Awareness, Attitudes, Perceptions and Practices of Scabies Infestation among Caregivers of Children under 5 Years of Age in Villages of Kwale County, Kenya
Background: Scabies, an ectoparasitic disease affects over 300 million people globally. In Kenya, scabies prevalence is at 8.3%. In 2017, the World Health Organization listed it among Neglected Tropical Diseases (NTDs) targeted for elimination by 2030. Creating awareness of hygiene practices, community support and behavior change are essential for successful elimination. The objective of this study was to assess knowledge, perceptions, attitudes, practices and health-seeking behaviors among communities of Kwale County, Kenya. Methods: A mixed methods cross-sectional survey was conducted in eight purposively selected villages of Kwale County after a review of “Diseases of the skin” report. A close-ended questionnaire was administered to 301 caregivers of children under 5 years with observed scabies lesions or reporting a scabies infestation in the previous six months. Four focus group discussions (FGDs) were held with community members stratified by age and gender. Quantitative data was analyzed using Stata version 15.0 and qualitative data by NVivo version 12. Results: Scabies infestation was more common in males, 51.8% than in females, with 56.8% of the infested children below 36 months of age. The main mode of transmission, 59.8% was skin contact with an infected person. The most common symptom of scabies was itching, 90.4% while lack of sleep was the main consequence, 77.1%. Slightly over half, 54.2% indicated that scabies was caused by poor personal hygiene while 41.5% stated that they were not aware of what caused scabies. A majority, 91.7% reported seeking care from a local health facility with, 54.3% indicating a delay in seeking medical care. The qualitative results showed stigma related to scabies infestation and it was viewed as a sign of HIV/AIDS disease. Conclusion: There is a need to create awareness of scabies, causes, prevention, and management, to avert myths and misconceptions and emphasis seeking immediate medical care crucial towards scabies elimination.
References
[1]
Hengge, U.R., Currie, B.J., Jäger, G., Lupi, O. and Schwartz, R.A. (2006) Scabies: A Ubiquitous Neglected Skin Disease. The Lancet Infectious Diseases, 6, 769-779. https://doi.org/10.1016/s1473-3099(06)70654-5
[2]
Engelman, D. and Steer, A.C. (2018) Control Strategies for Scabies. Tropical Medicine and Infectious Disease, 3, Article 98. https://doi.org/10.3390/tropicalmed3030098
[3]
Arlian, L.G. and Morgan, M.S. (2017) A Review of Sarcoptes scabiei: Past, Present and Future. Parasites & Vectors, 10, Article No. 297. https://doi.org/10.1186/s13071-017-2234-1
[4]
Zhang, W., Zhang, Y., Luo, L., Huang, W., Shen, X., Dong, X., et al. (2020) Trends in Prevalence and Incidence of Scabies from 1990 to 2017: Findings from the Global Burden of Disease Study 2017. Emerging Microbes & Infections, 9, 813-816. https://doi.org/10.1080/22221751.2020.1754136
[5]
Karimkhani, C., Colombara, D.V., Drucker, A.M., Norton, S.A., Hay, R., Engelman, D., et al. (2017) The Global Burden of Scabies: A Cross-Sectional Analysis from the Global Burden of Disease Study 2015. The Lancet Infectious Diseases, 17, 1247-1254. https://doi.org/10.1016/s1473-3099(17)30483-8
[6]
Engelman, D., Cantey, P.T., Marks, M., Solomon, A.W., Chang, A.Y., Chosidow, O., et al. (2019) The Public Health Control of Scabies: Priorities for Research and Action. The Lancet, 394, 81-92. https://doi.org/10.1016/s0140-6736(19)31136-5
[7]
Romani, L., Steer, A.C., Whitfeld, M.J. and Kaldor, J.M. (2015) Prevalence of Scabies and Impetigo Worldwide: A Systematic Review. The Lancet Infectious Diseases, 15, 960-967. https://doi.org/10.1016/s1473-3099(15)00132-2
[8]
WHO (2021) World Health Organization. https://www.who.int/neglected_diseases/diseases/scabies-and-other-ectoparasites/en/
[9]
Hay, R.J., Steer, A.C., Engel-man, D. and Walton, S. (2012) Scabies in the Developing World—Its Prevalence, Complications, and Management. Clinical Microbiology and Infection, 18, 313-323. https://doi.org/10.1111/j.1469-0691.2012.03798.x
[10]
WHO (2005) Epide-miology and Management of Common Skin Diseases in Children in Developing Countries. World Health Organization, Gene-va.
[11]
Van Hecke, E. and Bucinco, G. (1980) Prevalence of Skin Disease in Rwanda. International Journal of Dermatology, 19, 526-529. https://doi.org/10.1111/j.1365-4362.1980.tb00382.x
[12]
Schmeller, W. and Dzikus, A. (2001) Skin Dis-eases in Children in Rural Kenya: Long-Term Results of a Dermatology Project within the Primary Health Care System. Brit-ish Journal of Dermatology, 144, 118-124. https://doi.org/10.1111/j.1365-2133.2001.03962.x
[13]
Kiprono, S.K., Muchunu, J.W. and Masenga, J.E. (2015) Skin Diseases in Pediatric Patients Attending a Tertiary Dermatology Hospital in Northern Tanzania: A Cross-Sectional Study. BMC Dermatology, 15, Article No. 16. https://doi.org/10.1186/s12895-015-0035-9
[14]
WHO (2019) Informal Consultation on a Framework for Scabies Con-trol Meeting Re-port. World Health Organization Regional Office for the Western Pacific Manila.
[15]
El-Moamly, A.A. (2021) Scabies as a Part of the World Health Organization Roadmap for Neglected Tropical Diseases 2021-2030: What We Know and What We Need to Do for Global Control. Tropical Medicine and Health, 49, Article No. 64. https://doi.org/10.1186/s41182-021-00348-6
[16]
Water Security and Climate Reports. June 2014 and September 2016.
[17]
Ongugo, P.O., Wekesa, C., Ongugo, R., Abdallah, A., Akinyi, L. and Pakia, M. (2014) Small-Holder Innovation for Resilience (SIFOR): Qualitative Baseline Study, Mijikenda Community, Kenyan Coast. Reports, KEFRI.
[18]
Kenya National Bureau of Statistics (2019) Kenya Population and Housing Census, 2019.
[19]
County Government of Kwale (2018) Kwale County Integrated Development Plan (2018-2022).
[20]
Stephanie, E. (2003) Slovin’s Formula Sampling Techniques. Houghton-Mifflin.
[21]
Ararsa, G., Merdassa, E., Shibiru, T. and Etafa, W. (2023) Prevalence of Scabies and Associated Factors among Children Aged 5-14 Years in Meta Robi District, Ethiopia. PLOS ONE, 18, e0277912. https://doi.org/10.1371/journal.pone.0277912
[22]
Osti, M.H., Sokana, O., Phelan, S., Marks, M., Whitfeld, M.J., Gorae, C., et al. (2019) Prevalence of Scabies and Impetigo in the Solomon Islands: A School Survey. BMC Infectious Diseases, 19, Article No. 803. https://doi.org/10.1186/s12879-019-4382-8
[23]
Kouotou, E.A., Nansseu, J.R.N., Kouawa, M.K. and Zoung-Kanyi Bissek, A. (2016) Prevalence and Drivers of Human Scabies among Children and Adolescents Living and Stud-ying in Cameroonian Boarding Schools. Parasites & Vectors, 9, Article No. 400. https://doi.org/10.1186/s13071-016-1690-3
[24]
Feldmeier, H. (2009) Epidermal Parasitic Skin Diseases: A Neglected Category of Poverty-Associated Plagues. Bulletin of the World Health Organization, 87, 152-159. https://doi.org/10.2471/blt.07.047308
[25]
Walton, S.F. and Currie, B.J. (2007) Problems in Diagnosing Scabies, a Global Disease in Human and Animal Populations. Clinical Microbiology Reviews, 20, 268-279. https://doi.org/10.1128/cmr.00042-06
[26]
Lopes, M.J., da Silva, E.T., Ca, J., Gonçalves, A., Rodrigues, A., Manjuba, C., et al. (2019) Perceptions, Attitudes and Practices towards Scabies in Communities on the Bijagós Islands, Guinea-Bissau. Transactions of the Royal Society of Tropical Medicine and Hygiene, 114, 49-56. https://doi.org/10.1093/trstmh/trz102
[27]
Marks, M., Kwakye-Maclean, C., Doherty, R., Adwere, P., Aziz Abdulai, A., Duah, F., et al. (2017) Knowledge, Attitudes and Practices Towards Yaws and Yaws-Like Skin Disease in Ghana. PLOS Ne-glected Tropical Diseases, 11, e0005820. https://doi.org/10.1371/journal.pntd.0005820
[28]
Walker, S.L., Lebas, E., De Sario, V., Deyasso, Z., Doni, S.N., Marks, M., et al. (2017) The Prevalence and Association with Health-Related Quality of Life of Tungiasis and Scabies in Schoolchildren in Southern Ethiopia. PLOS Neglected Tropical Diseases, 11, e0005808. https://doi.org/10.1371/journal.pntd.0005808
[29]
Worth, C., Heukelbach, J., Fengler, G., Walter, B., Liesenfeld, O. and Feldmeier, H. (2012) Impaired Quality of Life in Adults and Children with Scabies from an Impoverished Community in Brazil. International Journal of Dermatology, 51, 275-282. https://doi.org/10.1111/j.1365-4632.2011.05017.x
[30]
Hegab, D., Kato, A., Kabbash, I. and Dabish, G. (2015) Scabies among Primary Schoolchildren in Egypt: Sociomedical Environmental Study in Kafr El-Sheikh Administrative Area. Clinical, Cosmetic and Investigational Dermatology, 8, 105-111. https://doi.org/10.2147/ccid.s78287
[31]
Karim, S.A., Anwar, K.S., Khan, M.A.H., Mollah, M.A.H., Nahar, N., Rahman, H.E.M.R., et al. (2007) Socio-Demographic Characteristics of Chil-dren Infested with Scabies in Densely Populated Communities of Residential Madrashas (Islamic Education Institutes) in Dhaka, Bangladesh. Public Health, 121, 923-934. https://doi.org/10.1016/j.puhe.2006.10.019
