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The Prevalence of Scabies, Skin Infection and Rheumatic Heart Disease in a Cross-Sectional Study of Tongan Primary
Simon Thornley1, Toakase Fakakovikaetau2, Mele Tilema Cama3
1Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand.
Insights
High rates of scabies and skin infections in Tongan schoolchildren are linked to rheumatic heart disease (RHD). Controlling scabies could significantly reduce RHD incidence in the region.
Area of Science:
- Public Health
- Infectious Diseases
- Cardiology
Background:
- Scabies is prevalent in the Pacific, potentially contributing to rheumatic heart disease (RHD).
- Skin conditions are common among children in the region.
- Understanding the link between skin infections and RHD is crucial for public health interventions.
Purpose of the Study:
- To determine the prevalence of scabies and other skin conditions in Tongan schoolchildren.
- To investigate the association between these skin conditions and RHD.
- To inform strategies for controlling both skin infections and RHD.
Main Methods:
- Screening of 400 schoolchildren on Tongatapu for scabies, skin infections, and RHD using echocardiography.
- Training health workers for accurate diagnosis of skin conditions.
- Statistical analysis including prevalence ratios and Fisher's exact tests.
Main Results:
- Echocardiographic features of RHD were found in 4.5% of children.
- Scabies prevalence was 29.8%, impetigo 20%, and severe bacterial skin infection 15.5%.
- Children with scabies and skin infection were 4.65 times more likely to have RHD; a significant trend of increasing RHD prevalence with more severe skin conditions was observed.
Conclusions:
- A high prevalence of scabies, bacterial skin infections, and RHD exists among Tongan schoolchildren.
- Enhanced scabies control is recommended to reduce bacterial infections and RHD incidence.
- Mass drug administration is suggested as a control strategy.
Background:
Scabies is a common health issue in the Pacific and may contribute to rheumatic heart disease (RHD). This study assessed the prevalence of scabies and other skin conditions among Tongan schoolchildren and examined the association between these conditions and RHD.
Methods:
Children from four primary schools on Tongatapu were screened for scabies, other skin conditions and RHD. Health workers were trained to recognise scabies and related skin conditions accurately. All children also underwent echocardiographic screening to detect heart valve abnormalities consistent with RHD. Statistical analysis included prevalence ratio calculations, and Fisher's exact tests to evaluate associations between skin and heart findings.
Results:
Four hundred children were screened (mean age: 8 years 6 months), with 18 (4.5%) having echocardiographic features of RHD. The prevalence of scabies was 29.8% (119/400), while the prevalence of impetigo was 20% and more severe bacterial skin infection was 15.5%. Children with both scabies and skin infection were 4.65 times more likely than children without any such lesions to have RHD (95% confidence interval: 1.60-13.6). Children with scabies, impetigo and bacterial infection were associated with progressively higher prevalence of RHD (p for trend = 0.008). The population attributable fraction for scabies and infection as a potential cause of RHD was 26.5%.
Conclusions:
The results indicate a very high prevalence of scabies, bacterial skin infection, and RHD among Tongan school children. Enhanced treatment and control of scabies are likely to reduce the incidence of both bacterial infection and RHD. Mass drug administration is recommended.
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