Prevalence of scabies and community knowledge, attitudes, and practices on the disease in the middle belt of Ghana

Background : The development of a global scabies strategy is hampered by inadequate epidemiological data from most countries including Ghana. This study investigated the prevalence of scabies infection and community knowledge, attitudes, and practices towards the disease in the middle belt of Ghana to provide evidence to inform programmatic decisions. Methods : A cross-sectional study was carried out in five communities in the Wenchi municipality and Tain district of the Bono region of Ghana between June and August 2021. Written informed consent was obtained from the participants and the consent of young children was obtained from their parents or legal guardians. Standardised skin examinations were carried out on whole areas of the skin for signs of scabies such as burrows, vesicles, papules and distribution of rash throughout the body. Skin scrapings from suspected scabbed areas on the skin were taken and examined under microscopy to determine whether the scraped samples from patients contained mites, eggs or faecal pellets. Structured questionnaires were also given to participants to assess their knowledge, attitudes and practices on scabies. Results : A total of 164 people participated in the study [median age: 27.5, interquartile range (17‒46.8) years] of which 101(61.6%) were females. Overall prevalence of scabies was 14.6 % (15/103, 95% CI: 9.0-22.7) with the Abekwai 3 community recording the highest prevalence of 21.9% (7/32, 95% CI:11.0-38.8). The prevalence of scabies was highest at 28.6% (2/7, 95% CI = 8.2 – 64.1) in those aged 31-40 years and lowest at 10.8% (4/37, 95% CI = 4.3-24.7) in those above 40 years. The infestation was slightly more prevalent in females at 16.4% (10/61, 95% CI = 9.2-27.6) than in males at 11.9% (5/42, 95% CI = 5.2 – 25.0%). Surprising, only 29.3% had good level of knowledge on the disease whilst 32.9% had good attitudes and practices towards scabies and its control in the communities. Being <30 years old, being male and having a high level of knowledge were significantly associated with higher odds of increased risk perception of the disease. Conclusion : Our study has confirmed a high prevalence of scabies in the middle belt of Ghana. This prevalence is above the WHO threshold of 10% where MDA is indicated for the community. We have also demonstrated a worryingly low level of knowledge, good attitudes and practices on the disease in our study communities, highlighting the need for enhanced, coordinated and targeted educational and behavioural change campaigns by the Ghana National Neglected Tropical Diseases Programme to remedy the situation. Further, the study demonstrates the need for research to assess the scope of the scabies situation in other communities in Ghana to help inform programmatic decisions.