Assessment of scabies diagnosis and the impact of MDA for onchocerciasis on the burden of scabies in an endemic community in Ghana

BACKGROUND: Scabies is a neglected tropical disease with substantial public health impact, especially in resource-limited countries like Ghana. Worldwide, more than 300 million people are affected by scabies. In Ghana, scabies outbreaks have been occurring frequently, especially among school-going children. This study assessed scabies burden, diagnostic accuracy, and the effect of ivermectin-based Mass Drug Administration (MDA) on scabies prevalence in the Sefwi Wiawso Municipality of the Western North Region of Ghana. METHODS: A total of 341 participants were recruited at health facilities within the Municipality between October 2022 and October 2023. Scabies was diagnosed using the 2020 The International Alliance for the Control of Scabies (IACS) consensus criteria, and demographic data were collected. Health facility diagnoses were compared with study findings, and the relationship between MDA intake and scabies occurrence was also assessed. RESULTS: There was equal representation of both males (N = 172) and females (N = 169) with the mean ages of recruited male and female participants being 23.49 ± 14.26 years and 25.28 ± 13.68, respectively. IACS consensus criteria assessment of all participants showed 83% had clinical scabies and 10% had suspected scabies. Participants with basic education (JHS and primary) were disproportionately more likely to be diagnosed with either clinical or suspected scabies (p = 0.006). Ivermectin MDA intake was significantly associated with scabies diagnosis (p = 0,001). Study participants who had received at least 3 rounds of ivermectin MDA over the years were less likely to be diagnosed with either clinical (18.73%) or suspected (14.71%) scabies (p = 0.009). Study participants who reported more than 3 skin condition symptoms were significantly more likely to be diagnosed with clinical scabies (89.4%) compared to suspected scabies (64.71%) (p < 0.001). Clinical and suspected scabies were also only correctly diagnosed in 43.82% and 14.71% of participants, respectively, prior to training of health workers on the IACS consensus criteria tool (p < 0.001). CONCLUSIONS: Scabies is often overlooked in health facilities in Ghana, highlighting the need for better diagnostic capacity. The observed reduction in scabies burden with ivermectin MDA supports its use in integrated control programs for neglected tropical diseases.