Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK.
Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
BMJ Open. 2023 Nov 8;13(11):e075103. doi: 10.1136/bmjopen-2023-075103.
Provide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014-2017.
Retrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings.
Formal and informal refugee/migrant camps in Europe 2014-2017.
Twelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium).
Participants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid).
We recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.
了解 2014-2017 年期间在欧洲的正规和非正规难民营/移民营地治疗疥疮或管理疥疮疫情的医护人员的经验和看法。
采用半结构式电话访谈和框架分析法进行回顾性定性研究。主要通过参与难民/移民医疗工作的医护人员的在线网络招募研究对象。
2014-2017 年期间欧洲的正规和非正规难民营/移民营地。
12 名参与者（4 名医生、4 名护士、3 名辅助卫生工作者、1 名医学生），他们曾在欧洲 7 个国家的 15 个地点的难民营（6 个非正规营地，9 个正规营地）工作过。
参与者报告称，在他们工作过的营地，疥疮诊断主要是临床诊断（没有进行皮镜检查），治疗和疫情管理差异很大。7 名参与者表示提供了杀疥药物，而 5 名参与者表示仅提供了对症治疗。他们将营地描述为工作困难的地方，居民生活条件很差。控制疥疮的主要障碍包括：（1）缺乏水、卫生和个人卫生设施，具体表现为：缺少/有限的淋浴设施（难以冲洗掉局部用杀疥药物），无法清洗衣服和床上用品（可能会增加传播/再感染）；（2）社会因素：语言、污名、治疗不依从和流动（干扰接触者追踪和后续治疗）；（3）医疗保健因素：杀疥药物短缺和种类繁多、缺乏检查隐私和工作人员缺乏经验；（4）组织因素：过度拥挤、机构间协调不力、缺乏国家当局的支持和虐待（例如，不提供基本设施、营地居民和非政府组织（NGO）援助阻碍自我护理）。
我们建议为营地制定可获得的疥疮指南，使用共识诊断标准和口服伊维菌素群体治疗。此外，由于描述的大部分工作是由小型志愿人员组成的非政府组织完成的，我们更广泛的医疗保健界应该思考如何更好地支持这些举措及其服务对象。
