Frequency of Scabies in Dhaka City: Survey in a Tertiary Care Hospital

Background: Scabies is a neglected tropical disease affecting over 565 million people annually, with high prevalence in low- and middle-income countries. In Bangladesh, up to 77% of children have experienced scabies, yet it remains underdiagnosed and poorly understood.

Objectives: To determine the frequency of scabies among patients at a tertiary care hospital, Bangladesh and identify associated risk factors, environmental characteristics in Bangladesh.

Methods: A cross-sectional study was conducted in the Dermatology and Venereology outpatient department of Ashiyan Medical College Hospital from January to December 2023, enrolling 120 patients with skin diseases.

Results: The study revealed an overall scabies prevalence of 34.2%, with the highest occurrence among individuals aged 19-36 years and a notably higher rate among males (40.0%) compared to females (28.3%). The majority of cases were mild in severity (73.2%), with moderate cases accounting for 24.4% and severe cases representing just 2.4%. Anatomically, the most frequently affected sites were hands (80.5%), interdigital spaces (78.0%), and wrists (63.4%), demonstrating the characteristic distribution of scabies lesions. Environmental and demographic factors played a crucial role in disease transmission, with 93.3% of participants living in crowded conditions and 84.2% exposed to dust. Winter emerged as a significant season for scabies transmission, with 72.5% of cases occurring during colder months. Family history of skin infections was prevalent in 71.7% of participants, suggesting a potential genetic or environmental predisposition. Hygiene-related factors were particularly noteworthy, with 81.7% of participants sharing sleeping spaces and 53.3% sharing bedding or clothing. Statistical analysis revealed significant associations between scabies occurrence and sleeping arrangements, bathing frequency, and the presence of pruritus in close contacts.

Conclusion: The study highlights the substantial burden of scabies in urban Bangladesh, emphasizing the need for targeted public health interventions addressing living conditions, hygiene practices, and community awareness.

Scabies is a prominent neglected tropical illness that is mostly seen in lower- and middle-income nations in South-East Asia and sub-Saharan Africa. Over 565 million people worldwide are afflicted with this illness each year [1]. It significantly affects the expense of therapy, missed job or school, and psychological effects [2]. Nearly 4.84 million disability-adjusted life years are caused by this illness [1]. Scabies affect more than 300 million individuals every year, which equals 2.8% of the world’s population [3.] Epidemiological data from different parts of the world indicate that the prevalence of scabies can range from 0.2% to 71% [4]. The Pacific region and Latin America have shown the highest prevalence [5]. Geographically, areas with tropical weather, developing countries, and little access to water have higher rates of scabies infections [6]. Scabies was listed as a neglected tropical disease by the World Health Organization (WHO) [7]. The infestation affects hundreds of millions of individuals in impoverished urban and rural communities worldwide [3]. People who live in cramped, unsanitary settings are more susceptible to a variety of infectious illnesses. Acute watery diarrhea, fever, skin conditions, acute respiratory infections, and cough and cold with or without pneumonia are the most common infectious disorders [8]. Recently, scabies, caused by Sarcoptes scabiei var. hominis, a parasitic mite, have emerged as one of the most common afflictions within the FDMN community [9]. This illness is spread by using contaminated personal items or by coming into close, continuous contact with infected skin [10]. Itching and scratching are the most common clinical manifestations, followed by bacterial infection-related consequences such as cellulitis, impetigo, and abscesses, as well as a breakdown of the skin's barrier function [11]. A report from Medicine Sans Frontieres (MSF) claims that an environment that is favourable to fast mite transmission is created by overcrowding in shelters, poor access to water, and intimate physical contact between residents [12]. Social attitudes, migration, access to healthcare services, housing circumstances, hygienic conditions, and crowding all have an impact on the spread of scabies. Overcrowding, sleeping together, sharing clothing and towels, poor hygiene, malnourishment, and visiting scabies epidemic regions are all considered to be common risk factors for scabies [13,14]. Furthermore, close proximity and frequent physical contact facilitate the rapid spread of the mite [10]. According to a Brazilian research, violent conflicts, homelessness, congestion, and sharing of clothing, bedding, and pillows are all associated with high frequency and re-infestations in endemic areas [15]. Another research of Cameroonian detainees revealed that sharing a bed or clothing and having less education were risk factors for scabies [14]. According to research in Poland, Scabies was more common among those who lived in unhygienic and unsanitary environments [16]. However, scabies remains one of the major under-recognized global health concerns, especially in the lower-income and middle-income countries. For example, nearly 77% of children in Bangladesh have had scabies, according to the most recent study available [17]. While the burden of non-communicable illnesses is increasing and Bangladesh is undergoing an epidemiological shift, the general prevalence of scabies is nearly unchanged in a few specific populations, such as residential religious schools and urban slums [18]. Despite this huge burden of disease, scabies often remains underdiagnosed and untreated in these resource-poor communities. Understanding the epidemiology and risk factors of scabies infection among this larger population group might guide development of further prevention strategies. Therefore, to determine the frequency of scabies among the tertiary care hospital in Bangladesh was the objective of the present study.

This cross-sectional study was conducted in the outpatient department of Dermatology and Venereology in Ashiyan Medical College Hospital Bangladesh from January 2023-December 2023. In total 120 skin diseases patients attended the OPD of the mentioned hospital were included as the study population. According to the inclusion criteria of this study, patients of several age either male or female suffering from any kind of skin disease for at least one month were included as the study subjects. This study was approved by the ethical committee of the mention hospital. Proper written consents were taken from all the participants before data collection. Proper diagnosis from reputed and government registered diagnostic centres were performed. Cases with doubtful diagnosis were excluded from the study. The socio-demographic profiles and diseases pattern were recorded in a data sheet. A predesigned questioner was used in data collection. All data were collected, processed and analyzed by using MS Office and SPSS version 25 programs as per need.

Scabies is a disease of poverty affecting predominantly from low socioeconomic condition. The initial suspicion of the increasing trend of scabies infection among different age groups has been revealed in this study. Individuals aged 19-36 highest prevalence rates. This observation aligns with earlier research that identified elevated scabies rates within this age group [19]. Numerous elements, including heightened social connections among young individuals and weakened immune systems in the elderly, may be involved in this correlation [20]. The gender-specific patterns in scabies prevalence did not achieve statistical significance despite the study population having almost equal proportions of males and females. In the current study, Married people had a greater frequency of scabies than single people, according to our findings of an interaction between marital status and scabies infection. This research suggests that the social actions and living environment of married individuals may make scabies more likely to spread. FDMN people typically get married early and have children within a year or two of getting married, which encourages their families to grow quickly [21]. Our research uncovered that a majority of these individuals originate from large families. However, the escalating pace at which their families are growing surpasses their housing’s capacity to expand concurrently [22]. Scabies are more common among illiterate people, highlighting the connection between literacy and health. This agrees with the results of an Egyptian study that revealed that the level of education of both the participants and their parents affected the severity of scabies symptoms [23]. People who live in congested areas share more beds, clothing, and other everyday conveniences with bigger families than with smaller ones. It is well known that scabies spreads swiftly in crowded places when people come into close touch with one another [20]. According to the results, people who had previously acquired scabies were far more likely to contract the disease again than people who had never contracted it. 

Table 1: Distribution of the respondents according to Sociodemographic characteristics (n = 120).