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Mass scabies management in an orphanage of rural community: An experience

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Introduction

Scabies is an important health problem characterized by continuous transmission throughout the year. It is ubiquitous, contagious, and debilitating parasitic dermatoses, known since antiquity and having widespread distribution in the tropics. The worldwide prevalence has been estimated at about 300 million cases yearly, although it may be an overestimate.1 Scabies occurs in both sexes, at all ages, in all ethnic groups, and at all socioeconomic levels. In India, the incidence ranges from 13% to 59% in rural2 and urban areas.3

Scabies is a Latin word that simply means to scratch and is caused by the mite Sarcoptes scabiei var-hominis, and is usually associated with conditions of overcrowding, low socioeconomic standards, low level of education and poor hygiene.4 Overcrowding and sexual contacts are the most common, but not exclusive modes of transmission. The mite of scabies burrows into the outer layer of the skin (stratum corneum) and feeds on skin cells and fluids. It is this feeding action, and its products (digestive secretions and feces) that provoke an immune reaction from the body which results in itching and other symptoms of scabies. Scabies causes considerable discomfort and can result in severe secondary complications such as impetigo, cellulitis, pyoderma, bacteraemia and post-streptococcal glomerulonephritis.5, 6, 7

The study was undertaken in the Rural Health Training Centre of a medical college located at Kasurdi village, in Pune district of Maharashtra. During routine visits, three school going children of a nearby orphanage reported with the clinical symptoms suggestive of Scabies i.e. insomnia due to severe itching at night, rashes, irritability leading to school absenteeism and poor quality of life. On examination, the children were found to be having scabies. Scabies in orphanages are not uncommon but unfortunately are hard to treat because of reasons like delayed diagnosis, inadequate treatment, malnutrition, associated allergic and bacterial infections and inadequate follow-up.8 It was thus decided that all the children at the orphanage be examined and an intervention to cure all children of the orphanage be undertaken.

The study thus aimed to assess the prevalence of Scabies in an orphanage in a rural village of Maharashtra State and to conduct a mass Scabies treatment and follow-up of all children and care givers. The study in addition also provided health education and trained the care givers for timely management of scabies in the setup.

Section snippets

Methodology

A medical team comprising residents of Community Medicine Dept along with a medicosocial worker visited the orphanage housing 50 children on 12 Sep 08. The Team was adequately trained by an entomologist and Community Medicine specialist on investigation and treatment. A written informed consent from care taker was taken.

The case definition for scabies which was considered in the present study was all cases presenting with the following symptoms:

  • pimple-like rashes or burrows between

Results

Out of total 50 children, 45 (90%) children were males and 05 (10%) were females. All the girls were found to be infested with scabies. Total children infected were 41 (82%) out of which 36 (88%) were males (Table 1). In the age wise distribution, 21 (51%) of the infected were in age group 10–15 yrs followed by 11 (27%) in 5–10 yrs (Table 1).

The site of involvement was noted and it was found that majority of children had generalized scabies 20 (60.9%) followed by web spaces and wrist (Table 2).

Discussion

In our case study it has been seen that about 81% of the inmates of the orphanage were suffering from frank scabies and its associated problems. The study found that health education, community participation and simple intervention with cheap and readily available lotions like 25% Benzyl Benzoate could drastically improve the patients symptomatically reducing their itching and irritation along with sound sleep in the night thus improving quality of life and reduction in school absenteeism.

In an

Conclusion

Community scabies is an important health problem characterized by continuous transmission throughout the year with high prevalence in susceptible population. The disease is embedded in a complex web of causation characterized by poor living conditions and a low level of education. This study has clearly shown that Mass treatment and follow-up, if properly undertaken along with its environmental component and health education is curative, cheap and an effective long term community treatment tool

Conflicts of interest

All authors have none to declare.

Acknowledgement

I acknowledge the contribution of residents of Dept of Community Medicine Maj Shabeena, Maj Yaduvir, Maj Diva Reddy, Maj Sumit Lathwal, Maj Avinash Surana, Maj Seema Sharma and Maj Pushkar Singh.

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Available online 24 August 2012

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