High prevalence of scabies and common skin disease in an Aboriginal community in the Northern Territory: results of a population-based screening study

Background: Scabies is a Neglected Tropical Disease with skin manifestations caused by a parasitic mite. It can lead to secondary complications which cause significant morbidity and mortality. The prevalence of scabies in remote Aboriginal communities is believed to be among the highest in the world but no recent prevalence assessments have been conducted in northern Australia. Methods: An observational cross-sectional prevalence assessment was conducted in a remote Aboriginal community in the Northern Territory, as part of a community health initiative led by the local Aboriginal Community-Controlled Health Organisation. Community residents and visitors of all ages were eligible to undergo a simplified skin assessment following verbal consent. Scabies was diagnosed when residents had 3 or more typical skin lesions in a typical body distribution, based on International Alliance for Control of Scabies (IACS) consensus criteria. Treatment of skin disease was according to national clinical guidelines with support from the local healthcare centre.The prevalence of scabies and other skin disease was estimated. To consider whether scabies prevalence was associated with underlying sociodemographic factors or co-infection with another skin disease, adjusted odds ratios were calculated with binomial 95% confidence intervals based on multivariate logistic regression with robust standard errors. Statistical significance was achieved when p<0.05. Results: 1353 people from a remote Aboriginal community of approximately 3800 residents underwent a complete simplified skin assessment. The prevalence of scabies was 25.4% (344/1353, 95%CI=23.1-27.7) and 698 people (51.6%, 95%CI=48.4-53.8) had at least one skin disease identified during the study period. On multivariate analysis, young children aged 0–1 year had the highest prevalence of scabiesand an increased risk of scabies (59.4%, aOR=6.22, p<0.001; 95%CI=2.41-16.09). Conclusions: The prevalence of scabies in this remote Aboriginal community was very high, especially in young infants. Community-led strategies are required to address the burden of scabies, impetigo and their sequelae.