A Case-Control Study of Risk Factors for Scabies Among Patients Attending Dermatology Clinics in Afghanistan

Scabies is a highly contagious parasitic skin disease and neglected tropical disease disproportionately affecting populations in poverty and fragile health systems. In Afghanistan, evidence on its environmental and socioeconomic determinants remains scarce. This case-control study aimed to identify demographic, socioeconomic, household, and behavioral risk factors associated with scabies among patients attending dermatology clinics in Kabul province.

A clinic-based case-control study was conducted between March 2024 and May 2025, enrolling 410 participants (210 microscopically confirmed cases, 200 controls). Univariable and multivariable logistic regression analyses identified independent predictors of scabies.

In multivariable analysis, reduced bathing frequency was the strongest independent predictor (OR = 22.11, CI: 9.19-53.15 for 2-3 times/week vs. ≥ 4 times/week), followed by suboptimal personal hygiene (OR = 8.06, CI: 3.19-20.38), sharing blankets (OR = 6.43, CI: 3.20-12.92), sharing clothes (OR = 3.98, CI: 1.72-9.22), and living in a mud house (OR = 3.65, CI: 1.86-7.17 vs. apartment). Protective factors included brick housing (OR = 0.048, CI: 0.008-0.29), female gender (OR = 0.32, CI: 0.14-0.75), employment (OR = 0.31, CI: 0.11-0.84), and age ≥ 45 years (OR = 0.32, CI: 0.13-0.77).

Scabies in Afghanistan is strongly driven by environmental deprivation, inadequate housing, poor hygiene, and material-sharing practices. These findings underscore the need for integrated control strategies combining case management and mass drug administration with improvements in housing quality, water access, sanitation, hygiene promotion, and health education within Afghanistan's fragile health system.