Objective:

To comprehensively summarize available data on the prevalence and risk factors of scabies among children and adolescents in Africa to inform future public health strategies aimed at reducing the burden of disease.

Approach:

• Literature Search: MEDLINE, EMBASE, African Index Medicus, and African Journals Online were searched for published studies reporting primary data on scabies prevalence or risk factors among children and adolescents in Africa from January 1, 2000, through August 9, 2025. Reference lists of relevant articles and reviews were also searched manually.
• Study Selection: Cross-sectional studies reporting prevalence or risk factors and case-control studies reporting risk-factor data were eligible. Articles without primary data were excluded, and duplicate reports from the same study or registry were represented by the most comprehensive report with the largest sample size.
• Meta-analysis: Random-effects meta-analysis was used to pool prevalence estimates and adjusted risk estimates, with subgroup analyses performed according to geographic region, study area, setting, investigator type, diagnostic method, and risk of bias.

Key Findings:

• A total of 35 studies comprising 45,425 participants were included; 31 were cross-sectional studies and 4 were case-control studies.
• The pooled prevalence of scabies was 5.7% (95% CI, 3.6%-8.2%) across all included studies and 9.4% (95% CI, 6.5%-12.8%) among studies focused specifically on scabies.
• Pooled prevalence was highest in Eastern Africa at 7.4% and lowest in Central Africa at 3.2%, with no statistically significant difference between geographic regions.
• Prevalence was significantly higher in community-based studies than in school-based studies (12.8% vs 4.2%; P = 0.002).
• Factors associated with increased scabies risk included a family size of 5 or more, rural residence, not using detergent for bathing or washing clothes, sleeping on the floor, sharing bedding or clothes, and contact with a scabies case.

Interpretation:

The review found a substantial burden of scabies among children and adolescents in parts of Africa, with prevalence varying widely according to geographic region, study setting, population characteristics, and diagnostic approach. Several associated factors were linked to poverty and living conditions, including larger household size, rural residence, inadequate hygiene, sleeping on the floor, and sharing clothes or bedding. However, the high heterogeneity of prevalence estimates and evidence of small-study effects for some risk-factor analyses mean that these findings should be interpreted cautiously.

Limitations:

• Included studies came from a limited number of African countries, so pooled estimates may not fully represent scabies epidemiology across the continent.
• Substantial heterogeneity was present in several analyses, particularly prevalence estimates, partly reflecting differences in study populations, settings, and case ascertainment.
• Available data were insufficient for age-stratified analyses, preventing assessment of how age influenced scabies prevalence.
• The included studies were conducted before publication of the International Alliance for the Control of Scabies Consensus Criteria, and diagnostic methods were not standardized.

Conclusion:

Scabies prevalence among children and adolescents was high in some parts of Africa and varied considerably by geographic region, study setting, population characteristics, and methods of case ascertainment. Poverty-related factors, including large household size, rural residence, inadequate personal hygiene, sleeping on the floor, and clothing sharing, were important associated factors. The findings support improving living conditions, targeting interventions toward impoverished and rural communities, and conducting future African studies using standardized International Alliance for the Control of Scabies diagnostic criteria.