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Abstract

Background:

Scabies is one of the major neglected tropical diseases among children in deprived communities. Studies conducted among schoolchildren in Africa are limited and inconsistent. Thus, the aim of this study is to estimate the pooled magnitude and predictors of scabies in African schoolchildren.

Methods:

The pooled prevalence estimate with 95% confidence intervals was performed using a random-effects model. Heterogeneity between studies was assessed using the I² statistic. Subgroup analyses and sensitivity analyses were performed to explore potential sources of heterogeneity. Publication bias was evaluated using the funnel plot, Begg’s, and Egger’s tests.

Results:

A total of 28,482 subjects from 19 studies were included. The pooled prevalence of scabies among African schoolchildren was 10.81% (2459/28482) with (95% CI: 7.10–14.51). Factors such as being male (aOR = 1.86; 95% CI: 0.72–3.01), children who have a history of sharing clothes with their family (aOR = 1.76; 95% CI: 0.62–2.91), having illiterate parents (aOR = 0.96; 95% CI: 0.51–1.41), having history of contact with skin itching cases/scabies (aOR = 3.37; 95% CI: 1.70–5.03), infrequent cloth wash (aOR = 5.30; 95% CI: 1.26–9.34), sharing common sleeping beds/fomites (aOR = 2.13; 95% CI: 0.04–4.22), family member with itchy signs/scabies (aOR = 5.83; 95% CI: 1.45–10.21), and not taking a bath with water and soap (aOR = 8.51; 95% CI: −4.14 to 21.15) were factors associated significantly with scabies.

PROSPERO registration:

CRD42024542762.

Conclusion:

In the present scenario, scabies ranges from 2.0% to 17.80% and is higher in Cameroon. Therefore, policymakers and health planners should put a great deal of emphasis on the implementation of relevant prevention and control measures.

Keywords

Child scabies skin diseases neglected diseases parasites mites schools Africa

Introduction

Human scabies is a parasitic skin infection caused by tiny mites called Sarcoptes scabiei var. hominis that burrow into the skin and cause itching and a rash.^1,2 Scabies can cause rashes on different parts of the body, with the specific areas affected varying depending on a person’s age.^2–5 Scabies is a prevalent skin disease that affects a large number of people globally but is most common in developing nations and tropical regions, impacting individuals of all ages, from babies to the elderly. Children and older people in resource-poor areas and tropical countries with high population density are at increased risk.

Symptoms of scabies infestations include superficial burrows, severe itching, which worsens during the night, and a widespread rash that can cover a large part of the body or be contained to specific areas like finger webspaces, the wrist, elbow, armpit, penis, nipple, waist, and buttocks.⁶ Bacterial superinfection is common in scabies skin lesions and, if left untreated, it can lead to infection of deep structures, septicemia, rheumatic fever, and renal failure.⁷ Moreover, scabies causes intense itchiness in school kids, which can create significant emotional and health challenges like feelings of embarrassment, exclusion, fatigue, school absenteeism, loss of performance at school, lack of concentration or memory, intellectual disability, bipolar disorder, trouble focusing, and sleep disturbances.^8,9 Scabies and its associated problems have a substantial financial impact on individuals, families, communities, and healthcare systems.^10,11

Globally, over 200 million people are affected, with a prevalence ranging from 0.2% to 71.4%.¹² Reports from schools in Malaysia,¹³ Turkey,¹⁴ and Thailand¹⁵ yielded a prevalence of 31%, 33%, and 87.3%, respectively, and 61%–62% in Bangladesh.¹⁶ Several pieces of evidence from the literature show that the prevalence of scabies in African countries is persistently high. Scabies research carried out at schools showed 4% in Mali,¹⁷ 0.7% in Malawi,¹⁷ and 8.3% in Kenya.¹⁸ Moreover, the prevalence of scabies is 5.2% in Guinea-Bissau,¹⁹ 15.9% in Gambia,²⁰ 2.9% up to 65% in Nigeria,^21,22 and 2.5% to 78.4% in Ethiopia.^23,24

Epidemiological studies have shown the associated factors with the prevalence of scabies infestations are poor hygiene, poverty, overcrowded living conditions, family history of scabies, sharing beds or clothes, younger age, male sex, big families, lack of knowledge about scabies, parent illiteracy, low household income, residency in rural areas, the existence of livestock or rodents at home, seasonal conditions, and movement to contaminated areas.^25,26 In Africa, scabies is driven by events like flooding, drought, civil war and conflict, poor water supply and sanitation, and overcrowding living conditions.²⁷

Africa’s unique geographical location, climate, and cultural features create ideal conditions for various parasites to thrive.²⁸ Understanding the burden and distribution of scabies is crucial for developing effective prevention strategies. In recent years, there has been a rise in research on scabies epidemiology, with a meta-analysis in Ethiopia revealing a prevalence of 14.5%.²⁹ However, no systematic review specifically focusing on the prevalence of scabies among schoolchildren in Africa has been carried out. To address this gap, the current study aims to analyze existing data to provide up-to-date and reliable estimates that can inform prevention and control measures across the continent.

Methods

Design and protocol registration

This systematic review and meta-analysis was designed to estimate the continental pooled prevalence of scabies among schoolchildren in Africa. The result was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline³⁰ (see Supplemental File 1). The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024542762.

Search strategy

Five databases (PubMed (Medline), Google Scholar, Scopus, Science Direct, and African Journals Online) were used to retrieve published and unpublished works. Language and time restrictions were not taken during the search for studies, and all published and unpublished studies up to June 2024 were included. We looked through reference lists of articles to find studies that were not accessed in online databases. We searched studies using different terms alone or together, using words like “OR” or “AND.” The search keywords used were “prevalence,” “associated factors,” “contributing factors,” “predictors,” “Sarcoptes scabiei,” “scabies,” “child,” “schoolchildren,” “children,” “Africa,” “Nigeria,” “Ethiopia,” “Egypt,” “Democratic Republic of the Congo (DRC),” “Tanzania,” “South Africa,” “Kenya,” “Uganda,” “Sudan,” “Algeria,” “Morocco,” “Angola,” “Ghana,” “Mozambique,” “Madagascar.” “Côte d’Ivoire,” “Cameroon,” “Niger,” “Mali,” “Burkina Faso,” “Malawi,” “Zambia,” “Chad,” “Somalia,” “Senegal,” “Zimbabwe,” “Guinea,” “ Rwanda,” “Benin,” “ Burundi,” “Tunisia,” “South Sudan,” “Togo,” “Sierra Leone,” “Libya,” “Congo,” “Central African Republic,” “Liberia,” “Mauritania,” “Eritrea,” “Gambia,” “Botswana,” “Namibia,” “Gabon,” “Lesotho,” “Guinea-Bissau,” “Equatorial Guinea,” “Mauritius,” “Eswatini,” “Djibouti,” “Comoros,” “Cabo Verde,” “Sao Tome and Principe,” and “Seychelles,”

Inclusion and exclusion criteria

To determine which articles to include in this study, we considered a specific set of criteria: (1) observational findings; (2) studied in Africa and reported the prevalence or magnitude of scabies among schoolchildren; and (3) published from 24 February 2015 to 1 June 2024. The exclusion criteria include (1) reviews and case reports; (2) confusing or unclear analysis results; (3) studies out of scope (schoolchildren); (4) studies reporting other skin diseases; and (5) inaccessible works.

Study selection and quality appraisal

All retrieved articles were imported into EndNote X8 (Thomson Reuters, USA). After excluding duplications, the titles and/or abstracts of articles were independently screened by two authors (IA and KT). The authors resolved their dispute by talking it out with AG. A full-text appraisal was conducted on articles that met our research question’s criteria and were considered sufficiently valid. JBI critical appraisal checklist for simple prevalence,³¹ case-control,³² and randomized controlled clinical trials (RCTs)³³ studies were used for quality appraisal using 9, 10, and 13 criteria, respectively. For each question, a score was assigned (yes “for reported,” no for “not reported” or “not applicable,” unclear for “confused reports”); the scores were summarized across the items to achieve a total score of 0–9, 0–10, and 0–13 for simple prevalence, case–control, and RCT studies, respectively. Based on the points they received, the studies were sorted into low, medium, and high-quality categories. Only articles classified as medium or high quality were considered in the meta-analysis (see Supplemental File 2).

Data extraction

Data from studies meeting the necessary criteria were extracted and recorded in an Excel spreadsheet. Information such as the name of the first author, publication year, country, study area (setting), study design, sampling method, sample size, cases, prevalence, and response rate were extracted from the eligible studies (Table 1).

Table 1.

Detailed characteristics of eligible studies.

Author	Year	Country	Study area	Study design	Sampling method	Sample size	Cases	Prevalence (%)	Response rate (%)
El-Moselhy et al.	2015³⁶	Egypt	Al-Marg region	CS	Simple random	1987	67	3.4	—
Hegab et al.	2015³⁷	Egypt	Kafr El-Sheikh	CS	Simple random	2104	92	4.4	—
Kouotou et al.	2016³⁸	Cameroon	Cameroonian boarding schools	CS	Convenient	1902	338	17.8	—
El-Sherbiny et al.	2017³⁹	Egypt	Fayoum and Sinuris	CS	Systematic random	5186	197	3.8	—
Lulu et al.	2017⁴⁰	Ethiopia	Illubabor	CS	Systematic random	828	115	13.9	100
Walker et al.	2017⁴¹	Ethiopia	Yirgacheffe	CS	Systematic random	343	19	5.5	—
Roger and Ngatu	2018⁴²	DRC	Kinsenso	CS	Simple random	2204	75	3.4	—
Dagne et al.	2019⁴³	Ethiopia	Dabat	CS	Simple random	494	46	9.3	91.84
Ejigu et al.	2019⁴⁴	Ethiopia	Damboya	UCC	Systematic random	711	237	33.3	98
Kaburi et al.	2019⁴⁵	Ghana	Accra	CS	Simple random	823	92	11.2	—
Birjandi et al.	2019⁴⁶	Ghana	Accra	CS	Convenient	2766	286	10.3	—
Reta et al.	2020⁴⁷	Ethiopia	Habru	UCC	Systematic random	300	100	33.3	—
Tefera et al.	2020⁴⁸	Ethiopia	Raya Alamata	CS	Simple random	495	64	12.93	100
Amare and Lindtjorn	2021⁴⁹	Ethiopia	Wonago	CS	Simple random	864	46	5.3	—
Emeka	2021⁵⁰	Nigeria	Anambra	CS	Simple random	5000	500	10.00	—
Fatimata et al.	2021⁵¹	Senegal	Dakar	RCT	Systematic random	959	70	7.29	—
Walle and Ferede	2023⁵²	Ethiopia	Gondar	CS	Simple random	622	55	8.8	98
Hassen et al.	2023⁵³	Ethiopia	Goro Gutu	CS	Simple random	447	51	11.4	97
Joseph et al.	2024⁵⁴	Tanzania	Rufiji district	CS	Simple random	447	9	2.0	99

DRC: democratic republic of the Congo; CS: cross-sectional; UCC: unmatched case-control; RCT: randomized controlled trial.

Data analysis

For this meta-analysis, the study utilized STATA version 14 software (StataCorp LLC, College Station, Texas, USA). A random effects model was employed to determine the overall prevalence of scabies, with a 95% confidence interval (CI). The I² statistics were utilized to gauge the level of heterogeneity among the collected data. A value of 25, 50, or 75 for I² signifies low, moderate, or high heterogeneity, respectively.³⁴ Additional examinations were conducted, such as subgroup and sensitivity analyses, to identify potential sources of heterogeneity. To evaluate publication bias within the collected articles, a funnel plot, and Begg’s and Egger’s tests were used. A p-value of less than 0.05 in Begg’s and Egger’s tests indicates a statistically significant presence of publication bias.³⁵

Results

Selection of studies

The selection process of this study is shown in Figure 1. A total of 1274 articles were retrieved from the five electronic databases. The first 365 articles were removed due to duplicates. Then, 525 articles were excluded after evaluating the title and/or abstract. Another 178 studies were excluded after the full text evaluation. Furthermore, a total of 187 articles were removed due to review articles (n = 20); qualitative studies (n = 23); other skin diseases among schoolchildren (n = 65); out-of-schoolchildren studies (n = 74); and correspondence, proceedings, and letters to the editor (n = 5). In the end, a total of 19 articles were identified as meeting the necessary requirements and were subsequently incorporated into the systematic review and meta-analysis.

Figure 1.

Flow diagram summarizing the selection of eligible studies.

Characteristics of included studies

The detailed characteristics of the included studies are summarized in Table 1. The 19 eligible studies were studied in 8 countries. Ethiopia had the highest number of eligible studies (9), followed by Egypt (three studies). Ghana has two studies, and one study was conducted in Nigeria, Senegal, Cameroon, the Democratic Republic of the Congo (DRC), and Tanzania. Sixteen studies were cross-sectional, two were case-controls, and the remaining one was a randomized clinical trial. All studies are school-based, and a total of 28,482 children were involved. The sample size among schoolchildren in the included studies ranged from 300 to 5186.

Pooled prevalence of scabies

The pooled prevalence of scabies among schoolchildren in Africa is 10.81% (95% CI: 7.10–14.51), obtained from 2459 scabies-infested schoolchildren. Substantial heterogeneity was observed in the studies (I² = 94.7%, p < 0.001) (Figure 2).

Figure 2.

Forest plot displaying the pooled magnitude of scabies among schoolchildren in Africa.

Subgroup analysis

A subgroup analysis was conducted due to notable heterogeneity within the data, and the results are shown in Table 2 and in Supplemental File 3. The pooled prevalence of scabies among studies conducted using sample sizes of less than 900 (13.25%; 95% CI: 7.72–18.78) was higher than >900 sample sizes (6.96%; 95% CI: 3.91–10.01). Among African countries, Cameroon had the highest prevalence (17.80%; 95% CI: 12.00–23.60), followed by Ethiopia (14.79%; 95% CI: 8.23–21.34), Ghana (11.01%; 95% CI: 7.45–14.58), Nigeria (10.00%; 95% CI: 2.30–17.70), Senegal (7.29%; 95% CI: 4.14–15.19), Egypt (3.83%; 95% CI: 1.45–6.20), and the DRC (3.40%; 95% CI: −0.65 to 7.45). While the lowest prevalence was observed in Tanzania at 2.00% (95% CI: −0.60 to 4.60). A high overall estimate was observed in case–control studies (33.30%; 95% CI: 30.26–36.34) as compared to cross-sectional studies (7.77%; 95% CI: 5.75–9.78) and randomized clinical trial studies (7.29%; 95% CI: 4.14–10.44). The pooled prevalence estimate of scabies was greater in studies using the systematic random sampling method (16.12%; 95% CI: 5.85–26.38) than in studies utilizing the convenient (14.54%; 95% CI: 7.25–21.82) and simple random sampling methods at 7.05% (95% CI: 4.76–9.34). The pooled prevalence of scabies increases from 6.98% (95% CI: 3.69–10.27) during the period between 2015 and 2018 to 12.90% (95% CI: 7.41–18.39) in the next 6 years (2019–2023). Overall, 19 studies are included in this systematic review and meta-analysis with a total sample size of 28482.

Table 2.

Subgroup analysis on the pooled prevalence of scabies among schoolchildren in Africa.

Variables	Characteristics	Included studies	Sample size	Prevalence (95% CI)	I², p–value
Sample size	<900	11	22555	13.25 (95% CI: 7.72–18.78)	94.7, P<0.001
Sample size	>900	8	5927	6.96 (95% CI: 3. 91–10.01)	70.3, P=0.001
Country	Ethiopia	9	5104	14.79 (95% CI: 8.23–21.34)	97.0, P<0.001
	Egypt	3	9277	3.83 (95% CI: 1.45–6.20)	0.0, P=0.949
	Ghana	2	3589	11.01 (95% CI: 7.45–14.58)	0.0, P=0.841
	DRC	1	2204	3.40 (95% CI: −0.65 to 7.45)	0.0, P−
	Nigeria	1	5000	10.00 (95% CI: 2.30–17.70)	0.0, P−
	Cameroon	1	1902	17.80 (95% CI: 12.00–23.60)	0.0, P−
	Senegal	1	959	7.29 (95% CI: 4.14–10.44)	0.0, P−
	Tanzania	1	447	2.00 (95% CI: −0.60 to 4.60)	0.0, P−
Study design	CS	16	26512	7.77 (95% CI: 5.75–9.78)	77.1, P<0.001
	UCC	2	1011	33.30 (95% CI: 30.26–36.34)	0.0, P=1.000
	RCT	1	959	7.29 (95% CI: 4.14–10.44)	0.0, P−
Sampling method	Systematic random	6	8327	16.12 (95% CI: 5.85–26.38)	98.0, P<0.001
	Simple random	11	15487	7.05 (95% CI: 4.76–9.34)	75.2, P<0.001
	Convenient	2	4668	14.54 (95% CI: 7.25–21.82)	55.9, P=0.132
Publication year	2015–2018	7	14554	6.98 (95% CI: 3.69–10.27)	79.3, P<0.001
Publication year	2019–2024	12	13928	12.90 (95% CI: 7.41–18.39)	94.7, P<0.001
	Overall	19	28482	10.81% (95% CI: 7.10–14.51)	94.7, P<0.001

DRC: democratic republic of the Congo; CS: cross-sectional; UCC: unmatched case-control; RCT: randomized controlled trial.

Quality assessment and publication bias

Details on the quality assessment of each study are found in Supplemental File 2. Briefly, 100% of the included studies were of high quality (low risk of bias). Publication bias was apparent in the included studies since the funnel plot showed asymmetry (Figure 3(a)). In the same way, both Begg and Egger tests, which are based on regression analysis (see Supplemental File 4), indicated that there is a significant presence of publication bias, with a p-value of 0.001. Due to the heterogeneous nature of the studies, we conducted a sensitivity analysis by excluding each study individually to evaluate how each one affected the overall effect size. In the study on scabies among African schoolchildren, the research by Ejigu et al.⁴⁴ and Reta et al.⁴⁷ played a significant role in affecting the overall outcome. The pooled estimates of 7.67 (6.83–8.51) were recorded after eliminating individual studies at a time, specifically those studies conducted by the abovementioned authors (Ejigu et al.⁴⁴ and Reta et al.⁴⁷). After completely removing those two studies, as indicated in Figure 3(b), the estimate becomes 6.65 (5.80−7.51).

Figure 3.

(a) Funnel plot representing evidence of publication bias; (b) Sensitivity analysis result of the involved studies that assessed the effect of individual studies on the overall prevalence of scabies.

Factors associated with scabies infestation among schoolchildren

In this work, parent education and family members with itchy signs or scabies were reported in 8 articles; sharing history of cloth with family in six articles; male sex and having history of contact with skin itching cases or scabies in five articles; sharing common sleeping beds/fomites in four articles; infrequent cloth washing in three articles; and avoiding bathing with soap and water in two articles were significantly associated with scabies among schoolchildren in Africa (Table 3).

Table 3.

Several factors associated with the magnitude of scabies among schoolchildren in Africa.

Variables	Number of articles	Pooled odds ratio (95% CI)	I-squared (%)	I² p-value
Male	5	1.86 (0.72, 3.01)	85.6	<0.001
Family size above 5	5	1.97 (1.10, 2.84)	15.3	0.317
Poor family wealth or income status	3	2.17 (1.53, 2.82)	0.0	0.513
Students not attend or less than grade 5	4	1.95 (1.18, 2.73)	0.0	0.397
Rural residence	3	1.82 (−0.12, 3.17)	64.5	0.060
Sharing history of cloth with family	6	1.76 (0.62, 2.91)	91.5	<0.001
No formal family education	8	0.96 (0.51, 1.41)	91.6	<0.001
Sharing clothes with scabies case	2	3.18 (1.95, 4.40)	0.0	0.433
Having history of contact with skin itching cases/scabies	5	3.37 (1.70, 5.03)	59.7	0.042
Infrequent bath	3	3.10 (1.04, 5.16)	0.0	0.623
Infrequent cloth wash	3	5.30 (1.26, 9.34)	80.5	0.006
Sharing common sleeping beds/fomites	4	2.13 (0.04, 4.22)	84.9	<0.001
Family member with itchy signs/scabies	8	5.83 (1.45, 10.21)	75.5	<0.001
Family or caregiver poor knowledge about scabies	2	4.41 (2.78, 6.03)	0.0	0.748
Having animals inside house	2	1.91 (0.65, 3.16)	67.0	0.082
Not taking a bath with water and soap	2	8.51 (-4.14, 21.15)	74.8	0.046

However, family size was reported in five articles, students not attending grade level in four articles, wealth or income status, infrequent baths, and rural residence were reported in three articles. Furthermore, sharing clothes with a scabies case, family or caregiver poor knowledge about scabies, and having animals inside the house were reported in two articles, but according to this systematic review and meta-analysis, none of these factors mentioned above was significantly associated with scabies among schoolchildren in Africa (Table 3).

Discussion

Scabies is a significant global health problem, disproportionately affecting children in developing countries, especially in Africa. The current work aimed to assess the pooled magnitude of scabies and its drivers among schoolchildren in Africa. In the current study, 19 studies with 28,482 subjects were included.

The current pooled data reveals that scabies affected 10.81% of the schoolchildren. A consistent result was reported in Nigeria (10.5%).⁵⁵ However, as compared to the current finding, a higher prevalence was reported in Australia (16.5%),⁵⁶ Malaysia (31%),¹³ Turkey (33%),¹⁴ Solomon Islands (54.3%),⁵⁷ Bangladesh (61%–62%),¹⁶ Sierra Leone (67%),⁵⁸ and Thailand (87.5%).¹⁵ Conversely, our result was higher than studies conducted in Taiwan (1.4%),⁵⁹ and Australia (8.2%).⁶⁰ These variations could be due to sociodemographic characteristics, data collection season, population of the participant in the study, sample sizes, methodology used, and economic status.

This meta-analysis revealed that children who have a history of sharing clothing with family were 1.76 times more vulnerable to scabies infestation than children who did not share their clothing with family. Previous studies also reported similar results.^37,38,61,62 This might be due to the consequences of living in impoverished conditions.

Children from families with illiterate parents in the study had scabies at a rate 0.96 times greater than those with parents who could read and write. The current result is in line with several previous studies conducted elsewhere.^{37,40,44,53,63–65} This could be explained by the fact that children from educated families have better opportunities to earn more money and better personal and environmental sanitation, in addition to better health-seeking behavior than others.⁴⁰

The other associated predictor was sharing common sleeping beds/fomites with others. Schoolchildren who shared common sleeping beds/fomites were 2.13 times more likely to be infested with scabies than their counterparts. This finding is in line with studies conducted elsewhere.^{37,38,66–69} Close contact while sleeping in the same bed with a person who has scabies might be a cause of acquiring the disease. However, previous research conducted in Ethiopia did not find a significant association between scabies and the sharing of sleeping beds or fomites.^26,70,71

Boys are almost twice as likely as girls to acquire scabies, with this gender difference being statistically significant. This finding is consistent with the studies done in the southern Ethiopia,^44,49 northern Ethiopia,^47,69 and Cameroon.³⁸ A Cameroonian boarding schools study,³⁸ reported that boys were more likely to share sleeping beds, had higher rates of close contact with individuals experiencing itching, practiced less frequent handwashing with soap, and had longer fingernails compared to girls. These factors may contribute to increased scabies infestation among boys. Additionally, close skin-to-skin contact during play, fights, or sports can facilitate scabies mite transmission in males. Conversely, the findings from studies conducted in Ghana⁴⁶ and Gambia²⁰ demonstrated a higher prevalence of scabies among females. These contrasting results highlight the potential influence of cultural and geographical factors on scabies epidemiology.

Children with a history of contact with itchy skin or scabies are 3.37 times more likely to get scabies. Additionally, children with family members with itchy signs or a history of scabies were 5.83 times more likely to have scabies. This finding is supported by several studies.^38,44,48,61 This is expected because scabies is a disease transmissible by contact. If there was a family history of scabies, the transmission rate might be high since there is a high probability of contact within the family.

In this study, infrequent cloth washing and not taking a bath with soap and water were significantly associated with scabies infestation. This finding revealed that children whose cloth was not frequently washed had a 5.30 and those who took baths only with water had an 8.51 times greater chance of being infected with scabies compared to those who frequently washed their cloth and their bodies with both water and soap. Although hygiene standards are not effective against mites and do not modify the likelihood of contracting scabies,^72,73 our study and others^{23,26,53,74,75} confirmed that scabies and poor personal hygiene are associated risk factors. Other studies do not confirm this association.^76,77

The study found differences in the prevalence of scabies in children according to country, with Cameroon having the highest prevalence (17.80%) and Tanzania having the lowest prevalence (2.0%). This difference might be due to differences in lifestyle and health-care-seeking behavior.

The pooled prevalence figure of scabies increased over time from 6.98% in 2015–2018 to 12.90% in 2019–2024. This variation could be attributed to the difference between the advancement of diagnostic tools, differences in the study season, increased accessibility to health facilities, and education and awareness of skin diseases, including scabies, which could result in a decrease in the number of scabies cases.

Strengths and limitations

The unique aspect of this systematic review and meta-analysis is that it is the first to report the pooled magnitude of scabies in African schoolchildren. Furthermore, the pooled risk factors associated with scabies infestation were identified. However, this review has its own limitations. Variations in data collection methods and sample sizes across various studies could be the reason for the observed heterogeneity in the current review. In general, this study did not consider all countries in Africa due to the lack of availability of articles; therefore, the estimate may not fully represent the continent’s prevalence of scabies infestation.

Conclusion

The pooled prevalence of scabies among the published studies included, increased from 6.98% during 2015−2018 to 12.90% between 2019 and 2023. Regardless of the cause, the increase in scabies prevalence has the potential to negatively impact the health and well-being of schoolchildren. Policymakers and health planners should put a great deal of emphasis on the implementation of relevant prevention and control measures. Further in this population, extensive research is needed across different African countries to understand the nature, dynamics, and risk factors associated with scabies.

Supplemental Material

sj-docx-1-smo-10.1177_20503121241274757 – Supplemental material for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis

Supplemental material, sj-docx-1-smo-10.1177_20503121241274757 for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis by Abayeneh Girma, Indiris Abdu and Kasaye Teshome in SAGE Open Medicine

Supplemental Material

sj-docx-2-smo-10.1177_20503121241274757 – Supplemental material for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis

Supplemental material, sj-docx-2-smo-10.1177_20503121241274757 for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis by Abayeneh Girma, Indiris Abdu and Kasaye Teshome in SAGE Open Medicine

Supplemental Material

sj-docx-3-smo-10.1177_20503121241274757 – Supplemental material for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis

Supplemental material, sj-docx-3-smo-10.1177_20503121241274757 for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis by Abayeneh Girma, Indiris Abdu and Kasaye Teshome in SAGE Open Medicine

Supplemental Material

sj-docx-4-smo-10.1177_20503121241274757 – Supplemental material for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis

Supplemental material, sj-docx-4-smo-10.1177_20503121241274757 for Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis by Abayeneh Girma, Indiris Abdu and Kasaye Teshome in SAGE Open Medicine

Footnotes

Acknowledgements

None.

Author contributions

AG, IA, KT were actively engaged in conceptualization, resources, data curation, methodology, software, formal analysis, investigation, validation, visualization, and supervision, writing—original draft and writing—review and editing. All authors read and approved the final version of the manuscript.

Availability of data and materials

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Abayeneh Girma

Supplemental material

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References

Heukelbach

Walton

Feldmeier

Ectoparasitic infestations. Current infectious disease reports 2005; 7: 373-380.

Stamm

Strowd

LC.

Ignoring the “Itch”: the global health problem of scabies. The American journal of tropical medicine and hygiene 2017; 97: 1647.

Jackson

Heukelbach

Filho

AFdS

, et al. Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil. Tropical Medicine & International Health 2007; 12: 493-502.

Currie

Kemp

Walton

, et al. Scabies: more than just an irritation. 2004.

Johnston

Sladden

Scabies: diagnosis and treatment. Bmj 2005; 331: 619-622.

Yotsu

Yoshizumi

Izri

Biology of Sarcoptes scabiei and Its Relevance to Human Scabies: Clinical Symptoms, Treatment, and Management. Scabies. Springer, 2023, pp.19-34.

Hay

Steer

Engelman

, et al. Scabies in the developing world–-its prevalence, complications, and management. Clinical microbiology and infection 2012; 18: 313-323.

Al-Dabbagh1a

Younis

Sliman

The differential diagnoses and complications of scabies variants. 2023.

Jannic

Bernigaud

Brenaut

, et al. Scabies itch. Dermatologic clinics 2018; 36: 301-308.

10.

Hay

Castanon

Hernandez

, et al. Wastage of family income on skin disease in Mexico. BMJ 1994; 309: 848.

11.

Verma

Srivastava

Measurement of the personal cost of illness due to some major water-related diseases in an Indian rural population. International journal of epidemiology 1990; 19: 169-176.

12.

Romani

Steer

Whitfeld

, et al. Prevalence of scabies and impetigo worldwide: a systematic review. The Lancet infectious diseases 2015; 15: 960-967.

13.

Zayyid

Saadah

Adil

, et al. Prevalence of scabies and head lice among children in a welfare home in Pulau Pinang, Malaysia. Tropical biomedicine 2010; 27: 442-446.

14.

Öztürkcan

Özçelik

Saygi

Spread of scabies and pediculus humanus among the children at Sivas orphanage. Indian pediatrics 1994; 31: 210-213.

15.

Pruksachatkunakorn

Wongthanee

Kasiwat

Scabies in Thai orphanages. Pediatrics international 2003; 45: 719-723.

16.

Talukder

Farooque

, et al. Controlling scabies in madrasahs (Islamic religious schools) in Bangladesh. Public health 2013; 127: 83-91.

17.

Landwehr

Keita

Pönnighaus

, et al. Epidemiologic aspects of scabies in Mali, Malawi, and Cambodia. International Journal of Dermatology 1998; 37: 588-590.

18.

Schmeller

Dzikus

Skin diseases in children in rural Kenya: long-term results of a dermatology project within the primary health care system. British Journal of Dermatology 2001; 144: 118-124.

19.

Marks

Sammut

Cabral

, et al. The prevalence of scabies, pyoderma and other communicable dermatoses in the Bijagos Archipelago, Guinea-Bissau. PLoS neglected tropical diseases 2019; 13: e0007820.

20.

Armitage

Senghore

Darboe

, et al. High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: A cross-sectional study. PLoS neglected tropical diseases 2019; 13: e0007801.

21.

Sambo

Idris

Umar

, et al. Prevalence of scabies among school-aged children in Katanga rural community in Kaduna state, Northwestern Nigeria. Annals of Nigerian Medicine 2012; 6: 26-26.

22.

Ugbomoiko

Oyedeji

Babamale

, et al. Scabies in resource-poor communities in Nasarawa state, Nigeria: epidemiology, clinical features and factors associated with infestation. Tropical medicine and infectious disease 2018; 3: 59.

23.

Wochebo

Haji

Asnake

Scabies outbreak investigation and risk factors in Kechabira district, Southern Ethiopia: unmatched case control study. BMC research notes 2019; 12: 1-6.

24.

Belachew

Kassie

Burden and drivers of human scabies among children and adults in northwestern Ethiopia: the case of the neglected tropical disease. International Journal of Infectious Diseases 2018; 73: 317.

25.

Nazari

Azizi

Epidemiological pattern of scabies and its social determinant factors in west of Iran. Health 2014; 2014.

26.

Sanei-Dehkordi

Soleimani-Ahmadi

Zare

, et al. Risk factors associated with scabies infestation among primary schoolchildren in a low socio-economic area in southeast of Iran. BMC pediatrics 2021; 21: 249.

27.

Balcha

Bizuneh

Hunduma

Scabies Outbreak Investigation and Its Risk Factors in Gumbichu District, East Shewa Zone, Central Ethiopia: Unmatched Case-Control Study. Journal of Clinical Rheumatology Research 2022; 2: 20-29.

28.

Girma

Genet

Magnitude and Determinants of Intestinal Parasites among Children under Five in Ethiopia During 2010–2023: A Systematic Review and Meta-Analysis. Fetal and Pediatric Pathology 2024; 43: 47-65.

29.

Azene

Aragaw

Wassie

GT.

Prevalence and associated factors of scabies in Ethiopia: systematic review and Meta-analysis. BMC infectious diseases 2020; 20: 1-10.

30.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj 2021; 372.

31.

Munn

Moola

Lisy

, et al. Systematic reviews of prevalence and incidence. Joanna Briggs Institute reviewer’s manual 2017: 5-1.

32.

Moola

Munn

Tufanaru

, et al. Chapter 7: Systematic reviews of etiology and risk. JBI manual for evidence synthesis JBI 2020; 10.

33.

Tufanaru

Munn

Aromataris

, et al. Systematic reviews of effectiveness. Joanna Briggs Institute reviewer’s manual 2017; 3.

34.

Higgins

Thompson

SG.

Quantifying heterogeneity in a meta-analysis. Statistics in medicine 2002; 21: 1539-1558.

35.

Egger

Smith

Schneider

, et al. Bias in meta-analysis detected by a simple, graphical test. Bmj 1997; 315: 629-634.

36.

El-Moselhy

Hassan

Abdelhady

, et al. Risk factors and effects of infestation with pediculosis capitis and Scabies among primary school students in Cairo, Egypt. The Egyptian Journal of Hospital Medicine 2015; 59: 191-207.

37.

Hegab

Kato

Kabbash

, et al. Scabies among primary schoolchildren in Egypt: sociomedical environmental study in Kafr El-Sheikh administrative area. Clinical, cosmetic and investigational dermatology 2015: 105-111.

38.

Kouotou

Nansseu

JRN

Kouawa

, et al. Prevalence and drivers of human scabies among children and adolescents living and studying in Cameroonian boarding schools. Parasites & vectors 2016; 9: 1-6.

39.

El Sherbiny

Abd El Raheem

Nasif

, et al. Epidemiological study of scabies in primary schools, Fayoum Governorate-Egypt. J Primary Health Care Gen Pract 2017; 1.

40.

Lulu

Tolesa

Cris

Prevalence and associated factors of skin diseases among primary school children in Illuababorzone, Oromia Regional State, South West Ethiopia. Indo Am J Pharm Res 2017; 7: 7374-7383.

41.

Walker

Lebas

De Sario

, et al. The prevalence and association with health-related quality of life of tungiasis and scabies in schoolchildren in southern Ethiopia. PLoS neglected tropical diseases 2017; 11: e0005808.

42.

Roger

Ngatu

. Frequency and Clinical Features of Sarcoptic Skin Disease (Scabies) in Congolese Schoolchildren. Occupational and Environmental Skin Disorders: Epidemiology, Current Knowledge and Perspectives for Novel Therapies 2018: 143-150.

43.

Dagne

Dessie

Destaw

, et al. Prevalence and associated factors of scabies among schoolchildren in Dabat district, northwest Ethiopia, 2018. Environmental health and preventive medicine 2019; 24: 1-8.

44.

Ejigu

Haji

Toma

, et al. Factors associated with scabies outbreaks in primary schools in Ethiopia: a case–control study. Research and reports in tropical medicine 2019: 119-127.

45.

Kaburi

Ameme

Adu-Asumah

, et al. Outbreak of scabies among preschool children, Accra, Ghana, 2017. BMC public health 2019; 19: 1-9.

46.

Birjandi

Oroei

Emadi

, et al. Scabies among high school students in Accra, Ghana: Risk factors and health literacy. Iranian Red Crescent Medical Journal 2019; 21.

47.

Reta

Derseh

Sahilu

BY.

Determinants of scabies among primary school children in Habru district: A case-control study. 2020.

48.

Tefera

Teferi

Ayalew

, et al. Prevalence of scabies and associated factors among primary school children in Raya Alamata District, Tigray, Ethiopia, 2017/2018. J Infect Dis Epidemiol 2020; 6: 154.

49.

Amare

Lindtjorn

Risk factors for scabies, tungiasis, and tinea infections among schoolchildren in southern Ethiopia: A cross-sectional Bayesian multilevel model. PLoS neglected tropical diseases 2021; 15: e0009816.

50.

Emeka

NK.

Prevalence of scabies among secondary school students in Anambra State, Nigeria. World Journal of Biology Pharmacy and Health Sciences 2021; 8: 001-007.

51.

Fatimata

Adama

Issa

, et al. Scabies in Koranic schools in Dakar, Senegal: Comparison of two therapeutic modalities. Public Health of Indonesia 2021; 7: 172-181.

52.

Walle

Ferede

AJ.

Prevalence of scabies and associated factors among Governmental Elementary School Students in Gondar town Northwest Ethiopia. Journal of Practical & Professional Nursing 2023; 7: 046. DOI: 10.24966/PPN-5681/100046.

53.

Hassen

Ame

Mummed

, et al. Magnitude and Factors Associated With Scabies Among Primary School Children in Goro Gutu Woreda, East Hararghe Zone, Ethiopia. Int J Med Parasitol Epidemiol Sci Volume 2022; 3: 84.

54.

Joseph

Mushi

Palilo

, et al. Prevalence of Sarcoptes scabiei infestation and its associated factors among primary school children: A school-based cross-sectional survey in the Rufiji district, Tanzania. IJID regions 2024; 11: 100365.

55.

Kalu

Wagbatsoma

Ogbaini-Emovon

, et al. Age and sex prevalence of infectious dermatoses among primary school children in a rural South-Eastern Nigerian community. Pan African Medical Journal 2015; 20.

56.

Tasani

Tong

Andrews

, et al. The importance of scabies coinfection in the treatment considerations for impetigo. The Pediatric infectious disease journal 2016; 35: 374-378.

57.

Osti

Sokana

Phelan

, et al. Prevalence of scabies and impetigo in the Solomon Islands: a school survey. BMC infectious diseases 2019; 19: 1-7.

58.

Terry

Kanjah

Sahr

, et al. Sarcoptes scabiei infestation among children in a displacement camp in Sierra Leone. Public health 2001; 115: 208-211.

59.

Y-H

H-Y

Hsieh

Y-J.

Survey of infectious skin diseases and skin infestations among primary school students of Taitung County, eastern Taiwan. Journal of the Formosan Medical Association= Taiwan yi zhi 2000; 99: 128-134.

60.

Yeoh

Anderson

Cleland

, et al. Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections. PLoS neglected tropical diseases 2017; 11: e0005726.

61.

Tunje

Churko

Haftu

, et al. Prevalence of scabies and its associated factors among school age children in Arba Minch zuria district, Southern Ethiopia, 2018. bioRxiv 2020: 2020.2003. 2016.993576.

62.

Kumar

Devi

Jahnavi

, et al. A study on prevalence of skin infections among School children in Hyderabad, Telangana state. International Journal of Contemporary Medical Research 2016; 3: 1862-1864.

63.

Karim

Anwar

Khan

, et al. Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh. Public health 2007; 121: 923-934.

64.

Feldmeier

Jackson

Ariza

, et al. The epidemiology of scabies in an impoverished community in rural Brazil: presence and severity of disease are associated with poor living conditions and illiteracy. Journal of the American Academy of Dermatology 2009; 60: 436-443.

65.

Stanton

Khanam

Nazrul

, et al. Scabies in urban Bangladesh. The Journal of tropical medicine and hygiene 1987; 90: 219-226.

66.

Ararsa

Merdassa

Shibiru

, et al. Prevalence of scabies and associated factors among children aged 5–14 years in Meta Robi District, Ethiopia. Plos one 2023; 18: e0277912.

67.

Yasmin

Ullah

Khan

MIU

, et al. Epidemiological study of scabies among school going children in district Haripur, Pakistan. Arthropods 2017; 6: 59-66.

68.

Misganaw

Nigatu

Gebrie

, et al. Prevalence and determinants of scabies among school-age children in Central Armachiho district, Northwest, Ethiopia. Plos one 2022; 17: e0269918.

69.

Yassin

Dadi

Nega

, et al. Scabies Outbreak Investigation among “Yekolo Temaris” in Gondar Town, North Western Ethiopia, November 2015. Electronic Journal of Biology 2017; 13: 203-209.

70.

Sara

Haji

Gebretsadik

Scabies outbreak investigation and risk factors in east Badewacho district, Southern Ethiopia: unmatched case control study. Dermatology research and practice 2018; 2018.

71.

Enbiale

Baynie

Ayalew

, et al. “Stopping the itch”: mass drug administration for scabies outbreak control covered for over nine million people in Ethiopia. The Journal of Infection in Developing Countries 2020; 14: 28S-35S.

72.

Cinotti

Perrot

Labeille

, et al. Inefficacy of alcohol-based hand rub on mites in a patient with hyperkeratotic scabies. Clinical and experimental dermatology 2015; 40: 177-181.

73.

Middleton

Cassell

Jones

, et al. Scabies control: the forgotten role of personal hygiene–Authors’ reply. The Lancet infectious diseases 2018; 18: 1068-1069.

74.

Andrews

McCarthy

Carapetis

, et al. Skin disorders, including pyoderma, scabies, and tinea infections. Pediatric Clinics 2009; 56: 1421-1440.

75.

Ahmed

Jradi

AlBuraikan

, et al. Rate and factors for scabies recurrence in children in Saudi Arabia: a retrospective study. BMC pediatrics 2019; 19: 1-6.

76.

Walton

Currie

BJ.

Problems in diagnosing scabies, a global disease in human and animal populations. Clinical microbiology reviews 2007; 20: 268-279.

77.

Kouotou

Nansseu

JRN

Sangare

, et al. Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon. Australasian Journal of Dermatology 2018; 59: e6-e10.

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