Scabies outbreak management in refugee/migrant camps in Europe 2014–2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives

Abstract

ObjectivesProvide 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.DesignRetrospective 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.SettingFormal and informal refugee/migrant camps in Europe 2014–2017.ParticipantsTwelve 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).ResultsParticipants 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).ConclusionsWe 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.

Estudos Multidisciplinares Sobre Saúde Da Criança E Do Adolescente

“…Apesar de serem doenças que não incidem diretamente no aumento de mortalidade, elas oferecem graus incapacidades psicológicas, pois apresentam um acometimento externo, visível a todos. Gestão de surtos de sarna em campos de refugiados/migrantes na Europa 2014-2017  (Middleton et al, 2023).…”

“…Nesse desfecho, criase um elo preocupante, uma vez que a epidemiologia da Escabiose no Brasil não é tão conhecida como deveria. Middleton et al (2023), corrobora ao afirmar que essa mesma característica é considerada em Portugal, ainda mais pelo fato de que a doença não é definida como obrigatória pelo sistema de saúde.…”