BACKGROUND: Scabies 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. METHODS: A 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. RESULTS: The 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%. CONCLUSIONS: Scabies 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.
BACKGROUND:Scabies 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. METHODS: A 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. RESULTS: The 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%. CONCLUSIONS:Scabies 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.
Authors: Gregor Lawrence; Judson Leafasia; John Sheridan; Susan Hills; Janet Wate; Christine Wate; Janet Montgomery; Nirmala Pandeya; David Purdie Journal: Bull World Health Organ Date: 2005-01-21 Impact factor: 9.408
Authors: Stephen L Walker; Shelui Collinson; Joseph Timothy; Samuel K Zayzay; Karsor K Kollie; Neima Candy; Eglantine Lebas; Katherine Halliday; Rachel Pullan; Mosoka Fallah; Michael Marks Journal: PLoS Negl Trop Dis Date: 2020-10-05
Authors: Thérèse M Kearns; Richard Speare; Allen C Cheng; James McCarthy; Jonathan R Carapetis; Deborah C Holt; Bart J Currie; Wendy Page; Jennifer Shield; Roslyn Gundjirryirr; Leanne Bundhala; Eddie Mulholland; Mark Chatfield; Ross M Andrews Journal: PLoS Negl Trop Dis Date: 2015-10-30
Authors: Laura M Korte; Asha C Bowen; Anthony D K Draper; Kim Davis; Annette Steel; Ines Teodora; Ivonia Mascarenhas; Benjamin Dingle; Joshua R Francis Journal: PLoS Negl Trop Dis Date: 2018-05-31
Authors: Daniel S Mason; Michael Marks; Oliver Sokana; Anthony W Solomon; David C Mabey; Lucia Romani; John Kaldor; Andrew C Steer; Daniel Engelman Journal: PLoS Negl Trop Dis Date: 2016-06-27
Authors: Shu Ki Tsoi; Susanna J Lake; Li Jun Thean; Alexander Matthews; Oliver Sokana; Mike Kama; Salvador Amaral; Lucia Romani; Margot Whitfeld; Joshua R Francis; Susana Vaz Nery; Michael Marks; John M Kaldor; Andrew C Steer; Daniel Engelman Journal: BMC Public Health Date: 2021-11-10 Impact factor: 3.295
Authors: Myra Hardy; Josaia Samuela; Mike Kama; Meciusela Tuicakau; Lucia Romani; Margot J Whitfeld; Christopher L King; Gary J Weil; Tibor Schuster; Anneke C Grobler; Daniel Engelman; Leanne J Robinson; John M Kaldor; Andrew C Steer Journal: PLoS Med Date: 2021-11-10 Impact factor: 11.069