Can ivermectin mass drug administrations to control scabies also reduce skin and soft tissue infections? Hospitalizations and primary care presentations lower after a large-scale trial in Fiji

Middleton, Jo

doi:10.1016/j.lanwpc.2022.100454

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…MDA needs to be initiated as the outbreak can no longer be controlled through standard care 52. Ivermectin MDAs for scabies were first trialled in Oceania in the late 1990s and have proven to be effective at reducing community prevalence 53. Ideally two doses of oral ivermectin (200 µg/kg) should be given 7–14 days apart, with alternative scabicides provided to whom ivermectin is presently not recommended (children weighing <15 kg or <90 cm height; pregnant women; women breast feeding in the first week).…”

Section: Discussionmentioning

confidence: 99%

Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge

Yirgu,

Middleton,

Fekadu

et al. 2023

BMJ Open

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BackgroundThe WHO aims to prevent, eliminate or control neglected tropical diseases, including scabies, by 2030. However, limited epidemiological data presented a challenge to control efforts, especially in high burden countries. There was a major scabies outbreak in northern Ethiopia starting in 2015 and prevalence has since increased across much of the country.ObjectiveTo estimate scabies prevalence, identify its predictors, and assess community perception of, and knowledge about, the infestation.DesignPopulation-based cross-sectional study.Study settingAyu Guagusa district, Amhara region, northern Ethiopia.Participants1437 people who were members of 381 randomly selected households participated in the study. Five trained mid-level health workers clinically diagnosed people with scabies.Outcome measuresClinically diagnosed scabies infestation.Data analysisMulti-level logistic regression models were fitted to adjust for individual and household-level confounding variables, and identify predictors of scabies infestation.ResultsScabies prevalence was 13.4% (95% CI 11.8 to 15.5). Households of more than five people (adjusted OR (aOR)=3.5, 95% CI 1.2 to 10.2) were associated with increased odds of developing scabies, however, females had lower odds (aOR=0.5 95% CI 0.3 to 0.8). Scabietic lesions most frequently involved the trunk (62.0%), and vesicles were the most common types of lesions (67.7%). Two-thirds of adult study participants had heard about scabies and most obtained scabies related information from informal sources. Only 32% of cases sought care for scabies from any source.ConclusionScabies prevalence was high, signifying the need for community-based control interventions. Host density and sex were important predictors of scabies. Despite the favourable attitude toward the effectiveness of scabies treatment, healthcare seeking was low.

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Section: Discussionmentioning

confidence: 99%

Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge

Yirgu,

Middleton,

Fekadu

et al. 2023

BMJ Open

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“…This may be particularly so for action on neglected tropical skin diseases, which are highly prevalent across the Pacific 52. The region has been key to developing integrated skin interventions to control scabies and reduce soft tissue infections 53. Tinea imbricata, which is only found in a small number of populations worldwide but is highly distributed across Melanesia,25 54 55 has been neglected as regards research and treatment 23.…”

Section: Discussionmentioning

confidence: 99%

“… 52 The region has been key to developing integrated skin interventions to control scabies and reduce soft tissue infections. 53 Tinea imbricata, which is only found in a small number of populations worldwide but is highly distributed across Melanesia, 25 54 55 has been neglected as regards research and treatment. 23 An integrated skin intervention 56 in Wanang and surrounding areas, targeting tinea imbricata alongside yaws, tropical ulcers and scabies ( figure 4 ), may relieve considerable suffering, and act as a model for the region and beyond.…”

Section: Discussionmentioning

confidence: 99%

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Middleton,

Colthart,

Dem

et al. 2023

BMJ Open

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ObjectivesDetermine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development.DesignClinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases.SettingWanang (pop. c189), a rainforest community in Madang province, Papua New Guinea.Participants129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f<40 years; m<40 years; f>40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded.ResultsOf 113 examined, 11 were ‘well’ (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) ‘malaria’, (B) ‘sotwin’, (C) ‘grile’) translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning.ConclusionsThis study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang’s community to develop sustainably, without sacrificing their forest home.

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“…52 The region has been key to developing integrated skin interventions to control scabies and reduce soft tissue infections. 53 Tinea imbricata, which is only found in a small number of populations worldwide but is highly distributed across Melanesia, 25 54 55 has been neglected as regards research and treatment. 23 An integrated skin intervention 56 in Wanang and surrounding areas, targeting tinea imbricata alongside yaws, tropical ulcers and scabies (figure 4), may relieve considerable suffering, and act as a model for the region and beyond.…”

Section: Unanswered Questions and Future Researchmentioning

confidence: 99%

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Middleton¹,

Colthart²,

Dem³

et al. 2023

Preprint

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Objectives. Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area. Design. Clinical and rapid anthropological assessment (individual primary care assessments, Key Informant [KI] interviews, Focus Groups [FGs], ethnography) with parallel treatment of urgent cases.Setting. Wanang (pop. c189), a village in the rainforests of Madang province, Papua New Guinea.Participants. 129 villagers provided medical histories (54 females (f), 75 males (m); median 19y, range 1mo–73y), 113 had clinical assessments (51f, 62m; median 18y, range 1mo–73y). 26 ≥18y participated in sex-age stratified FGs (f<40y; m<40y; f>40y; m>40y). Five KIs were interviewed (1f, 4m). Data collectors recorded daily ethnographic fieldnotes.Results. Of 113 examined, 11 were ‘well’, 62 (30f, 32m) treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories, and clinical examinations. For example, ethnoclassifications of three ([a]“malaria”, [b]“sotwin”, [c]“grile”) translated to the five biomedical conditions diagnosed most ([a] malaria, 9 villagers; [b] upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; [c] tinea imbricata, 15), and were highly represented in declared medical histories ([a] 75 participants, [b] 23, [c] 35). However, 29.2% of diagnoses (49 of 168) were limited to one or two people. Treatment approaches included plant-medicines, stored pharmaceuticals and occasionally rituals. Protracted travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols or easily reachable aid post; remote town hospital; unfamiliarity with institutions; medicine costs. FG service introduction priorities were: aid post; child vaccinations; transport; perinatal/birth care; family planning.Conclusions. In a place with no prior health data, this study enabled service planning and demonstrated medical need sufficient to acquire funding to establish local primary care. In doing so, it has aided Wanang’s community to develop sustainably, without sacrificing their forest home.

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Can ivermectin mass drug administrations to control scabies also reduce skin and soft tissue infections? Hospitalizations and primary care presentations lower after a large-scale trial in Fiji

Cited by 6 publications

References 15 publications

Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge

Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

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