PT  - JOURNAL ARTICLE
AU  - Maria João Lopes
AU  - Eunice Teixeira da Silva
AU  - Janete Ca
AU  - Adriana Gonçalves
AU  - Amabelia Rodrigues
AU  - Cristóvão Mandjuba
AU  - Jose Nakutum
AU  - Umberto D’Alessandro
AU  - Jane Achan
AU  - James Logan
AU  - Robin Bailey
AU  - Anna Last
AU  - Steve Walker
AU  - Michael Marks
TI  - Perceptions, attitudes and practices towards scabies in communities on the Bijagós Islands, Guinea-Bissau
AID  - 10.1101/574327
DP  - 2019 Jan 01
TA  - bioRxiv
PG  - 574327
4099  - http://biorxiv.org/content/early/2019/08/30/574327.short
4100  - http://biorxiv.org/content/early/2019/08/30/574327.full
AB  - Introduction Scabies is highly endemic among impoverished populations and has been recently included in the WHO’s list of neglected tropical diseases (NTDs). Community support and behavioural changes are essential for the success of control interventions. This study aimed to explore beliefs, prevention attitudes and health care-seeking behaviours towards scabies in the Bijagós Archipelago of Guinea-Bissau.Methods Data were collected through two methods. Community key informants (community members, community health workers, healthcare workers and traditional healers) were interviewed using snowball sampling. A questionnaire covering perceptions, attitudes and practices was administered to community members using random cluster sampling. Thematic analysis of qualitative data was applied to identify themes. Descriptive statistics were used for quantitative data analysis.Results There was a satisfactory awareness about scabies, but perceptions about disease causation and transmission were imprecise. Misconceptions about personal hygiene as the primary measure for scabies prevention were recurrent. Some participants recognised the importance of early treatment to interrupt transmission. Treatment of close contacts was not considered important. Costs were the main determining factor for treatment choice between traditional healer and the local health centre. Late presentation and delayed treatment were common and associated with poverty and stigmatisation. Scabies impaired quality of life by affecting social interactions, health, fitness to work and school attendance.Conclusions There is a need to improve education, recognition, management and affordable access to treatment. Community education, healthcare workers’ training and skin NTDs integrated control programmes should address the challenges highlighted in this study.Authors Summary Scabies is a common skin infection in low income settings. We conducted a study in Guinea-Bissau to explore the knowledge, attitudes and practices about scabies. We conducted interviews with healthcare workers, traditional healers and community members and additionally used an oral-administered questionnaire with a larger sample of community residents. Most individuals had knowledge of scabies and were aware that person to person transmission occurred. However personal and environmental hygiene were both incorrectly identified as particularly important in the transmission of scabies. Cost played a major role in determining where individuals sought care and both poverty and disease associated stigma resulted in delays seeking care. There is a need to improve community and health care worker education about scabies and improve affordable access to treatment.