In doing some background research for this blog entry, I discovered scabies causes 1 death in Australia per year. Yikes!
That aside, the point of this blog was to help illustrate that health is not just about big killer diseases. And that non-lethal diseases are not issues that do not need to be taken seriously. A non-lethal disease like scabies still represents a burden on the community. It drains on health resources, it also drains on family resources, and can also be a source of conflict and agitation.
This paper is an Australian study published through PLoS Neglected Tropical Diseases, it examines scabies and treatment uptake in two rural Aboriginal communities in northern Australia. A number of factors lead to these communities experiencing a high burden of scabies infestation – including distance from resources, household overcrowding and high mobility between households. Those most at risk are young children.
In general, the best known way to control endemic scabies is through community-based mass treatment initiatives. However these initiatives require community awareness and cooperation in order to be successful. This study looked to not only measure levels of cooperation and success, but also what barriers exist in the community that might hinder such initiatives.
Scabies is primarily an inflammatory condition caused by the bodies reaction to burrowing behaviour and eggs laid by the scabies mite (pictured to the left). In Australia, the approved treatment for scabies is a topical cream, permethin that is applied to the entire body. In the study, a “Healthy Skin Day” was held in the community, and all community members were advised to utilise the cream over an 8-day period. The study then followed those households in which at one or more cases of childhood scabies were subsequently identified.
If a child was diagnosed with scabies, the parent was given cream to use not only on the child, but every other member of the household. Not only is this because there is likely to be others not diagnosed but affected in the same household, but the mites are likely to just leave the treated person and go over to new host.
As expected scabies susceptibility was lower in households that experienced universal treatment. However, while 80% of children directly diagnosed with scabies used the supplied creams, compliance rates amongst other people advised to follow the treatment because of someone else in the household being diagnosed was less satisfactory (44% of these persons used the cream). Just over three quarters of households had at least one household member not take the treatment, and in almost a fifth no one followed the treatment. The study also noted that treatment cooperative households were more likley to remain in the study, meaning that if anything these statistics are possibly over-estimating compliance rates.
There were multiple factors that contributed to treatment not being followed through: treatment not being a priority, treatment was not considered necessary, and treatment caused discomfort. The first two of these responses point to issues in education and trust. The community needs to be aware of the burden of disease on the community, and the benefits of treatment. Trust is a more trickier issue, as the relationship between indigenous communities and the government is one giant elephant that I’m not quite ready to take on that I’m not quite wanting to take on at the moment. The last points to a question of whether the proscribed treatment is appropriate for these communities.
The authors point out that in a hot, crowded environment, a sticky cream-like substance is possibly not the most enjoyable of treatments to experience. The cream also needs to be washed off in the morning, and with drought and water access also being an issue in regional communities, provides further complications with treatment compliance. Sadly while creams like permethin are the only treatments available in Australia at present, oral treatments for scabies do exist and would seem on the front a more acceptable treatment for the tropical environment. Pills might also be considered more like “real working medicine” and therefore encourage higher rates of compliance.
This study, while obviously not carried out with unlimited resources, does a very good job at highlighting the multiple factors that complicate rural health.
La Vincente, S., Kearns, T., Connors, C., Cameron, S., Carapetis, J., & Andrews, R. (2009). Community Management of Endemic Scabies in Remote Aboriginal Communities of Northern Australia: Low Treatment Uptake and High Ongoing Acquisition PLoS Neglected Tropical Diseases, 3 (5) DOI: 10.1371/journal.pntd.0000444
Image credit: Scabies by MacAllenBrothers