Clinical Scorecard: Epidemiology and Contributing Factors of Scabies Among Children and Adolescents in Africa: A Systematic Review and Meta-Analysis

At a Glance

Key Highlights

• Scabies affects approximately 204 million people worldwide and is recognized by the World Health Organization as a neglected tropical disease.

• Children and adolescents are particularly vulnerable because they are more likely to be infested and to develop severe complications from secondary bacterial infections.

• The pooled prevalence of scabies was 5.7% across all included studies and 9.4% among studies focused specifically on scabies.

• Prevalence varied according to geographic region, study setting, investigator type, and diagnostic method.

• Factors associated with increased scabies risk included large family size, rural residence, lack of detergent for bathing or washing clothes, sleeping on the floor, sharing bedding or clothes, and contact with a scabies case.

Guideline-Based Recommendations

Diagnosis

• The review does not establish a new diagnostic guideline. Included studies used clinical diagnosis, with microscopy for confirmation in a minority of studies. The authors note that standardized diagnostic criteria, such as the International Alliance for the Control of Scabies Consensus Criteria, are needed in future studies.

Management

• The review does not provide treatment recommendations. The authors emphasize improving living conditions and targeting interventions toward impoverished and rural communities as important components of scabies control.

Monitoring & Follow-up

• The authors state that improved epidemiological data are needed to map the burden of scabies, guide control strategies, and establish monitoring and evaluation.

Risks

• Scabies can lead to secondary bacterial skin infections such as impetigo, abscesses, and cellulitis, with potential progression to septicemia, post-streptococcal glomerulonephritis, and rheumatic heart disease.

• Associated factors included large household size, rural residence, inadequate personal hygiene, sleeping on the floor, sharing clothes or bedding, and contact with a scabies case.

Patient & Prescribing Data

The review included 35 studies with 45,425 participants and focused on children and adolescents in Africa. The source does not provide prescribing data or specific treatment regimens.

Clinical Best Practices

• Interpret pooled prevalence estimates cautiously because of substantial heterogeneity across studies.

• Use standardized diagnostic criteria in future epidemiological studies to improve comparability of prevalence estimates.

• Focus control strategies on poverty-related factors and living conditions identified in the review, particularly in impoverished and rural communities.

Related Resources & Content

1. World Health Organization. Scabies. WHO. Accessed September 18, 2022. https://www.who.int/news-room/fact-sheets/detail/scabies.

2. Karimkhani C, Colombara DV, Drucker AM, Norton SA, Hay R, Engelman D, et al. The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17:1247-1254. doi:10.1016/S1473-3099(17)30483-8.

3. Hay RJ, Steer AC, Engelman D, Walton S. Scabies in the developing world—its prevalence, complications, and management. Clin Microbiol Infect. 2012;18:313-323. doi:10.1111/j.1469-0691.2012.03798.x.

4. Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: scabies. J Am Acad Dermatol. 2020;82:533-548. doi:10.1016/j.jaad.2019.05.109.

5. Engelman D, Marks M, Steer AC, Beshah A, Biswas G, Chosidow O, et al. A framework for scabies control. PLoS Negl Trop Dis. 2021;15:e0009661. doi:10.1371/journal.pntd.0009661.

6. Kouotou EA, Nansseu JR, Kouawa MK, Zoung-Kanyi Bissek AC. Prevalence and drivers of human scabies among children and adolescents living and studying in Cameroonian boarding schools. Parasit Vectors. 2016;9:400. doi:10.1186/s13071-016-1690-3.