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Abstract
Background Scabies is a skin infestation caused by the human itch mite, affecting people globally across all demographics. However, it is more prevalent among children, individuals with poor hygiene, those in overcrowded or slum areas and people affected by drought and war. There is limited research on scabies in Ethiopia and none specifically focused on marginalised communities. This study aimed to assess the burden of scabies and its contributing factors among pastoralist communities in Ethiopia.
Methods A community-based, unmatched case–control study (1:2 ratio) was conducted in Meinit Goldiya District to assess risk factors for scabies. The researchers collected line-listed data on scabies and conducted face-to-face interviews from January to February 2023, with a sample of 156 cases and 312 controls. Data were gathered using a structured questionnaire and analysed with SPSS V.22. OR, p values and 95% CI were calculated to identify associated factors. Independent factors were determined using a p value of <0.05 and the corresponding 95% CI in the multivariable model.
Results A total of 4269 scabies cases were reported in the district, with an attack rate of 7.9%. Of the reported cases, 52.8% (2254 cases) were male. The multivariable analysis identified several factors significantly associated with scabies: sleeping with infected individuals (adjusted OR (AOR)=3.70 (2.08, 6.61)), sharing washing facilities with patients with scabies in the past 6 months (AOR=4.05 (2.30, 7.13)), placing clothes together with infected individuals’ clothes (AOR=4.71 (2.64, 8.42)) and households with a daily water consumption of ≥25 L per person per day, which was a protective factor (AOR=0.06 (0.03, 0.12)).
Conclusion Scabies is a public health issue in the district, with significant risk factors including sleeping, washing and contact with patients with scabies, as well as daily water consumption levels. To address this, the study recommends strengthening active case surveillance, offering health education and ensuring health facilities are stocked with treatment medications.
- Dermatological epidemiology
- EPIDEMIOLOGIC STUDIES
- Health & safety
- Public health
- Infectious diseases & infestations
Data availability statement
Data are available upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- Dermatological epidemiology
- EPIDEMIOLOGIC STUDIES
- Health & safety
- Public health
- Infectious diseases & infestations
Strengths and limitations of this study
This study was conducted in a marginalised/pastoralist community, marking the first study in the area.
Cases were selected using a simple random sampling technique to ensure representativeness.
Data quality was maintained by providing training to data collectors and conducting thorough data cleaning.
Case selection relied on a registered list based on case definitions, without laboratory confirmation, which could introduce misclassification bias.
Recurrent cases were included in the calculation of the attack rate, which may have influenced the results.
Background
Scabies is a skin infestation caused by the human itch mite (Sarcoptes scabiei var hominis), an ectoparasitic mite that burrows under the skin of mammalian hosts.1 Scabies typically affects areas such as the sides and webs of the fingers, the flexor sides of the wrists, and the extensor sides of the elbows and waist.2 Symptoms of scabies usually develop 3–6 weeks after the initial infestation; however, individuals with a history of infestation may experience symptoms within 1–3 days of reinfestation. Prompt treatment with topical creams and oral medications is crucial to prevent outbreaks.3 Preventive measures for scabies include avoiding contact with infected individuals, treating all household members and washing contaminated bedding and clothing.4 5
The parasite is found worldwide and affects people of all races and social classes.6 Recognised by the WHO as a neglected tropical disease, scabies impacts millions globally, particularly those in temperate regions, with a higher prevalence in overcrowded and impoverished areas.7 Scabies affects all age and ethnic groups, with prevalence influenced by factors such as poor housing, socioeconomic status and hygiene.8 Vulnerable populations include children, individuals in crowded environments and those impacted by drought or conflict.9
Scabies is a global health issue, affecting over 200 million people at any given time and more than 400 million annually, particularly those in hot, tropical regions.3 Its prevalence among marginalised populations living in overcrowded conditions highlights significant and often-neglected public health challenges in developing countries.10 The prevalence of scabies varies widely, from 0.2% in developed countries to 24% in developing nations.11 By the end of the 20th century, its prevalence was approximately 5% globally, increasing to 30% during wartime.6 In sub-Saharan Africa, the prevalence of scabies ranges from 1.3% to 17%. Specific figures include 9.7% in Southeast Asia, 13% in India and 6.1% among school children in Burkina Faso.11 12
Since 2017, Ethiopia has experienced frequent outbreaks of scabies in regions such as Amhara, Oromia, Southern Nations, Nationalities and Peoples (SNNP) and Tigray.13 The 2008 National Health and Nutrition survey reported a scabies prevalence rate of 5.5%, which rose to 15% by 2015.5 14 Studies in various regions of Ethiopia have revealed the following scabies prevalence rates: 22.5% in Gondar City,15 5.5% in Yekolo-Memories (Southern Ethiopia),16 11% in East Badewacho District,16 9.4% in Tach Gayint District17 and 13.4% in the Amhara Region.18
Various studies have identified multiple factors affecting scabies, including age, family size, sleeping and having contact with infected individuals, educational status, hygiene practices, sharing beds or clothing, frequency of showering, detergent use, frequency of changing clothes and water availability. These factors are significantly associated with the occurrence of scabies.14–20 The Ethiopian interim guideline indicates that knowledge of scabies transmission, treatment and prevention, as well as factors such as religion and occupation, may influence its prevalence.17
While existing studies have highlighted the prevalence and factors associated with scabies, none has specifically focused on marginalised communities, such as pastoralists. This study aims to assess the prevalence of scabies and the factors influencing its occurrence in the pastoral community of Meinit Goldiya District. The findings will help inform targeted interventions for controlling and preventing scabies among the pastoralist population in Southwest Ethiopia.
Methods and materials
Study setting, design and period
An unmatched case–control study was conducted in Meinit Goldiya District from 30 January to 25 February 2023. Meinit Goldiya, located in Southwest Ethiopia Peoples Region within Bench Sheko Zone, shares borders with Meinit Shasha, Debub Bench, SheyBench and Keffa Zone. The main town is Bachuma. According to the 2007 Census by the Central Statistical Agency, the woreda has a population of 88 863, comprising 43 594 men and 45 269 women, with an urban population of 2547 individuals, accounting 2.87% of the total population.
Populations
The source population consisted of all individuals living in Meinit Goldiya District. Cases were randomly selected from the 420 identified cases listed in the line list across six kebeles within the district, forming the study population.
Inclusion and exclusion criteria
Cases
Any resident of Meinit Goldiya District displaying signs and symptoms of scabies, defined following the definition for a suspected case, was included during the identification of cases in the line list and during verification interviews recorded in the registration book.
Controls
Any resident of Meinit Goldiya District who lived in the same family or village as neighbouring cases but did not exhibit signs or symptoms of scabies was included in the study.
Sample size determination and sampling method
The sample size for the unmatched case–control study was calculated using Epi Info V.7, with assumptions of 95% CI, 90% power, an OR of 2 and a control to case ratio of 2:1. These calculations were based on a study in Yekolo Temaris, Gondar Town, which found that 26.6% of controls had close contact with an ill person.15 The total calculated sample size was 156 cases and 312 controls.
Cases were selected using a simple random sampling technique from the 420 registered cases in the line list, identified by teams from the zonal health department, district health office and health centre staff according to the Ethiopian interim guidelines for multisectoral scabies outbreaks. Controls were enrolled from the families of the cases or from the same villages, provided they had no history of scabies during the study period. If no suitable controls were available from the families, they were selected from neighbouring villages.
Data collection methods
Data were collected from cases and controls in exposed villages through house-to-house visits from 30 January to 25 February 2023. Participants were interviewed using structured questionnaires, with primary data collected by a trained public health officer following the Ethiopian interim guideline for multisectoral scabies outbreak response. For children who could not respond, data were obtained from their mothers or caregivers. A total of 156 cases and 312 controls were interviewed to assess sociodemographic variables and exposure status.
Operational definitions
A suspected case is defined as an individual exhibiting signs and symptoms consistent with scabies.21 22
A confirmed case is defined as an individual who has undergone a skin scraping with mites, mite eggs or mite faeces identified by a trained healthcare professional.21 22
A contact is defined as a person who shows no signs or symptoms of scabies but has had direct, prolonged skin-to-skin contact with a suspected or confirmed case within 2 months prior to the onset of scabies symptoms in that case.21 22
Infrequent changing of clothes refers to individuals who wear the same clothes for more than 1 week without washing or changing them.
General knowledge about scabies includes correctly answering at least one question regarding its transmission, one prevention method or one treatment option.
Attack rate is defined as the percentage of total new cases identified divided by the at-risk population.
Prolonged contact refers to daily interactions with patients during their regular activities or living together.17
Putting clothes together with the patient’s clothes refers to the practice of storing or transporting one’s clothing alongside the clothing of a patient, typically in the same bag or other containers.
Data processing and analysis
Data were entered using EpiData V.4.6 and exported to SPSS V.22 for analysis. Descriptive analysis was conducted for sociodemographic characteristics and other risk factors, presenting the results as frequencies, proportions, rates, mean/median and SD. Risk factors were statistically identified by calculating the OR with 95% CI through bivariate and multivariable logistic regression analyses. Variables with a p value of less than 0.2 were included in the multivariable analysis to identify significant factors, with p values less than 0.05 considered significant in the multivariable logistic regression analysis.
Patient and public involvement
Patients or the public were not involved in the design, or conduct, or reporting or dissemination plans of our research.
Results
Sociodemographic characteristics
A total of 156 cases and 312 controls were interviewed using a standardised questionnaire. Among the participants, 237 (50.6%) were male, with a mean age of 33.29 years (±17.61 years). Additionally, 65% of the participants identified as Protestant Christians and 41.9% reported using less than 25 L of water per person per day (table 1).
Sociodemographic characteristics of participants in Meinit Goldiya District, Southwest Ethiopia
Age distribution and scabies outbreak
The district reported a total of 4269 cases of scabies, resulting in an attack rate of 7.9%. Among these cases, 2254 (52.8%) were male. Individuals under 15 years old represented 35.1% of cases, while those over 45 years accounted for 31.6%. The age-specific attack rate was 6.49% for individuals under 15 and 26.29% for those over 45, indicating a higher incidence among the older population (table 2).
Age distribution of patients with scabies in Meinit Goldiya District, Southwest Ethiopia
Hygiene and scabies-related characteristics
Among the 156 cases interviewed, 49.4% were male. Most (79%) initially reported itching, which worsened at night for 99% of cases. The hands (55.8%) and wrists (39.7%) were the most affected areas. Additionally, 27.6% of cases experienced repeated infections. Of the total cases, 26.9% were classified as severe, with 136 (87.2%) exhibiting skin lesions, 82 (52.6%) suffering from crusted scabies and 87 (55.8%) presenting with skin sores. Furthermore, 38.5% of cases were categorised as mild (table 3).
Hygiene and scabies-related characteristics of participants in Meinit Goldiya District, Southwest Ethiopia
Factors associated with scabies
After performing a bivariate binary logistic regression analysis, 10 variables were selected for inclusion in the multivariable binary logistic regression analysis. Ultimately, four variables were found to be significantly associated with scabies in the multivariable analysis: sleeping with patients with scabies (adjusted OR (AOR)=3.70 (2.08, 6.61)), washing with patients with scabies in the past 6 months (AOR=4.05 (2.30, 7.13)), sharing clothes with infected individuals (AOR=4.71 (2.64, 8.42)) and having a household daily water consumption of ≥25 L per person per day (AOR=0.06 (0.03, 0.12)) (table 4).
Factors associated with scabies among participants in Meinit Goldiya District, Southwest Ethiopia
Discussion
The study found an overall attack rate of scabies of 7.9% and a prevalence rate of 4.2% in the pastoralist district of Meinit Goldiya. Four significant predictors of scabies were identified: sleeping with patients with scabies, washing with patients with scabies in the past 6 months, mixing clothes with those of infected individuals and household daily water consumption.
The prevalence of scabies in Menit Goldia was similar to the rates reported in other districts of SNNP, Amhara,23 Oromia and Tigray regions in 2015, which were around 5%.14 However, it was higher than the prevalence in Tach Gayint District (2.67%),17 Kacha Bira District (0.4%)20 and Dogatemben District (0.03%).20 The elevated prevalence in Menit Goldia may be due to delays in investigating and implementing prevention and control measures. Conversely, it was lower than the prevalence reported in East Badewacho District (11%)16 and Meta Robi District (19.26%).8 The observed differences in the prevalence of scabies may be attributed to sociodemographic variations and differences in methodological approaches, particularly the focus on only new cases of scabies during the study period.
Individuals who slept with patients with scabies had 3.7 times higher odds of developing the disease compared with those who did not. This finding aligns with studies conducted in Kacha Bira District of Gambella Region,20 among Yekolo members at St Lideta Church15 and in East Badewacho District in Southern Ethiopia.16 This is primarily due to close contact with an infected individual when sleeping together. Such proximity facilitates the direct transfer of the human itch mite, which causes scabies, from the skin of the infected person to their sleeping partner. The skin-to-skin contact during sleep can create an environment conducive to the spread of the mites, increasing the likelihood of transmission.
Individuals who washed with patients with scabies in the past 6 months had four times higher odds of developing scabies compared with those without such contact. This is supported by studies in Raya Alamata District24 and Woldia District.25 Additionally, individuals who shared clothes with patients with scabies had 4.7 times higher odds of developing the disease compared with those with no contact, consistent with findings from studies among Yekolo members at St Lideta Church,16 Meta Robi District8 and Tach Gayint District.17 The increased odds of developing scabies in individuals with such contact can be attributed to the transfer of mites from the patient’s clothing to others, which is facilitated by limited access to water for washing and maintaining hygiene practices.
Individuals consuming more than 25 L of water per person per day had 0.94 times lower odds of developing scabies compared with those using less than 25 L. This finding is consistent with the recommendations from the scabies interim guidelines by the Federal Ministry of Health and the Centers for Disease Control and Prevention.4 17 The lower odds of developing scabies in individuals with higher water consumption may be due to their ability to maintain better hygiene practices, such as frequent washing of clothes, hand washing and regular showering, which are important preventive measures against diseases.7 17 26
Strengths and limitation of the study
This study was conducted in a marginalised/pastoralist community, marking the first study in the area. Cases were selected using a simple random sampling technique to ensure representativeness. Data quality was ensured through training provided to data collectors and through data cleaning. The main limitation of this study was that cases were selected based only on case definition, without laboratory confirmation, which could introduce misclassification bias. Moreover, recurrent cases were considered in the calculation of the attack rate, which may have influenced the outcomes.
Conclusion
The study found a high attack rate of scabies, particularly among older individuals, and indicated poor surveillance in the district. Significant risk factors for scabies included sleeping, washing and having close contact with infected individuals, as well as daily water consumption. Scabies continues to be a public health issue due to delayed detection and drug shortages, leading to widespread transmission. To address this, the study recommends ensuring the availability of necessary medications for early treatment, improving hygiene practices and living conditions through education, enhancing active case surveillance, providing health education on treatment and prevention, and improving water tracking and storage at critical service points.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by Mizan-Tepi University (MTU/2245/23). Participants gave informed consent to participate in the study before taking part.
Acknowledgments
We express our gratitude to the study participants, data collectors, supervisors and the District Health Office staff for their dedication and commitment to participating in the study.
Footnotes
Contributors NS and TY conducted the study, coordinated data collection, conducted statistical analysis and drafted the manuscript. NS was involved in the study design and tool development. Both authors reviewed and approved the final manuscript. NS serves as the guarantor of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.