Paediatric Department, Royal Darwin Hospital, Darwin, Australia.
Paediatric Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste.
PLoS Negl Trop Dis. 2018 May 31;12(5):e0006400. doi: 10.1371/journal.pntd.0006400. eCollection 2018 May.
Scabies and impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease.
School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test.
The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9-15). The prevalence of scabies was 22.4% (95% CI 20.2-24.7%) and active impetigo 9.7% (95% CI 8.3-11.4%); 68.2% of students had evidence of either active or healed impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2-12.4), p<0.01). There was no difference in the prevalence of active impetigo between urban and rural sites. More than a third of participants were moderately or severely underweight. Stunting was markedly more common in the rural district of Ermera.
Scabies and impetigo are common in Timor-Leste, with very high prevalence of scabies in the rural district of Ermera. Improvements in prevention and treatment are needed, with prioritised activities in the rural areas where prevalence is highest.
疥疮和脓疱疮是常见且重要的皮肤疾病，在发展中国家往往被忽视。东帝汶有关疥疮和脓疱疮流行的数据有限。包括蜂窝织炎、菌血症、肾炎、急性风湿热和风湿性心脏病在内的后遗症显著增加了疾病负担。
2016 年 10 月，我们从东帝汶帝力（城市）和埃梅拉（农村）的学校招募了学生，开展了一项流行病学研究。使用标准问卷记录人口统计学、人体测量学和皮肤检查结果。根据暴露表面的临床检查诊断脓疱疮和疥疮，感染性疾病儿科医生通过临床照片进行相关性回顾。计算疥疮和脓疱疮的患病率，并使用相对风险和 95%置信区间描述二元风险因素关联。使用逻辑回归多变量分析计算调整后的优势比。使用 Mann-Whitney 秩和检验分析连续变量的关联。
本研究共纳入 1396 名学生；中位年龄 11 岁（四分位距 9-15）。疥疮的患病率为 22.4%（95%CI 20.2-24.7%），活动性脓疱疮为 9.7%（95%CI 8.3-11.4%）；68.2%的学生有活动性或已愈合的脓疱疮的证据。埃梅拉的学生比帝力的学生更有可能患有疥疮（患病率 32.0%对 5.2%，优势比 8.1（95%CI 5.2-12.4），p<0.01）。城市和农村地区活动性脓疱疮的患病率没有差异。超过三分之一的参与者体重不足或严重不足。埃梅拉农村地区的发育迟缓更为明显。
疥疮和脓疱疮在东帝汶很常见，埃梅拉农村地区的疥疮患病率非常高。需要改善预防和治疗，优先在患病率最高的农村地区开展活动。
