Royal Darwin Hospital, Darwin, Australia.
The Kirby Institute, University of New South Wales, Sydney, Australia.
Parasit Vectors. 2021 Mar 15;14(1):156. doi: 10.1186/s13071-021-04645-1.
Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA.
A cross-sectional school survey was conducted in April-May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated.
The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%.
Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.
疥疮和脓疱疮在许多热带、低收入和中等收入国家流行。伊维菌素的大规模药物给药（MDA）已成为控制这些疾病的一种策略。2019 年，东帝汶卫生部计划实施 MDA，包括伊维菌素，以控制淋巴丝虫病，因此我们进行了疥疮和脓疱疮的基线评估，以便更好地了解当地流行病学，并为未来评估 MDA 的影响的调查做出贡献。
2019 年 4 月至 5 月，在一个半城市（帝力）和两个农村地区（埃雷梅拉和马纳法伊）的六所小学进行了一项横断面学校调查。在调查日在校的 19 岁以下儿童有资格参加，我们共招募了 1183 名儿童。经过培训的卫生工作者使用 2020 年国际疥疮控制联盟（IACS）诊断标准对 1043 名参与者进行了访谈和检查，以临床诊断疥疮和脓疱疮。患病率按年龄和性别进行了调整。使用混合效应逻辑回归模型分析了疥疮和脓疱疮感染的可能性。所有模型都通过使用随机效应项来考虑学校层面的聚类。还估计了疥疮作为脓疱疮病因的人群归因风险。
总体加权疥疮患病率为 30.6%。农村马纳法伊的儿童患疥疮的可能性高于半城市帝力的儿童（53.6%比 28.2%，调整后的优势比 [AOR] 3.5）。大多数疥疮病例为轻度（3 至 10 个病变），病变通常分布在一个以上的身体部位。10 至 14 岁儿童的疥疮患病率低于 5 至 9 岁儿童。脓疱疮的总体加权患病率为 11.3%。与帝力相比，农村埃雷梅拉和马纳法伊的儿童患脓疱疮的可能性是帝力的两倍。患有疥疮的儿童患脓疱疮的可能性是没有疥疮的儿童的两倍，这对应于疥疮作为脓疱疮病因的归因风险为 22.7%。
东帝汶的疥疮和脓疱疮患病率在全球范围内处于较高水平，特别是在农村地区。疥疮感染与脓疱疮密切相关。东帝汶迫切需要全面的控制策略。
