Volume 10 Issue 1

Official Journals By StatPerson Publication

Table of Content - Volume 10 Issue 1 - April 2019

Incidence and sociodemographic profile of scabies in paediatric patients attending secondary health care hospital

Balasaheb Bapurao Suroshe¹, Kishor G Rathod^2*

^1,2Assistant Professor, Department of Pediatrics, Government Medical College, Jalgaon, Maharashtra, INDIA.

Email: balasaheb.suroshe@gmail.com

Abstract Background: Scabies is essentially a disease of children. The incidence of scabies has been found to vary from time to time. The aboriginal population in all countries and in both rural and urban areas is particularly at risk because of a number of factors such as crowded housing, shared beds, and crowded schools, etc. Aim: To study incidence and sociodemographic profile of scabies in pediatric patients with different age groups attending secondary health care hospital. Material and Methods: This prospective study was conducted over a period of 8 months on paediatric patients with scabies attending Skin and Paediatric OPD. Family history, per capita income, literacy and hygiene history was noted. Results: Scabies was found in 164 (62.1%); 92 (34.8%) and 8 (3%) cases with economic states of poor; average and good respectively. Overcrowding was noted in 238 (90.2%) and was absent in (9.8%).More commonly associated in-patients with poor and average hygiene (99.5%) than in the good hygiene. Conclusion: The important predisposing factors were overcrowding and poor hygiene. It was common in poor economic group. Thus, improving the socio-economic conditions, hygiene, avoiding overcrowding and proper treatment of cases and close contacts who are the sources of infection to children help in preventing scabies in children.

Key Word: Children, scabies, poor socioeconomic group, overcrowding, hygiene

INTRODUCTION

Scabies is a commonly encountered cutaneous infestation caused by the human itch mite, Sarcoptesscabiei var hominis, an organism that was identified with the disease over 300 years ago.¹It is a highly contagious infestation among close contacts and occurs in all ages. Although the presentation in adults follows a fairly distinctive pattern (but is also frequently missed), infants and young children have a more varied presentation and so are more easily misdiagnosed.²It is essentially a disease of children. Among children, the prevalence is highest in the age group below 5 years. The incidence of scabies has been found to vary from time to time. There is a decreasing prevalence with increasing age.¹Though earlier workers had reported higher incidence in different sexes, more recent studies have shown that there is no preponderance in either sex.^1,3As human scabies is contracted mainly by direct human contact, a pruritic rash in a family member should be pursued, keeping in mind that only one half to two thirds of family members become clinically infected.⁴The aboriginal population in all countries and in both rural and urban areas is particularly at risk because of a number of factors such as crowded housing, shared beds, and crowded schools and day care centers, high pediatric population, reduced access to medical or nursing care, failure to treat close contacts and lack of running water, which may predispose people to secondary skin infection. The present study was conducted to study incidence and sociodemographic profile of scabies in pediatric patients with different age groups attending secondary health care hospital.

MATERIAL AND METHODS

This prospective single centre study was conducted on 264 paediatric cases attending Skin and Paediatric OPD at secondary institute over a period of 8 months.

Inclusion criteria

Patients < 12 years of age including new borns
Symptomatology – history of contact with scabies, history of itch and rash
Lesions on skin – confirmed with dermatologists
Resistant cases – Already diagnosed

Exclusion criteria

Age above 12 years
Lesions which are not of scabies confirmed with skin physician
Patient’s already got cured with adequate treatment
Patient’s unable / does not come during follow up

METHODOLOGY

All new and old registered patients attending dermatology clinics; pediatric OPD; well-baby clinics below 12 years of completed age, at secondary institution were studied. Patients were grouped for study as – 0 to less than 2 yrs., more than 2-5 yrs and 6^th to12 yrs. Income of parents is grouped as – (per capita income). E¹ – less than 600 rupees/month. E² – above 600 – 1200 rupees; E³ – more than 1200/month. Family history for total members (for overcrowding), total affected (contact history). Literacy of parents as – IL – illiterate; I – up to primary school; II up to 10^th to 8^th III above 10^th standard. Housing: number of rooms; to see for overcrowding and mentioned as overcrowding if yes (+) and if not (-) ve.

Statistical analysis: All collected data was arranged in tabulated form. A computer based statistical analysis was done and chi-square test whenever indicated was used. Tables were made and graphs were plotted and results were obtained.

RESULTS

Out of studied patients (264) found to be 60 (22.7%); 87 (33%) and 117 (44.3%) in age groups < 2 yr.; 2-5 yr. > 6-12 yr., respectively suggesting commonest age affected < 6 yr. of age (55.7%) and more common in < 2 yr. of age. Boys were more affected 150 (56.8%) as compared to girls 114 (43.2%) i.e.,M:F-1.31:1.

Table 1: Distribution of the cases by sociodemographic variables

Variables		No.	Percentage
Age in years	< 2	60	22.7%
	2to 5	87	33%
	6 to 12	117	44.3%
Gender	Female	114	43.2%
Gender	Male	150	56.8%
Literacy Level of Parents	Primary	1	0.4%
	Upto 10 Std.	87	33%
	> 10 Std.	176	66.7%
Economic status (Rupees) Per capita Income of parent	<600	164	62.1%
	600 to 1200	92	34.8%
	>1200	8	3%
Total No. of members	3	7	2.7%
	4	67	25.4%
	5	109	41.3%
	6	54	20.5%
	7	20	7.6%
	8	3	1.1%
	9	1	0.4%
	10	3	1.1%
Family members affected Y/N	No	155	58.7%
Family members affected Y/N	Yes	109	41.3%
No. of rooms	1	231	87.5%
No. of rooms	2	33	12.5%
Over Crowding	Absent	26	9.8%
Over Crowding	Present	238	90.2%

Scabies was found in 164 (62.10%); 92 (34.8%) and 8 (3%) cases with economic states of poor; average and good respectively. Indicating scabies is common in poor and average economic groups. Overcrowding was noted in 238 (90.2%) and was absent in (9.8%). It means scabies is common in association with overcrowding. Family affected in 109 (41.3%) of study group.

Table 2: Distribution of the cases by various scabies infestation related variables

Variables		No.	Percentage
Duration of Infection	< 10 days	106	40.2%
	> 10 days	125	47.3%
	>1 month	33	12.5%
Hygiene	Good	1	0.4%
	Average	134	50.8%
	Poor	129	48.9%
Contact History	Absent	155	58.7%
Contact History	Present	109	41.3%
Itching	Absent	62	23.5%
Itching	Present	202	76.5%
Rx of Contacts	Yes	264	100%

Commonest duration of symptoms while presentation less than 1 month in 231 (87.5%) and only 33 (12.5%) have more than 1 month. Itching was noted in 202 (76.5%) and absent in 62 (23.5%).More commonly associated in-patients with poor and average hygiene (99.5%) than in the good hygiene.

DISCUSSION

Scabies is commonest in very young age children and young adolescent, and then incidence declines as mentioned by Crissey JH in his series.⁵In our study we found that 147 (55.7%) were affected less than 6 yrs. of age; out of which 40.81% found to be in less than 2 yr. of age. Other authors mentioned incidence common in early ages. As mentioned by Taplin D. et al,²46% patients were less than 10 years 84% of them were less than 1 year. Wakhlu et al⁶ in their study mentioned that 81.8%were less than 6 years of age and 54% were less than 2 years of age. Results are similar in both the studies showing incidence common in early age. The slight difference of results may be due to method of study (present study was carried as passive survey while other were active surveys). In present study; the group of patients, which failed to attend clinics, has not enumerated. The prevalence of scabies decreases with increasing age probably because of more intimate contact, of the preschool children with their family members. We found that males were more affected than females i.e. 1.31:1 (M: F) these results were similar to other studies by Wakhlu et al⁶M:F-1.28:1. We found that major group of affected patients belonged to average or poor hygiene; and it is rare in good hygiene groups. We found that hygiene was average in 50.8% (134) and poor in 48.9% (129) and good hygiene was found only 0.40% in patients. Study by Wakhlu et al⁶has mentioned that hygiene was found poor in (90.5%); The results showing similarity to be found poor hygiene. The difference of results may be due to that; we have not documented family history of hygiene (i.e., we have mentioned only Personal hygiene). Results were similar to other studies by Nair BKH,¹Taplin D,²Fred Baker⁴ and Valia RG et al.⁷We found that 238 (90.2%) patients had history of overcrowding. Study by Wakhlu et al⁶ has found overcrowding in (73.8%) of population. If has been repeatedly emphasized importance of this factor in transmission of scabies infestation by many other authors, e.g. Taplin D,² Valia RG et al.⁷If is affected by multiple other factors including economic status / education’s which are also in association with infestations. Almost 164 (62.1%) children with scabies in the present study belonged to be low-income group. 92(34.8%) Children belonged to average income group and only 8 (3%) children were belonged to good income group. These results are similar to studies by Wakhlu et al⁶where he mentioned, it was common with low economic group i.e. in class IV / V people. Other authors also emphasized importance in their studies by Fred Baker,⁴Valia RG et al⁷and Pomeranz and Fairly,⁸and other factors like- overcrowding poor personal or environmental conditions are with higher incidence in this group. Family members of 109 children (41.3%) found to be affected. In a study by Wakhlu et al⁶family member of affected patients were found to be in (73%).Other authors, also mentioned importance of close contact in very crowded conditions and transmission of scabies.^4,9,10

CONCLUSION

Scabies was commonly seen in children below 6 years of age with boys affected more than girls. More commonly associated in-patients with poor and average hygiene than in the good hygiene. The important predisposing factors were overcrowding and poor hygiene. It was common in poor economic groups. Thus, improving the socio-economic conditions, hygiene, avoiding overcrowding and proper treatment of cases and close contacts who are the sources of infection to children help in preventing scabies in children.

REFERENCES

Nair BKH, Joseph A, Narayanan PI, et al. Epidemiology of scabies. Indian J Dermatol. Venereol 1973; 39: 101-105.
Taplin D, Meinking TL, Infestations. In: Schachner. LA, Hansen RC, eds. Pediatric dermatology. New York: Churchil Livingstone, 1988: 1465-1515.
Epstein E. Trends in scabies. Arch Dermatol 1955; 71: 192.
Fred Baker F, Calgary, et al. Scabies Management. Pediatric and Child Health 2001; 6 (110):775-777.
Crissey JH. Scabies and Pediculosis Pubis. Urologic Clinics of North America 1984; 11(1):171-176.
Wakhlu I, Thakur S, et al. Clinical Profile of Scabies in North Indian Children. Indian pediatrics 1988; 25: 1050-1053.
Valia RG,Valia AR. Scabies. IAVDL Textbook and Atlas Of Dermatology, 2nd Ed. 2001; 68, 346-352, 423,778, 1516.
Pomeranz, Fairley. The Systemic evaluation of the skin in children. Pediatric Clinics of North America 1998; 45(1):61-63.
Alexander JO. Arthropods and human skin. New York: Springer Verlag 1984:227-291.
Angel TA, et al. Infestations in the Pediatric Patient. Pediatric Clinics of North America 2000; 47(4):921-935.

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