Society for Education Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India.
PLoS Negl Trop Dis. 2021 Apr 16;15(4):e0009330. doi: 10.1371/journal.pntd.0009330. eCollection 2021 Apr.
Scabies is often endemic in tribal communities and difficult to control. We assessed the efficacy of a community-based intervention using mass screening and treatment with oral ivermectin in controlling scabies.
METHODS/ FINDINGS: In this cluster randomised controlled trial, 12 villages were randomly selected from a cluster of 42 tribal villages in Gadchiroli district. In these villages, trained community health workers (CHWs) conducted mass screening for scabies. The diagnosis was confirmed by a physician. Six villages each were randomly allocated to the intervention and usual care arm (control arm). In the intervention arm (population 1184) CHWs provided directly observed oral ivermectin to scabies cases and their household contacts. In the usual care arm (population 1567) scabies cases were referred to the nearest clinic for topical treatment as per the standard practice. The primary outcome was prevalence of scabies two months after the treatment. Secondary outcomes were prevalence of scabies after twelve months of treatment and prevalence of impetigo after two and twelve months of treatment. Outcomes were measured by the team in a similar way as the baseline. The trial was registered with the clinical trial registry of India, number CTRI/2017/01/007704. In the baseline, 2 months and 12 months assessments 92.4%, 96% and 94% of the eligible individuals were screened in intervention villages and 91.4%, 91.3% and 95% in the usual care villages. The prevalence of scabies in the intervention and usual care arm was 8.4% vs 8.1% at the baseline, 2.8% vs 8.8% at two months [adjusted relative risk (ARR) 0.21, 95% CI 0.11-0.38] and 7.3% vs 14.1% (ARR 0.49, 95% CI 0.25-0.98) at twelve months The prevalence of impetigo in the intervention and usual care arm was 1.7% vs 0.6% at baseline, 0.6% vs 1% at two months (ARR 0.55, 95% CI 0.22-1.37) and 0.3% vs 0.7% at 12 months (ARR 0.42, 95% CI 0.06-2.74). Adverse effects due to ivermectin occurred in 12.1% of patients and were mild.
Mass screening and treatment in the community with oral ivermectin delivered by the CHWs is superior to mass screening followed by usual care involving referral to clinic for topical treatment in controlling scabies in this tribal community in Gadchiroli.
疥疮在部落社区中经常流行，难以控制。我们评估了在控制疥疮方面，采用社区为基础的大规模筛查和口服伊维菌素治疗的干预效果。
方法/发现：在这项聚类随机对照试验中，从马哈拉施特拉邦 Gadchiroli 区的 42 个部落村庄中随机选择了 12 个村庄。在这些村庄中，经过培训的社区卫生工作者（CHW）对疥疮进行了大规模筛查。医生对诊断进行了确认。每个村庄都被随机分配到干预组和常规护理组（对照组）。在干预组（人口 1184 人）中，CHW 为疥疮病例及其家庭接触者提供了直接观察口服伊维菌素治疗。在常规护理组（人口 1567 人）中，疥疮病例按照标准做法转诊到最近的诊所接受局部治疗。主要结局是治疗后两个月疥疮的患病率。次要结局是治疗 12 个月后疥疮的患病率以及治疗后 2 个月和 12 个月脓疱疮的患病率。结果由团队以与基线相同的方式进行测量。该试验在印度临床试验注册处进行了注册，编号为 CTRI/2017/01/007704。在基线、2 个月和 12 个月评估中，干预村庄中分别有 92.4%、96%和 94%的合格个体接受了筛查，常规护理村庄中分别有 91.4%、91.3%和 95%的合格个体接受了筛查。干预组和常规护理组的疥疮患病率分别为基线时的 8.4%比 8.1%，2 个月时的 2.8%比 8.8%[调整后的相对风险（ARR）0.21，95%CI 0.11-0.38]，12 个月时的 7.3%比 14.1%（ARR 0.49，95%CI 0.25-0.98）。干预组和常规护理组的脓疱疮患病率分别为基线时的 1.7%比 0.6%，2 个月时的 0.6%比 1%（ARR 0.55，95%CI 0.22-1.37），12 个月时的 0.3%比 0.7%（ARR 0.42，95%CI 0.06-2.74）。伊维菌素引起的不良反应发生在 12.1%的患者中，且为轻度。
在这个马哈拉施特拉邦的部落社区中，社区内大规模筛查和口服伊维菌素治疗由 CHW 提供，优于大规模筛查后进行常规护理，包括转诊到诊所接受局部治疗，可更好地控制疥疮。
