The Epidemiology of Scabies and Impetigo in Relation to Demographic and Residential Characteristics: Baseline Findings from the Skin Health Intervention Fiji Trial

Lucia Romani Kirby Institute, University of New South Wales, Sydney, Australia;

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Margot J. Whitfeld Department of Dermatology, St. Vincent’s Hospital, Sydney, Australia;

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Josefa Koroivueta Ministry of Health, Suva, Fiji;

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Mike Kama Ministry of Health, Suva, Fiji;

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Handan Wand Kirby Institute, University of New South Wales, Sydney, Australia;

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Lisi Tikoduadua Ministry of Health, Suva, Fiji;

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Meciusela Tuicakau Ministry of Health, Suva, Fiji;

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Aminiasi Koroi Ministry of Health, Suva, Fiji;

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Raijieli Ritova Ministry of Health, Suva, Fiji;

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Ross Andrews Menzies School of Health Research, Charles Darwin University, Darwin, Australia;

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John M. Kaldor Kirby Institute, University of New South Wales, Sydney, Australia;

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Andrew C. Steer Centre for International Child Health, University of Melbourne, Australia;
Murdoch Children’s Research Institute, Melbourne, Australia

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Scabies and associated impetigo are under-recognized causes of morbidity in many developing countries. To strengthen the evidence base for scabies control we undertook a trial of mass treatment for scabies. We report on the occurrence and predictors of scabies and impetigo in participants at baseline. Participants were recruited in six island communities and were examined for the presence of scabies and impetigo. In addition to descriptive analyses, logistic regression models were fit to assess the association between demographic variables and outcome of interest. The study enrolled 2051 participants. Scabies prevalence was 36.4% (95% confidence interval [CI] 34.3–38.5), highest in children 5–9 years (55.7%). Impetigo prevalence was 23.4% (95% CI 21.5–25.2) highest in children aged 10–14 (39.0%). People with scabies were 2.8× more likely to have impetigo. The population attributable risk of scabies as a cause of impetigo was 36.3% and 71.0% in children aged less than five years. Households with four or more people sharing the same room were more likely to have scabies and impetigo (odds ratios [OR] 1.6, 95% CI 1.2–2.2 and OR 2.3, 95% CI 1.6–3.2 respectively) compared to households with rooms occupied by a single individual. This study confirms the high burden of scabies and impetigo in Fiji and the association between these two conditions, particularly in young children. Overcrowding, young age, and clinical distribution of lesion are important risk factors for scabies and impetigo. Further studies are needed to investigate whether the decline of endemic scabies would translate into a definite reduction of the burden of associated complications.

Author Notes

Address correspondence to Andrew C. Steer, Centre for International Child Health, Royal Children’s Hospital Flemington Road, Parkville Victoria 3052, Australia. E-mail: andrew.steer@rch.org.au

Financial support: This study was funded by an Australian National Health and Medical Research Council project grant (1032310). Ivermectin was provided by Merck Sharp and Dohme, Australia.

Authors’ addresses: Lucia Romani, Handan Wand, and John M. Kaldor, Kirby Institute, University of New South Wales, Sydney, Australia, E-mails: lromani@kirby.unsw.edu.au, hwand@kirby.unsw.edu.au, and jkaldor@kirby.unsw.edu.au. Margot J. Whitfeld, Department of Dermatology, St. Vincent’s Hospital, Sydney, Australia, E-mail: mwhitfeld@stlderm.com.au. Josefa Koroivueta, Mike Kama, Meciusela Tuicakau, and Aminiasi Koroi, Ministry of Health, Suva, Fiji, E-mails: josefa.koroivueta@govnet.gov.fj, mnkama02@gmail.com, mtsatala@yahoo.com, and aminee.kay@gmail.com. Lisi Tikoduadua, Colonial War Memorial Hospital, Suva, Fiji, E-mail: liztiko@gmail.com. Ross Andrews, Menzies School of Health Research, Charles Darwin University, Darwin, Australia, E-mail: ross.andrews@menzies.edu.au. Andrew C. Steer, Murdoch Children’s Research Institute, Melbourne, Australia, and Centre for International Child Health, University of Melbourne, Australia, E-mail: andrew.steer@rch.org.au.

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