Furnival-Adams Joanna, López Valeria, Mundaca Hansel, Houana Amelia, Macucha Antonio, Elobolobo Eldo, Xerinda Aida, Munguambe Humberto, Materula Felisbela, Rabinovich Regina, Saute Francisco, Engelman Daniel, Chaccour Carlos
ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
Am J Trop Med Hyg. 2024 Sep 18;111(6):1320-1325. doi: 10.4269/ajtmh.24-0204. Print 2024 Dec 4.
Scabies is endemic in many resource-poor tropical areas, causing significant morbidity. However, our understanding of the true burden of scabies in Africa is limited, partly owing to limited capacity and challenges accessing the currently recommended diagnostic tools. The primary objective of this study was to assess the diagnostic accuracy of scabies assessments made by minimally trained field-workers. We trained field-workers with a minimum of secondary school education in the diagnosis of scabies. After the training, we assessed the diagnostic accuracy of assessments made by nine field-workers compared with the reference standard. In all, 193 individuals were assessed for scabies. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, as well as agreement (κ coefficients) between medical doctors and between field-workers. Of the 193 participants, 26% had scabies according to the reference standard. The sensitivity of field-worker diagnosis compared with the reference standard was 94% (95% CI: 90-99%), and the specificity was 96% (95% CI: 90-97%). The determination of severity by field-workers was less accurate; the sensitivity for severe scabies was 61% (95% CI: 48-74%), and the mean specificity was 97% (95% CI: 93-100%). This study demonstrated that field-workers without medical qualifications were capable of diagnosing scabies to a similar level of accuracy as experienced medical doctors after a short period of focal training. This may facilitate rapid assessments of scabies prevalence for public health purposes and decisions about mass drug administration implementation in similar settings.
疥疮在许多资源匮乏的热带地区呈地方性流行，会引发严重的发病率。然而，我们对非洲疥疮实际负担的了解有限，部分原因是获取当前推荐诊断工具的能力有限且面临挑战。本研究的主要目的是评估由受过最少培训的现场工作人员进行的疥疮评估的诊断准确性。我们对至少具有中学教育水平的现场工作人员进行了疥疮诊断培训。培训后，我们将9名现场工作人员的评估诊断准确性与参考标准进行了比较。总共对193人进行了疥疮评估。计算了敏感性、特异性、阳性预测值和阴性预测值，以及医生之间和现场工作人员之间的一致性（κ系数）。在193名参与者中，根据参考标准，26%的人患有疥疮。与参考标准相比，现场工作人员诊断的敏感性为94%（95%置信区间：90 - 99%），特异性为96%（95%置信区间：90 - 97%）。现场工作人员对严重程度的判定准确性较低；严重疥疮的敏感性为61%（95%置信区间：48 - 74%），平均特异性为97%（95%置信区间：93 - 100%）。本研究表明，未经医学资格培训的现场工作人员在经过短期集中培训后，能够以与经验丰富的医生相似的准确程度诊断疥疮。这可能有助于为公共卫生目的快速评估疥疮患病率，并为在类似环境中实施大规模药物给药决策提供便利。
