Socio-demographic characteristics of the respondents
A total of 825 (response rate of 97.6%) school-age children participated in the study. Of the total children, 53.2% (439/825) were men. Four hundred fifty-three 54.9% of the children were in the age group between 10–14 years old. The majority 81.6% (673/825) of the study subjects attended school whereas 18.4% (152/825) did not. The majority 91.3% of the respondents were Gamo ethnic group, 5.6% were Wolayta, 1.8% Amhara and the rest 1.3% others. More than half (60.1%) was a follower of Protestant Christianity followed by Orthodox Christianity (38.8%) and 1.1% others. Regarding family education, 50.0% of the mothers had no formal education, 44.2% had primary education, and 5.8% had secondary and higher educational levels. 43.9% of children’s father had no formal education, 41.1% had attended primary education and 15% had secondary and higher educational status. The majority 92.6% (764/825) of children’s mothers interviewed in this study were housewives, 5.8% were merchants, and 1.6% employed Gov’t/NGO. On the other hand, 91.6% (756/825) of the children’s father's farmer, 6.3% (52/825), and 2.1% (17/825) were Merchant and employed respectively (Table 1).
Table 1
Socio-demographic characteristics of the study subjects in Arba Minch zuria district, SNNPR, 2018; N = 825.
Socio-demographic variables Category | Number | Percent (%) |
Sex of the children | male | 439 | 53.2 |
female | 386 | 46.8 |
Age group | 5–9 years | 372 | 45.1 |
10–14 years | 453 | 54.9 |
Children attending school | Yes | 673 | 81.6 |
No | 152 | 18.4 |
Ethnicity | Gamo | 753 | 91.3 |
Wolayta | 46 | 5.6 |
Amhara | 15 | 1.8 |
Others* | 11 | 1.3 |
Religion | Protestant | 496 | 60.1 |
Orthodox | 320 | 38.8 |
Others** | 9 | 1.1 |
Family educations | Childs mother | No formal education | 412 | 50.0 |
Primary education | 365 | 44.2 |
Secondary and above | 48 | 5.8 |
Childs father | No formal education | 362 | 43.9 |
Primary education | 339 | 41.1 |
Secondary and above | 124 | 15 |
Occupational status of family | Childs mother | Housewife | 764 | 92.6 |
Merchant | 48 | 5.8 |
Employed Govt/NGO | 13 | 1.6 |
Childs father | Farmer | 756 | 91.6 |
Merchant | 52 | 6.3 |
Employed Govt/NGO | 17 | 2.1 |
Climatic zone | | Lowland | 325 | 39.4 |
Mid land | 416 | 50.4 |
High land | 84 | 10.2 |
Wealth Index | | 1 | 156 | 18.9 |
2 | 178 | 21.5 |
3 | 158 | 19.2 |
4 | 163 | 19.8 |
5 | 170 | 20.6 |
*zeyse, Gidicho, Gofa **muslim, Catholic, Hawariyat |
Prevalence of scabies among school-age children
The overall prevalence of scabies among school-age children 16.4% (135/825) [95% CI: 13.9%, 18.9%] scabies cases were identified. Out of which 45 (13.8%) [95%CI: 10.05%, 17.55%] were found in lowland, 65 (15.6%) [12.11%, 19.09%] in midland and 25 (29.8%) [95%CI: 20.019%, 39.58%] found in highland area. The prevalence of scabies among females was higher than male children, 17.1% and 15.7% respectively.
Home environment-related factors
More than three-quarters of the sample, 638/825 (77.3%) had a family size of greater than or equal to five, and only 187/825 (22.7%) had less than five family members with the mean family size of 6 and standard deviation 1.95. 80.2% (662/825) of the children share a bed with others whereas 19.8% (163/825) did not share their bed with other family members. From those families who had animals in their home, 366/825 (55.5%) of the children look animals and 294/825 (44.5%) did not deal with animals in their homes. 474/825 (57.5%), 239/825 (28.9%), and 112/825 (13.6%) of the respondents use electricity, kerosene light, and solar light in their home respectively. Majority 561 (68%) of the respondent's house was covered by an iron sheet and 264 (32%) did not. Almost all 815 (98.8%) of the family was living in a house built by soft bricks and 10 (1.2%) living in a hard brick.
The majority of 586/825 (71%) of the respondents use river/pond as a source of water for personal hygiene, 136/825 (16.5%) use pipe/tap water and the rest 103/825 (12.5%) use well/spring water in the study area. Regarding knowledge 636/825 (77.1%) of the family had good knowledge about scabies and 189/825 (22.9%) had poor knowledge. About 747 (90.5%) had a water source near their home < 30 minutes and 78 (9.5%) had a water source far away from home (Table 2).
Table 2
Home environment factors of the respondents in the study area, 2018; N = 825.
Variables Category | Frequency | Percentages |
Family size | < 5 | 187 | 22.7 |
>=5 | 638 | 77.3 |
Bed sharing | Yes | 662 | 80.2 |
No | 163 | 19.8 |
Dealing with animals | Yes | 366 | 55.5 |
No | 294 | 44.5 |
Type of light | Kerosene | 239 | 28.9 |
Solar | 112 | 13.6 |
Electricity | 474 | 57.5 |
House type iron sheet covered | Yes | 561 | 68 |
No | 264 | 32 |
Type of house built by | Soft bricks | 815 | 98.8 |
Hard bricks | 10 | 1.2 |
Source of water for personal hygiene | Pipe/tap water | 136 | 16.5 |
Well/spring | 103 | 12.5 |
River/pond | 586 | 71 |
Knowledge status | Good | 636 | 77.1 |
Poor | 189 | 22.9 |
Distance of water source from home | Near home/<=30 minute | 747 | 90.5 |
Far away from home > 30 minute | 78 | 9.5 |
Regarding personal hygiene, 85.8% (708/825) of the respondents wash their body frequently and 14.2% (117/825) had responded that they wash their body infrequently. The majority 80.2% (662/825) of the participants wash their clothes frequently, 19.8% (163/825) wash their clothes infrequently. More than three quarters 83.5% (689/825) of the respondents changed into clean clothes frequently whereas the rest 16.5% (136/825) changed clothes infrequently. 56.7% (468/825), 280/825 (34%), and 77/825 (9.3%) of the children wash their hair 1–7 days, 7–14 days, and more than 14 days respectively. 627/825 (76%) of the children share their clothes with any other person whereas 198/825 (24%) did not share their clothes. About 563 (68.2%) of the children cut their fingernails short/trimmed and 262/825 (31.8%) did not (Table 3).
Table 3
personal hygiene and sanitation characteristics of the respondents, 2018; N = 825.
Variables Category | Frequency | Percentages |
Body washing | Frequently | 708 | 85.8 |
Infrequently | 117 | 14.2 |
Washing clothes | Frequently | 662 | 80.2 |
Infrequently | 163 | 19.8 |
Changing of clothes | Frequently | 689 | 83.5 |
Infrequently | 136 | 16.5 |
Frequency of hair washing | 1–7 days | 468 | 56.7 |
7–14 days | 280 | 34 |
> 14 days | 77 | 9.3 |
Share clothes with other | Yes | 198 | 24 |
No | 627 | 76 |
Fingernails cut short/trimmed | Yes | 563 | 68.2 |
No | 262 | 31.8 |
Knowledge about scabies among children’s family
From the total respondents, 805/825 [97.6%] knew the signs and symptoms of scabies, and 78.7% knew parts of the body that are affected by scabies as finger webs, armpits, genitalia, abdomen, breast, waist and knees, 143/825 [17.3%] knew that scabies affects parts of body that are mostly covered and 33 [4%] said it affects mostly at genitalia area (Table 4).
Regarding respondent's knowledge about transmission, 545/825 [66.1%] knew scabies transmitted through skin to skin contact and infected fomites like clothing, bed linen, 213 [25.8%] through the skin to skin contact only, and 67 [8.1%] through fomites (Table 4).
Table 4
Knowledge of respondents about scabies infection in the study area, 2018; N = 825.
Variables | Categories | Frequency | % [percentage] |
Ever heard about scabies | Yes | 788 | 95.5 |
No | 37 | 4.5 |
Etiology of the disease | Parasite | 23 | 2.8% |
Germs | 246 | 29.8 |
The effect of scratching | 556 | 67.4% |
Signs and symptoms of scabies | Itchy skin rash worsens at night | 805 | 97.6 |
Don’t know | 20 | 2.4 |
Parts of the body that are affected by scabies | Finger webs, armpits, genitalia, buttocks, abdomen, breast, knees | 649 | 78.7% |
Parts that are mostly covered | 143 | 17.3% |
Mostly at genitalia | 33 | 4% |
Transmission way | Skin to skin contact and through contaminated fomites | 545 | 66.1% |
Through skin contact only | 213 | 25.8% |
Through fomites only | 67 | 8.1% |
Sufferer from scabies | All age group but mostly teenagers | 571 | 69.2 |
Teenagers only | 126 | 15.3 |
Only in a certain age groups | 128 | 15.5 |
Exchanging clothes spread scabies | Yes | 604 | 73.2 |
No | 221 | 26.8 |
Scabies be harmful to the health of the skin | Yes | 714 | 86.5 |
No | 111 | 13.5 |
Scabies patient need to be quarantined | No just need regular treatment simultaneous | 570 | 69.1 |
Just keep distant from scabies patient | 180 | 21.8 |
Need regular treatment only | 75 | 9.1 |
Ways to break the chain of scabies transmission | Disinfect fomites and give treatment | 454 | 55% |
Keep distant from scabies patient | 125 | 15.2% |
Need regular treatment only | 246 | 29.8% |
Drying mattress and pillows prevent scabies | Yes | 462 | 56% |
No | 363 | 44% |
Prevention measure for scabies | Frequent bathing and avoid physical contact with scabies patient | 439 | 53.2% |
Frequent bathing and cleanliness of clothes only | 239 | 29% |
Keep fomites from contamination only | 147 | 17.8% |
Factors associated with scabies disease
Overcrowding index more than 1.5 [AOR = 5.433, 95%CI: 2.264, 13.04] were 5 times more likely to have scabies than whose overcrowding index less than or equals to 1.5. Those children whose family member or entourage complaining of itchy skin rash in the past two weeks [AOR = 6.99, 95%CI: 2.81, 17.406] were 7 times high risk of getting scabies when compared to no complaining in the family about itching. Families who had fourth wealth quintile (AOR = 5.542, 95%CI: 1.402, 12.91) were 5.5 times more likely to have scabies when compared to the wealth quintile highest. Children whose family had poor knowledge about scabies [AOR = 5.2, 95% CI: 2.188, 12.358] were 5 more likely to be affected by scabies disease than those whose family had good knowledge. This study also revealed that children who were living in the lowland [AOR = 0.306, 95%CI = 0.109, 0.588] 69.4% reduced risk for scabies when compared to highland whereas children who were living in midlands [AOR = 0.053, 95%CI: 0.012, 0.24] were 94.7% less prone to scabies as compared to children living in highlands.
Those children who wash their clothes infrequently were 3.5 times higher risk of getting sick by scabies when compared to those children washing their clothes frequently [AOR = 3.53, 95%CI: 1.454, 8.566]. Children who wash their body infrequently had 6 times more prone to scabies than children who frequently wash their body [AOR = 6.321, 95%CI: 2.312, 17.284]. This study identified that children who share their clothes with others were 6 times more likely to develop scabies than children who did not share clothes [AOR = 6.013, 95%CI: 2.51, 14.4].
This study identified that children who had a history of contact were 10 times more prone to scabies than those who did not have contact history(AOR = 9.579, 95% CI: 4.03, 17.22). Those children who wash their hair 7–14 days and > 14 days (AOR = 7.118, 95%CI: 2.63, 19.268) (AOR = 5.11, 95%CI: 1.38, 18.899) were 7 and 5 times more likely to be affected than those children who wash hair 1–7 days respectively. Children who did not cut their finger short/trimmed were 7.6 times more prone to scabies when compared to children who cut short/trimmed (AOR = 7.6, 95%CI: 3.169, 18.245) (Table 5).
Table 5
Multivariable logistic regression analysis of factors associated with scabies among school-age children in Arba Minch zuria district, 2018; N = 825.
Variables | Categories | Scabies | COR [95% CI] | AOR [95%CI] |
Yes | No | Total |
Overcrowding Index | <=1.5 | 42[8.1%] | 476[91.9%] | 518 | 1 | |
> 1.5 | 93[30.3%] | 214[69.7%] | 307 | 4.925[3.306, 7.336] | 5.433[2.264,13.04]*** |
Fingernails cut short/trimmed | Yes | 24[4.3%] | 539[95.7%] | 563 | 1 | |
No | 111[42.4%] | 151[57.6%] | 262 | 16.509[10.249, 26.592] | 7.6[3.169, 18.245]* |
Family member/entourage complaining of itching in the past two weeks | Yes | 83[45.4%] | 100[54.6%] | 183 | 9.417[6.273, 14.138] | 6.99[2.81,17.406]*** |
No | 52[8.1%] | 590[91.9%] | 642 | 1 | |
Knowledge status | Good knowledge | 48[17.5%] | 588[92.5%] | 636 | 1 | |
Poor knowledge | 87[46%] | 102[54%] | 189 | 10.449[6.932, 15.749] | 5.20[2.188,12.358]*** |
Have you infected by scabies before? | Yes | 24[50%] | 24[50%] | 48 | 6[3.292, 10.937] | 0.921[0.17, 2.314] |
No | 111[14.3%] | 666[85.7%] | 777 | 1 | |
Climatic zone | Lowland | 45[13.8%] | 280[86.2%] | 325 | 0.379[0.216, 0.667] | 0.306[0.109, 0.588]** |
Midland | 65[15.6%] | 351[84.4%] | 416 | 0.437[0.255, 0.748] | 0.053[0.012, 0.24]*** |
Highland | 25[29.8%] | 59[70.2%] | 84 | 1 | 1 |
Sharing of bed with others | Yes | 122[18.5%] | 540[81.6%] | 662 | 2.607[1.431, 4.749] | 0.954[0.251, 3.635] |
No | 13[7.9%] | 150[92%] | 163 | 1 | 1 |
How often did the child change clean clothes | Frequently | 77[11.5%] | 590[88.5%] | 712 | 1 | 1 |
Infrequently | 58[36.7%] | 100[63.3%] | 113 | 4.444[2.975, 6.639] | 0.567[0.174, 1.849] |
How often did you wash your clothes | Frequently | 43[6.5%] | 619[93.5] | 662 | 1 | |
Infrequently | 92[56.4%] | 71[43.6%] | 163 | 18.653[12.043, 28.890] | 3.53[1.454, 8.566]* |
How often did you wash your body | Frequently | 61[8.6%] | 647[91.4%] | 708 | 1 | |
Infrequently | 74[63.2%] | 43[36.8%] | 117 | 18.253[11.541, 28.869] | 6.321[2.312,17.284]** |
Sharing of clothes | No | 33[5.1%] | 608[94.9%] | 641 | 1 | 1 |
Yes | 102[55.4%] | 82[44.6%] | 184 | 22.918[14.537, 36.131] | 6.013[2.51, 14.4]*** |
Distance to fetch water | Near home | 100[13.4%] | 647[86.6%] | 747 | 1 | 1 |
Far away | 35[44.9%] | 43[55.1%] | 78 | 5.266[3.215, 8.626] | 3.106[0.674, 14.313] |
History of contact with scabies patient | No | 18[3.1%] | 561[96.9%] | 579 | 1 | 1 |
Yes | 117[47.6%] | 129[52.4%] | 246 | 28.267[13.307, 48.114] | 9.579[4.03, 17.22]*** |
How often did you wash hair | 1–7 day | 17[3.6%] | 451[65.4%] | 468 | 1 | 1 |
7–14 day | 81[28.9%] | 199[71.1%] | 280 | 10.798[6.237, 18.694] | 7.118[2.63, 19.268]** |
> 14 day | 37[48.1%] | 40[51.9%] | 77 | 24.54[12.695, 47.434] | 5.11[1.38, 18.899]** |
Wealth Index | 1 | 27[17.3%] | 129[82.7%] | 156 | 1.408[0.765, 2.592] | 0.571[0.146, 2.237] |
2 | 23[12.9%] | 155[87.1%] | 178 | 0.998[0.534, 1.868] | 2.01[0.457, 8.87] |
3 | 25[15.8%] | 133[84.2%] | 158 | 1.265[0.681, 2.348] | 1.48[0.36, 6.072] |
4 | 38[23.3%] | 125[76.7%] | 163 | 2.045[1.149, 3.64] | 5.542[1.402, 12.9]* |
5 | 22[12.9%] | 148[87.1%] | 170 | 1 | 1 |
P < 0.05* p < 0.01** p < 0.001*; COR means crude odds ratios to see association between the explanatory variable with the outcome variable; AOR means adjusted odds ration which means looking association of the variable with the outcome variable after adjusting other confounding variables. |