A total of 1043 children underwent skin examination. Half the participants were from semi-urban (Dili 47.7%) compared to rural sites (Ermera 34.8%; Manufahi 17.5%) (Supplementary Table 1). Where data were available, 53.8% were girls, 46.2% were boys. The median age was 10 years (interquartile range, 8-11 years, range, 8 months to 18 years). Sex and age were not recorded for 87 (8.3%) and 78 (7.5%) participants, respectively.
Table 1. Scabies prevalence, severity, and diagnostic classification by municipality and age group.
|
Study sample
n
|
Scabies cases and unweighted prevalence
n (%)
|
AOR
(95% CI)
|
Severity
|
Diagnostic Classification
|
Very mild
n (%)
|
Mild
n (%)
|
Moderate
n (%)
|
Severe
n (%)
|
Clinical scabies B3
n (%)
|
Suspected scabies C1
n (%)
|
Suspected scabies C2
n (%)
|
Sex
|
|
|
|
Male
|
442
|
156 (35.3)
|
Ref.
|
5 (3.2)
|
107 (68.6)
|
39 (25.0)
|
5 (3.2)
|
92 (59.0)
|
23 (14.7)
|
41 (26.3)
|
Female
|
514
|
167 (32.5)
|
0.9 (0.7–1.2)
|
5 (3.0)
|
111 (66.5)
|
48 (28.7)
|
3 (1.8)
|
91 (54.5)
|
32 (19.2)
|
44 (26.3)
|
Total n
|
956
|
|
|
|
|
|
|
|
|
|
Age (years)
|
|
|
|
0–4
|
25
|
13 (52.0)
|
1.1 (0.5–2.7)
|
0
|
7 (53.8)
|
6 (46.2)
|
0
|
9 (69.2)
|
2 (15.4)
|
2 (15.4)
|
5–9
|
445
|
170 (38.2)
|
Ref.
|
7 (4.1)
|
106 (46.4)
|
53 (31.2)
|
4 (2.4)
|
99 (58.2)
|
31 (18.2)
|
40 (23.5)
|
10–14
|
487
|
140 (28.7)
|
0.7* (0.5–0.9)
|
3 (2.1)
|
104 (74.3)
|
29 (20.7)
|
4 (2.9)
|
76 (54.3)
|
21 (15.0)
|
43 (30.7)
|
15–18
|
8
|
1 (12.5)
|
0.3 (0.0–2.8)
|
0
|
1 (100)
|
0
|
0
|
0
|
1 (100)
|
0
|
Total n
|
965
|
|
|
|
|
|
|
|
|
|
Municipality
|
|
|
|
Dili
|
497
|
140 (28.2)
|
Ref.
|
3 (2.1)
|
91 (65.0)
|
40 (28.6)
|
6 (4.3)
|
80 (57.1)
|
20 (14.3)
|
40 (28.6)
|
Ermera
|
363
|
110 (30.3)
|
1.1 (0.5–2.3)
|
5 (4.5)
|
74 (67.3)
|
31 (28.2)
|
0
|
58 (52.7)
|
21 (19.1)
|
31 (28.2)
|
Manufahi
|
183
|
98 (53.6)
|
3.5* (1.6–8.0)
|
5 (5.1)
|
66 (67.3)
|
24 (24.5)
|
3 (3.1)
|
60 (61.2)
|
15 (15.3)
|
23 (23.5)
|
Total
|
1043
|
348 (33.4)
|
|
13 (3.7)
|
231 (66.4)
|
95 (27.3)
|
9 (2.6)
|
198 (56.9)
|
56 (16.1)
|
94 (27.0)
|
NB. Discrepancy for sex, age, and overall totals exist because of missing demographic data. AOR: adjusted odds ratio; CI: confidence interval; ref: reference category; * denotes significance at p<.05; B3: typical scabies lesions in a typical distribution and two history features consistent with clinical scabies; C1: typical scabies lesions in a typical distribution and one history feature consistent with suspected scabies; C2: atypical scabies lesions or atypical distribution and two history features consistent with suspected scabies.
Scabies
The weighted prevalence of scabies, adjusted for population sex and age, was 30.6% (95% CI 23.0–39.4). The unweighted prevalence was 33.4% (95% CI 30.6–36.3) (Table 1). Children aged 10 to 14 years were less likely to have scabies than 5 to 9 year olds (AOR 0.70, 95% CI 0.52–0.93, p=0.01). There was no significant difference in prevalence across other age or sex groups. The odds of scabies infection were 3.5 times greater in Manufahi compared to Dili (53.6% [95% CI 46.3-60.7] vs. 28.2% [95% CI 24.4–32.3], AOR 3.5, 95% CI 1.6–8.0, p=0.02). There were no detectable significant differences in odds of scabies between Ermera and Dili (30.3% vs. 28.2%, AOR 1.1, 95% CI 0.5–2.3, p=0.9). Most diagnosed scabies cases were of mild (66.4%) or moderate (27.3%) severity. More cases met clinical scabies criteria (56.7%) than suspected scabies (43.3%). No cases of crusted scabies were identified.
More than one-quarter of participants reported a household member (35.9%) or close contact (25.2%) with itch. Scabies was 18 times more likely in children who reported a household member or close contact with an itch (88.3%, AOR 18.2, 95% CI 10.7–31.2, p<0.001) compared to those with no household member or close contact with an itch. Fewer participants reported a household member (27.6%) or close contact (15.1%) with a rash similar to the appearance of scabies. The odds of scabies was not significantly associated with having a positive contact history with a typical rash (70.8%, AOR 1.4, 95% CI 0.8–2.3, p=0.14) compared to children without a positive contact history with a rash.
Most participants with scabies had lesions on more than one body region (64.7%), and lesions were most frequently located on the arms (54.2%) and legs (40.2%) (Table 2).
Table 2. Frequency of scabies-infested body region by age group.
|
Age (years)
|
|
|
0 – 2
n (%)
|
3 – 4
n (%)
|
5 – 9
n (%)
|
10 – 14
n (%)
|
15 – 18
n (%)
|
Total
n (%)
|
Body region
|
|
|
|
|
|
Arms
|
5 (45.5)
|
9 (45.0)
|
204 (53.1)
|
172 (56.6)
|
1 (50.0)
|
391 (54.2)
|
Legs
|
4 (36.4)
|
9 (45.0)
|
155 (40.4)
|
121 (39.8)
|
1 (50.0)
|
290 (40.2)
|
Face
|
2 (18.2)
|
2 (10.0)
|
19 (4.9)
|
10 (3.3)
|
0
|
33 (4.6)
|
Abdomen
|
0
|
0
|
6 (1.6)
|
1 (0.3)
|
0
|
7 (1.0)
|
NB. Most participants (64.7%) had scabies lesions on >1 body region. The 0 to 2 year old age group has been distinguished because typical distribution diagnostic criteria differs amongst infants 2 years old and younger12
|
Impetigo
The overall age and sex weighted prevalence of impetigo was 11.3% (95% CI 7.7–16.5). The unweighted prevalence was 12.5% (95% CI 10.6–14.6) (Table 3). There was no significant difference between sex and age groups. Relative to Dili, children were nearly twice as likely to have impetigo in the rural municipalities of Ermera (14.9% [95% CI 11.6–18.9] vs. 8.7% [95% CI 6.5–11.5], AOR 1.9, 95% CI 1.2–3.0, p=0.004) and Manufahi (18.0% [95% CI 13.1–24.3] vs. 8.7%, AOR 2.2, 95% CI 1.3–3.7, p=0.003). Of those with impetigo, 93.1% had very mild cases (less than 5 lesions). Impetigo was two times more likely in children who reported a household member or close contact with an itch (56.8%, AOR 1.9, 95% CI 1.1–3.5, p=0.03) compared to those with no household member or close contact with an itch. However, the odds of impetigo was not significantly associated with having a positive contact history with a typical rash (42.5%, AOR 0.9, 95% CI 0.5–1.6, p=0.64).
The prevalence of impetigo was twice as high in participants with scabies than those without (63/348, 18.1% [95% CI 14.4–22.5] vs. 67/695, 9.6% [95% CI 7.7–12.1], AOR 2.0, 95% CI 1.3–3.0, p=0.001), corresponding to a PAR of scabies as a cause of impetigo of 22.7% (95% CI 10.9–32.9).
Table 3. Impetigo prevalence and severity by municipality and age group.
|
Study sample
n
|
Impetigo cases and unweighted prevalence
n (%)
|
AOR
(95% CI)
|
Severity
|
Very mild
n (%)
|
Mild
n (%)
|
Moderate
n (%)
|
Severe
n (%)
|
Sex
|
|
|
|
|
|
|
|
Male
|
442
|
65 (14.7)
|
Ref.
|
59 (90.8)
|
5 (7.7)
|
1 (1.5)
|
0
|
Female
|
514
|
56 (10.9)
|
0.7 (0.5–1.1)
|
53 (94.6)
|
3 (5.4)
|
0
|
0
|
Total
|
956
|
|
|
|
|
|
|
Age (years)
|
|
|
|
|
|
|
|
0 – 4
|
25
|
7 (28.0)
|
2.0 (0.8–5.1)
|
6 (85.7)
|
1 (14.3)
|
0
|
0
|
5 – 9
|
445
|
58 (13.0)
|
Ref.
|
54 (93.1)
|
3 (5.2)
|
1 (1.7)
|
0
|
10 – 14
|
487
|
56 (11.5)
|
0.9 (0.6–1.4)
|
52 (92.9)
|
4 (7.1)
|
0
|
0
|
15 – 18
|
8
|
1 (12.5)
|
0.8 (0.1–6.9)
|
1 (100)
|
0
|
0
|
0
|
Total
|
965
|
|
|
|
|
|
|
Municipality
|
Dili
|
497
|
43 (8.7)
|
Ref.
|
40 (93.0)
|
3 (7.0)
|
0
|
0
|
Ermera
|
363
|
54 (14.9)
|
1.9* (1.2–3.0)
|
53 (98.1)
|
1 (1.9)
|
0
|
0
|
Manufahi
|
183
|
33 (18.0)
|
2.2* (1.3–3.7)
|
28 (84.8)
|
4 (12.1)
|
1 (3.0)
|
0
|
Total
|
1043
|
130 (12.5)
|
|
121 (93.1)
|
8 (6.2)
|
1 (0.8)
|
0
|
NB. AOR: adjusted odds ratio; CI: confidence interval; ref: reference category; * denotes significance at p<.05.
|
There was no evidence of multicollinearity on all regression analyses performed.