Maria João Lopes1,2, Eunice Teixeira da Silva3, Janete Ca3, Adriana Gonçalves1, Amabelia Rodrigues4, Cristóvão Mandjuba5, Jose Nakutum3, Umberto D'Alessandro6, Jane Achan6, James Logan7, Robin Bailey1,8, Anna Last1,8, Steve Walker1,8, Michael Marks1,8. 1. Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. 2. Infectious Diseases Department, Hospital Prof. Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal. 3. Region Sanitaria Bolama-Bijagós, Bubaque, Guinea-Bissau. 4. Bandim Health Project, Apartado 861 Bissau, Guinea-Bissau. 5. Ministry of Public Health, Avenida Unidade Africana, 26, Bissau, Guinea-Bissau. 6. MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara P.O. Box 273, Banjul, The Gambia. 7. Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK. 8. Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK.
Abstract
BACKGROUND: Scabies is highly endemic among impoverished populations and has been recently included in the WHO's list of neglected tropical diseases (NTDs). Community support and behavioural changes are essential for the success of control interventions. This study aimed to explore beliefs, prevention attitudes and healthcare-seeking behaviours towards scabies in the Bijagós Archipelago of Guinea-Bissau. METHODS: Data were collected through two methods. Community key informants (community members, community health workers, healthcare workers and traditional healers) were interviewed using snowball sampling. A questionnaire covering perceptions, attitudes and practices was administered to community members using random cluster sampling. Thematic analysis of qualitative data was applied to identify themes. Descriptive statistics were used for quantitative data analysis. RESULTS: There was a satisfactory awareness about scabies, but perceptions about disease causation and transmission were imprecise. Misconceptions about personal hygiene as the primary measure for scabies prevention were recurrent. Some participants recognised the importance of early treatment to interrupt transmission. Treatment of close contacts was not considered important. Costs were the main determining factor for treatment choice between traditional healer and the local health centre. Late presentation and delayed treatment were common and associated with poverty and stigmatisation. Scabies impaired quality of life by affecting social interactions, health, fitness to work and school attendance. CONCLUSIONS: There is a need to improve education, recognition, management and affordable access to treatment. Community education, healthcare workers' training and skin NTD integrated control programmes should address the challenges highlighted in this study.
BACKGROUND:Scabies is highly endemic among impoverished populations and has been recently included in the WHO's list of neglected tropical diseases (NTDs). Community support and behavioural changes are essential for the success of control interventions. This study aimed to explore beliefs, prevention attitudes and healthcare-seeking behaviours towards scabies in the Bijagós Archipelago of Guinea-Bissau. METHODS: Data were collected through two methods. Community key informants (community members, community health workers, healthcare workers and traditional healers) were interviewed using snowball sampling. A questionnaire covering perceptions, attitudes and practices was administered to community members using random cluster sampling. Thematic analysis of qualitative data was applied to identify themes. Descriptive statistics were used for quantitative data analysis. RESULTS: There was a satisfactory awareness about scabies, but perceptions about disease causation and transmission were imprecise. Misconceptions about personal hygiene as the primary measure for scabies prevention were recurrent. Some participants recognised the importance of early treatment to interrupt transmission. Treatment of close contacts was not considered important. Costs were the main determining factor for treatment choice between traditional healer and the local health centre. Late presentation and delayed treatment were common and associated with poverty and stigmatisation. Scabies impaired quality of life by affecting social interactions, health, fitness to work and school attendance. CONCLUSIONS: There is a need to improve education, recognition, management and affordable access to treatment. Community education, healthcare workers' training and skin NTD integrated control programmes should address the challenges highlighted in this study.
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