducted in any country and indeed the only one that we are aware of that is based on a rigorous sampling methodology and covers a substantial population and geographic area. Our survey confirms that scabies and impetigo are widespread problems in Fiji. While we observed that children are the most affected population group, no age group is free of scabies or impetigo, and there is an indication that prevalence increases after middle age. Scabies and impetigo are highly prevalent across all geographical divisions and both genders and in both the main ethnic groups.



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