Impact of scabies in resource-poor communities.
OBJECTIVE
Features of endemic scabies are specific in resource-poor and underprivileged communities, with implications for control measures on the community level. In this review, these special aspects are addressed.


RESULTS
Scabies is endemic in many resource-poor communities, with a prevalence of 20% and higher. Transmission is influenced by social attitudes, migration, access to healthcare services, housing conditions, hygiene conditions, and crowding. Endemic scabies occurs with severe infestations, complications, and sequels, mainly in children. Sleep loss as a result of scabies-related itching is common. Complications include secondary infections by group A streptococci and acute poststreptococcal glomerulonephritis. Shame, restriction of leisure activities, and stigmatization are common. Treatment of scabies includes a variety of topical compounds, but control on the community level is not an easy task. As ivermectin kills a variety of other parasites, this oral drug is increasingly used for mass treatment. Intervention should address socioemotional aspects using an integrated approach with professionals from different areas, and the community.


CONCLUSIONS
Scabies is a neglected disease and needs to be perceived as an important public health problem causing morbidity in many resource-poor communities. Future work on epidemiology, clinical aspects, transmission dynamics, socioeconomic aspects, and sustainable control in resource-poor communities is needed.
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil. heukelbach@web.de
Jorg
J
Heukelbach
Humphrey D
HD
Mazigo
Uade S
US
Ugbomoiko
D017281:Cost of Illness; D003906:Developing Countries; D006801:Humans; D011204:Poverty Areas; D012307:Risk Factors; D012532:Scabies / Q000453:epidemiology / Q000517:prevention & control; D012959:Socioeconomic Factors