High prevalence of scabies and common skin disease in an Aboriginal community in the Northern Territory: results of a population-based screening study

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It can lead to secondary complications which cause significant morbidity and mortality. The prevalence of scabies in remote Aboriginal communities is believed to be among the highest in the world but no recent prevalence assessments have been conducted in northern Australia. Methods: An observational cross-sectional prevalence assessment was conducted in a remote Aboriginal community in the Northern Territory, as part of a community health initiative led by the local Aboriginal Community-Controlled Health Organisation. Community residents and visitors of all ages were eligible to undergo a simplified skin assessment following verbal consent. Scabies was diagnosed when residents had 3 or more typical skin lesions in a typical body distribution, based on International Alliance for Control of Scabies (IACS) consensus criteria. Treatment of skin disease was according to national clinical guidelines with support from the local healthcare centre.The prevalence of scabies and other skin disease was estimated. To consider whether scabies prevalence was associated with underlying sociodemographic factors or co-infection with another skin disease, adjusted odds ratios were calculated with binomial 95% confidence intervals based on multivariate logistic regression with robust standard errors. Statistical significance was achieved when p<0.05. Results: 1353 people from a remote Aboriginal community of approximately 3800 residents underwent a complete simplified skin assessment. The prevalence of scabies was 25.4% (344/1353, 95%CI=23.1-27.7) and 698 people (51.6%, 95%CI=48.4-53.8) had at least one skin disease identified during the study period. On multivariate analysis, young children aged 0–1 year had the highest prevalence of scabiesand an increased risk of scabies (59.4%, aOR=6.22, p<0.001; 95%CI=2.41-16.09). Conclusions: The prevalence of scabies in this remote Aboriginal community was very high, especially in young infants. Community-led strategies are required to address the burden of scabies, impetigo and their sequelae. Scabies impetigo skin disease neglected tropical diseases northern Australia disease mapping surveillance Introduction Skin disease is common in limited-resource settings globally (1), and as much as 22% of health presentations in remote Aboriginal communities are skin-related (2, 3). Scabies is one of the most prevalent Neglected Tropical Diseases (NTDs) recognised by the World Health Organisation (WHO) (4-7). Scabies is an infectious skin disease caused by the parasitic mite Sarcoptes scabiei after direct skin contact with an infected person (8). It can lead to a breakdown in usual skin barrier function from itching and scratching the skin surface (8). Secondary sequelae of scabies cause significant morbidity and mortality for Aboriginal and Torres Strait Islander children in northern Australia (8-10). Scabies is a public health concern in Australia with a very high prevalence previously reported in the Northern Territory (NT) (11-14). Skin surveys conducted in remote Aboriginal communities in the NT between 1994 and 2010 reported a scabies prevalence as high as 28.8% across a community and 35% in children (13-16). There is an increased risk of impetigo with scabies infestation in children (17) with a prevalence between 22.5% and 46.0% previously reported in the NT (12-14, 16). Few studies have reported the prevalence of other skin conditions; 12–18% affected by tinea (15) and an overall prevalence of skin disease in young children of 28% (18) and 36% (19) in prior studies. Movement between communities, seasonal variation and demographic factors may impact the prevalence of scabies in communities in northern Australia. It is unclear whether historical prevalence assessments represent the current disease burden. Prior prevalence assessments utilised a full-body skin examination. However, a targeted skin examination may be less resource-intensive and more culturally acceptable in a community setting (20). Recent research suggests that a simplified approach to skin assessment, focusing on exposed regions achieves adequate sensitivity for detection of scabies (82.6%), when compared to the IACS consensus criteria (21, 22). This study aimed to determine the prevalence of scabies, impetigo and other common skin disease using a simplified skin assessment in a remote Aboriginal community in the Northern Territory, and to explore potential associations with scabies with sociodemographic demographic factors. This was done in the context of a Healthy Skin Week community health program, led by the local Aboriginal Community-Controlled Health Organisation (ACCHO), Mala’la Health Service Aboriginal Corporation (MHAC). This study provides baseline data that will be useful in evaluating the impact of community-led initiatives. Methods Ethics statement This study was endorsed by the MHAC Board and granted ethics approval by the Northern Territory Department of Health Human Research Ethics Committee (HREC 2022-4276). Study participants provided verbal informed consent. Children aged under 16 years were required to be accompanied by a consenting parent and/or guardian and provide age-appropriate assent to participate. Study aim This study aimed to determine the prevalence of scabies, impetigo, and other common skin conditions using a simplified skin assessment in a remote Aboriginal community in the Northern Territory, and to explore factors associated with scabies through multivariate analysis. Study design An observational cross-sectional prevalence assessment was conducted to determine the prevalence of skin disease in Maningrida. This study occurred during a one-week visit in November 2022 as part of Healthy Skin Week, during which numerous household-level activities were undertaken, comprising of individual and household level education, provision of cleaning equipment, availability of skip bins to facilitate a community-wide clean up and community education activities that were conducted in the local school and healthcare centre. This occurred in parallel with a mass drug administration (MDA) treatment program using ivermectin (or permethrin if ivermectin contraindicated). All community residents and visitors present in the community during the study period were eligible to be enrolled after providing verbal informed consent. There were no other exclusion criteria. Residential households in Maningrida and two remote outstations, allocated by major sub-divisions, were visited by field teams. Participant enrolment occurred throughout the day and continued into the early evening during the study period. If no individuals were present at a household during the first visit from the allocated field team, two further visits were attempted (with at least one visit on a subsequent day) before the house was recorded as empty and excluded from the study. Study setting This study was conducted in Maningrida, a remote Aboriginal community in West Arnhem Land (23). It is one of the largest remote Aboriginal communities in the Northern Territory approximately 500km east of the nearest tertiary referral centre at Royal Darwin Hospital, with more than 9 primary languages spoken in the region (24). Census data from 2021 suggests that Maningrida has 2523 community residents, with 91.2% of the population identifying as Aboriginal or Torres Strait Islander (23). Healthcare records from MHAC indicate there are approximately 3200 community residents, with as many as 3800 people residing in Maningrida and surrounding homelands at times. Training for study teams Each field team included at least one local Aboriginal Community Worker (ACW), one Remote Area Nurse (RAN) from MHAC, and a medical practitioner. The study team underwent 4-hours of standardised teaching which was delivered virtually and focused on identifying common skin conditions from a reference bank of clinical images previously collected for training purposes (25). Each medical practitioner achieved more than 90% on a written examination that included 50 clinical cases. Demographic data Demographic data, including participant name, age, hospital record number and residential lot number were recorded for each study participant. When available, information on the number of children (below and above 2 years of age) and the total number of people living in each household was recorded. Simplified skin assessment A simplified skin assessment tool was used to identify typical skin lesions following examination of exposed regions on the head and neck, arms (including hands), legs (including feet) and the trunk in children aged under 2 years and others with the trunk exposed already (22). Evidence of any skin disease (including scabies, impetigo, tinea, pityriasis versicolor, boils, cellulitis, crusted scabies or another skin condition) was recorded on a hard-copy Case Report Form for each study participant. The presence of 3 or more typical skin lesions in a typical body region was considered diagnostic for scabies, and body regions that exhibited typical lesions were recorded for all participants. The number or severity of lesions was not formally documented. Impetigo was diagnosed for all active and healing skin lesions of any size with features of erythema, yellow crusting, or pus. Data were checked and transcribed into the electronic medical records system of the MHAC (Communicare), and Research Electronic Data Capture (REDCap) tool hosted by the Menzies School of Health Research (26, 27). Treatment Treatment of skin disease was according to national clinical guidelines (28, 29). All participants were offered one dose of ivermectin (or permethrin, if ivermectin contraindicated) as part of the MDA treatment program associated with Healthy Skin Week, regardless of whether or not they had scabies. People with scabies identified in the medical record system were treated with a second dose by MHAC clinicians after 7 – 14 days. Statistical analysis The prevalence of scabies, impetigo, tinea/fungal disease, pityriasis versicolor, boils, cellulitis and crusted scabies was determined as a percentage of the total number of consenting participants who underwent a simplified skin assessment. Multivariate logistic regression assessed whether scabies was associated with underlying sociodemographic factors (including sex, age and household demographics) or co-infection with another skin disease. Variables were not included as predictors of scabies in the logistics regression if the prevalence was zero. Adjusted Odds Ratios (aOR) were calculated with binomial 95% confidence intervals and statistical significance was achieved when p<0.05. Deidentified data were extracted from REDCap and statistical analysis was performed using STATA SE (18.5, StataCorp LLC, College Station, TX, USA). Results Participant demographics There were 1390 people approached during Healthy Skin Week, from a total of 3800 community residents; 1372 (98.7%) consented and 1353 (97.3%) simplified skin assessments were completed. There were 344 people diagnosed with scabies in the community (25.4%). Most participants were female (724/1353, 53.5%) and the median age was 27 years (interquartile range 13 – 41 years) with a total range of 0-92 years. Residents from 306 (67.8%) residential households in the community were screened. Many households had 13 or more community residents living together (378/1353, 27.9%) with a median of 8 residents in each household (interquartile range 5 to 10 people). Most residential households had no children under 2 years of age (692/1000, 68.5%) living in the house, with a range of 0 to 6 children. Table 1: Demographic information for participants enrolled in the cross-sectional prevalence assessment (n=1353). Characteristics Number (n) Percentage (%) Age categories 0 – 1 year 32 2.4% 2 – 4 years 69 5.1% 5 – 9 years 140 10.4% 10 – 19 years 243 18.0% 20 – 29 years 251 18.6% 30 – 39 years 250 18.5% 40 – 49 years 169 12.5% 50+ years 199 14.7% Size of residential household 1 – 3 people 68 5.0% 4 – 6 people 337 24.9% 7 – 9 people 316 23.4% 10 – 12 people 254 18.8% 13+ people 378 27.9% Prevalence of scabies and common skin disease Overall, 51.6% (698/1353) of participants had at least one skin disease identified (see Table 2 ). Of participants who underwent a simplified skin assessment, 25.4% had scabies (344/1353, 95%CI=23.1-27.7), 23.4% had tinea/fungal disease (317/1353, 95%CI=21.2-25.8), 7.2% had impetigo (97/1353, 95%CI=5.9-8.7), 5.8% had headlice (78/1353, 95%CI=4.6-7.1), 4.6% had pityriasis versicolor (62/1353, 95%CI=3.6-5.8) and 0.9% had boils (12/1353, 95%CI=0.5-1.6). No cases of crusted scabies were diagnosed during the study period. Table 2: Skin disease prevalence in a remote Aboriginal community during a cross-sectional prevalence assessment (n=1353). Skin disease Number (n) Prevalence (%) 95% confidence interval Scabies 344 25.4% 23.1 – 27.7 Tinea/fungal 317 23.4% 21.2 – 25.8 Impetigo 97 7.2% 5.9 – 8.7 Headlice 78 5.8% 4.6 – 7.1 Pityriasis versicolor 62 4.6% 3.6 – 5.8 Boils 12 0.9% 0.5 – 1.6 Cellulitis 1 0.1% 0.0 – 0.5 Crusted scabies 0 0 0 At least one skin disease 698 51.6% Factors impacting the prevalence of skin disease There was no significant difference in scabies prevalence between male and female community residents (aOR=1.29, p=0.103, 95%CI=0.95-1.74). Children aged 0–1 year had the highest scabies prevalence (59.4%, aOR=6.22, p<0.001; 95%CI=2.41-16.09) compared to adults aged more than 50 years (see Table 3 ). Children aged 2–4 years (37.7%, aOR=3.16, p=0.002; 95%CI=1.50-6.68), 5-9 years (45.0%, aOR=4.01, p<0.001; 95%CI=2.13-7.56), and 10–19 years (36.6%, aOR=2.67, p=0.001; 95%CI=1.53-4.66) also had higher scabies prevalence. There was a non-significant finding of higher scabies prevalence in households with 10–12 residents (aOR=1.74, p=0.157; 95%CI=0.81-3.76). The presence of two young children (aged under 2 years) in the household was associated with an increased scabies prevalence (aOR=2.59, p=0.025; 95%CI=1.13-5.95). Impetigo was the only skin disease that was associated with a higher prevalence of scabies (aOR=2.76, p<0.001; 95%CI=1.59-4.80). Table 3: Associations with presence of scabies from multivariate analysis (n=1353). Category Scabies prevalence (%) aOR p-value Sex Male 173/629 (27.5%) Reference Female 171/724 (23.6%) 1.29 (0.95 – 1.74) 0.103 Age groups 0 – 1 years 19/32 (59.4%) 6.22 (2.41 – 16.09) <0.001 2 – 4 years 26/69 (37.7%) 3.16 (1.50 – 6.68) 0.002 5 – 9 years 63/140 (45.0%) 4.01 (2.13 – 7.56) <0.001 10 – 19 years 89/243 (36.6%) 2.67 (1.53 – 4.66) 0.001 20 – 29 years 35/251 (13.9%) 0.92 (0.51 – 1.67) 0.780 30 – 39 years 49/250 (19.6%) 1.19 (0.66 – 2.13) 0.561 40 – 49 years 31/169 (18.3%) 1.21 (0.62 – 2.34) 0.574 50+ years 32/199 (15.1%) Reference Residential household size 1 – 3 people 10/68 (14.7%) Reference 4 – 6 people 79/337 (23.4%) 1.34 (0.63 – 2.82) 0.446 7 – 9 people 85/316 (26.9%) 1.65 (0.78 – 3.50) 0.189 10 – 12 people 79/254 (31.1%) 1.74 (0.81 – 3.76) 0.157 13+ people 91/378 (24.0%) 1.29 (0.45 – 3.65) 0.632 Children in household (under 2-years) 0 167/692 (24.1%) Reference 1 79/279 (28.3%) 1.01 (0.70 – 1.43) 0.977 2 12/18 (42.9%) 2.59 (1.13 – 5.95) 0.025 3+ 4/11 (36.4%) 1.56 (0.40 – 6.10) 0.523 Skin disease Tinea/fungal 69/317 (21.8%) 1.86 (0.68 – 5.09) 0.230 Impetigo 56/97 (57.7%) 2.76 (1.59 – 4.80) <0.001 Headlice 30/78 (38.5%) 2.04 (0.80 – 5.22) 0.138 Pityriasis versicolor 9/62 (14.5%) 0.58 (0.17 – 1.90) 0.370 Boils 2/12 (16.7%) 0.36 (0.06 – 2.06) 0.249 Discussion During Healthy Skin Week, over half of the people who had a skin check (51.6%) had at least one skin disease, which is higher than previously reported in studies conducted in the NT (15, 18, 19). However, the very high prevalence of common skin disease is consistent with case-mix reviews profiling primary healthcare presentations in northern Australia (2, 3). Scabies was present in a quarter of participants (25.4%) which is comparable to the figure of 28.1% reported in the first prevalence survey conducted in 1994, albeit in a different remote Aboriginal community in the NT (13). This highlights that scabies persists in northern Australia, emphasising the urgent need for renewed public health efforts to reduce the primary and secondary burden of scabies in the Northern Territory. Scabies prevalence was highest in children aged 0-1 year (59.4%) in this study. Previous studies have similarly reported a high prevalence in infants and young children; however, this is the highest prevalence reported across all prior studies (12, 14, 16, 19, 30, 31). It has been suggested in international literature that this high prevalence may be linked to an increased prevalence of impetigo in younger age groups (32). Only one study conducted in 2010 showed no increase in the prevalence of scabies in young children. A possible explanation for this may be a low overall scabies prevalence following the East Arnhem Healthy Skin Program (15). Households with two young children aged under 2 years had an increased prevalence of scabies, which is consistent with larger studies conducted in Pacific island nations (33). Maintaining a broader focus on health infrastructure and optimising housing and environmental health measures for scabies control in endemic regions is essential (34). There was a strong correlation between impetigo and scabies co-infection, with 57.7% of residents with impetigo also having scabies. This relationship has previously been described in Australia (31) and Pacific island nations (25, 32, 35), but this is the highest co-infection rate reported in Australia to date (31, 36). Interestingly, this contrasts with the overall prevalence of impetigo in the community; which at 7.2% is much lower than previous reports (12, 13, 30, 37). Strengths and limitations This study enrolled a large number of participants as part of a community-wide prevalence assessment that was conducted in one of the largest remote Aboriginal communities in the Northern Territory. The research team supported the ACCHO to implement a community-led health initiative to address local health priorities after an extended period of consultation. The simplified skin assessment was standardised and undertaken by trained medical practitioners. Undertaking an observational cross-sectional prevalence assessment has generated robust baseline data at one time-point. Changes to the disease burden can be assessed at future time-points to consider the impact of community health interventions and the utility of different scabies surveillance methods. This study was attached to a community health initiative, which has the potential to be replicated in other remote settings in northern Australia, recognising that a different methodological approach may be used in different community settings to reflect local health priorities. It was the first study in Australia to utilise a simplified skin assessment which has been validated against the IACS Consensus criteria which may have impacted scabies prevalence in the community (21, 22, 38). Despite a high rate of consent (98.7%) among community residents approached during the study period, only one-third of the total population was screened (1390/3800, 36.5%) from two-thirds of residential households (306/450, 68%) in the community, in part due to time and human resource limitations, and the focus on engagement and education at each household visit. While standardised teaching was undertaken for all study team members, inter-observer validation to assess the diagnostic accuracy of different examiners in the study team was not performed. A confirmation bias may have led to an over-diagnosis of scabies by study team members when undertaking a simplified skin examination. Other factors may have influenced the reported scabies prevalence. Field teams conducted recruitment primarily during business hours, which may have limited the enrolment of residents who were at work or school during these times. Routine health service delivery may have been impacted during COVID-19 (39). Seasonal variations in scabies prevalence may not be apparent from this cross-sectional assessment. Future research Ongoing longitudinal surveillance is planned in conjunction with future Healthy Skin Week activities led by MHAC. Prevalence surveys conducted in other remote Aboriginal communities in the NT would also help understand whether the high prevalence of scabies is present throughout the region. Simplified approaches to scabies surveillance may increase feasibility of performing regular and repeated estimates of disease burden. Conclusion The prevalence of scabies in this remote Aboriginal community was very high, especially in infants and young children. Community-led strategies are required to address the burden of scabies, impetigo and their sequelae. Abbreviations International Alliance for Control of Scabies (IACS) Neglected Tropical Diseases (NTDs) Northern Territory (NT) Aboriginal Community-Controlled Health Organisation (ACCHO) Mala’la Health Service Aboriginal Corporation (MHAC) Aboriginal Community Worker (ACW) Remote Area Nurse (RAN) Mass drug administration (MDA) Research Electronic Data Capture (REDCap) Adjusted Odds Ratios (aOR) Declarations Ethics approval and consent to participate This study was endorsed by the Mala’la Health Board, and granted ethics approval by the Northern Territory Department of Health Human Research Ethics Committee (HREC 2022-4276). Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and following approval from the MHAC board. Competing interests The authors declare that they have no competing interests. Funding VC and JF were principal investigators in receipt of a project grant from the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (ACE-NTDs) to support a scabies control project in northern Australia. VC was in receipt of funding from the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (ACE-NTDs) through a PhD scholarship, the Commonwealth Government with a Research Training Program (RTP) scholarship and a PhD scholarship from the HOT NORTH Centre for Research Excellence. The funding source had no involvement in the conceptualisation, study design, data collection, analysis, decision to publish, or preparation of the manuscript. Authors' contributions Victoria RV Cox: Data curation, Funding acquisition, Formal analysis, Investigation, Methodology, Resources, Writing – original draft preparation, Writing – review & editing. Jessica Gatti: Conceptualisation, Funding acquisition, Resources, Writing – review & editing. Valda Bokmarkarry: Data curation, Investigation, Writing – review & editing. Kurt Brown: Data curation, Investigation, Writing – review & editing . Jayden Smith: Data curation, Investigation, Writing – review & editing. Natasha Bond: Data curation, Investigation, Writing – review & editing. Eileen Gunaburra: Data curation, Investigation, Writing – review & editing. Ana Malupo: Data curation, Investigation, Writing – review & editing. Jennifer P Yan: Data curation, Investigation, Writing – review & editing. Daniel Engelman: Conceptualisation, Funding acquisition, Resources . Bart J Currie: Conceptualisation, Funding acquisition, Supervision, Methodology. Joshua R Francis: Conceptualisation, Data curation, Funding acquisition, Investigation, Methodology, Resources, Supervision, Writing – review & editing. Acknowledgements We acknowledge the contribution of key community members, healthcare workers from the Mala’la Health Service Aboriginal Corporation, and the Mala’la Health Board for their cultural leadership and guidance, as well as the clinic manager and Director of Medical Services for their support of this project and ongoing collaboration. We acknowledge the importance of work conducted by One Disease, in particular Michelle Dowden and Meg Scolyer. We would also like to recognise the effort of medical practitioners in the study team who undertook skin checks and data entry: Daniel Cordas, Tayler Cosentino, Charlotte Cox, Robert Duguid, Catherine Fowler, Alexander Matthews, Nerida Moore and James White. We thank Dr Austen Anderson and Dr Crystal Williams for their support of Healthy Skin Week and the Australasian College of Dermatologists through the FATES program. We are grateful for use of the training materials and written clinical exam provided by the World Scabies Program. We thank Zhiqiang Wang for his advice and support in developing the statistical methods and methodological approach for this project. Authors' information Corresponding author: Dr Victoria RV Cox Menzies School of Health Research, JMB Building, Royal Darwin Hospital, 105 Rocklands Drive TIWI NT 0810 Email: [email protected] References World Health Organisation. Recognizing neglected tropical diseases through changes on the skin: a training guide for front-line health workers. Geneva, Switzerland: World Health Organisation; 2018 1st June. Thomas L, Bowen AC, Ly M, Connors C, Andrews RM, Tong SY. Burden of skin disease in two remote primary healthcare centres in northern and central Australia. Internal Medicine Journal. 2019;49(3):396-9. Hendrickx D. Revealing the public health significance of skin infections among Aboriginal children living in the Pilbara: a call to action in Western Australia [PhD thesis]. Perth, Western Australia: The University of Western Australia; 2017. 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British Journal of Dermatology. 2020;183(5):808-20. Tsoi SK, Lake SJ, Thean LJ, Matthews A, Sokana O, Kama M, et al. Estimation of scabies prevalence using simplified criteria and mapping procedures in three Pacific and southeast Asian countries. BMC Public Health. 2021;21(1):2060. Australian Bureau of Statistics. Maningrida. Canberra: Australian Bureau of Statistics; 2023 [20th June 2023]. Available from: https://www.abs.gov.au/census/find-census-data/quickstats/2021/ILOC70400301. West Arnhem Regional Council. Maningrida. Jabiru, Northern Territory: West Arnhem Regional Council; 2024 [Available from: https://www.westarnhem.nt.gov.au/our-communities/maningrida. Matthews A, Le B, Amaral S, Arkell P, Monteiro M, Clarke N, et al. Prevalence of scabies and impetigo in school-age children in Timor-Leste. Parasites & Vectors. 2021;14(1):156. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. 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Impact of single dose azithromycin on group A streptococci in the upper respiratory tract and skin of Aboriginal children. Paediatric Infectious Diseases Journal. 2002;21:375-80. Tasani M, Tong SYC, Andrews RM, Holt DC, Currie BJ, Carapetis JR, et al. The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo. The Pediatric Infectious Diseases Journal. 2016;35(4):347-8. Romani L, Koroivueta J, Steer AC, Kama M, Kaldor JM, Wand H, et al. Scabies and Impetigo Prevalence and Risk Factors in Fiji: A National Survey. PLoS Neglected Tropical Diseases. 2015;9(3):e0003452. Romani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, et al. The Epidemiology of Scabies and Impetigo in Relation to Demographic and Residential Characteristics: Baseline Findings from the Skin Health Intervention Fiji Trial. The American Journal of Tropical Medicine and Hygiene. 2017;97(3):845-50. Currie BJ. Scabies and Global Control of Neglected Tropical Diseases. New England Journal of Medicine. 2015;373(24):2371-2. Osti MH, Sokana O, Phelan S, Marks M, Whitfeld MJ, Gorae C, et al. Prevalence of scabies and impetigo in the Solomon Islands: a school survey. BMC Infectious Diseases. 2019;19(1):803. Wiegele S, McKinnon E, van Schaijik B, Enkel S, Noonan K, Bowen AC, et al. The epidemiology of superficial Streptococcal A (impetigo and pharyngitis) infections in Australia: A systematic review. PloS ONE. 2023;18(11):e0288016. Carapetis JR, Johnston F, Nadjamerrek J, Kairupan J. Skin sores in Aboriginal children. Journal of Paediatrics and Child Health. 1995;31(6):563. Engelman D, Fuller LC, Steer AC. Consensus criteria for the diagnosis of scabies: A Delphi study of international experts. PLoS Neglected Tropical Diseases. 2018;12(5):e0006549. Commonwealth of Australia. National Indigenous Australians Agency, National Partnership on Northern Territory Remote Aboriginal Investmen: End of Term Review. Canberra: Commonweatlh of Australia; 2022. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 17 Jul, 2025 Reviews received at journal 15 Jul, 2025 Reviewers agreed at journal 30 Jun, 2025 Reviews received at journal 28 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 06 Jun, 2025 Submission checks completed at journal 06 Jun, 2025 First submitted to journal 05 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6832896","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472151298,"identity":"7261afc8-f861-4a31-8277-dc6ebb4a403d","order_by":0,"name":"Victoria RV Cox","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYDACZjApAeF8QIgw49PC2ADTwjiDKC0MYC1Q7TzotmMDBseZnz/4uMdCnoH98DFp2xybPPl25sMfGCqsExvYzxhg1XKYzbBxxjMJwwaetGTj3G1pxYzNbGkSDGfSExt4crBqkWzmYWzmOSDB2CDBY/g4d9vhxGZmHjMGxrbDiQ0M+LXYA7UYHLbc9j+xjZn/8wfGf0At/G+wauFnhmhJBNvCuO1AYg8wEICWArVIYLeFn5nNcOaMAxLJbUC/GPZuS06cwcxmJpFwLN24TeJZATYtbPyHH3z4cKDOth8YYhI/t9klzu8//PjDhxpr2X7+5A3YgxmmF4WXgCEyCkbBKBgFo4AUAAArdlWYhuuDCgAAAABJRU5ErkJggg==","orcid":"","institution":"Charles Darwin University","correspondingAuthor":true,"prefix":"","firstName":"Victoria","middleName":"RV","lastName":"Cox","suffix":""},{"id":472151299,"identity":"8fad4928-ad48-468b-9216-eb10a83679ef","order_by":1,"name":"Jessica Gatti","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Gatti","suffix":""},{"id":472151300,"identity":"b9376061-6a72-4fdb-af1d-15fab2d4bbf7","order_by":2,"name":"Valda Bokmarkarry","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Valda","middleName":"","lastName":"Bokmarkarry","suffix":""},{"id":472151301,"identity":"da945e7d-ff3e-4813-9e0e-cdfb049de1cb","order_by":3,"name":"Kurt Brown","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Kurt","middleName":"","lastName":"Brown","suffix":""},{"id":472151302,"identity":"6ce3ee14-98a0-427f-a774-3bfdb4cbd6dc","order_by":4,"name":"Jayden Smith","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Jayden","middleName":"","lastName":"Smith","suffix":""},{"id":472151303,"identity":"4bc4596b-fb6a-4bc4-86f1-c78c185d0acf","order_by":5,"name":"Natasha Bond","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Natasha","middleName":"","lastName":"Bond","suffix":""},{"id":472151304,"identity":"94f2fe5c-65b9-4c69-88be-f0827daea63a","order_by":6,"name":"Eileen Gunaburra","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Eileen","middleName":"","lastName":"Gunaburra","suffix":""},{"id":472151308,"identity":"86a74d5b-b8b9-4918-b253-1c0b716d682a","order_by":7,"name":"Ana Malupo","email":"","orcid":"","institution":"Mala’la Health Service Aboriginal Corporation","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"","lastName":"Malupo","suffix":""},{"id":472151310,"identity":"cb0994e1-c972-4729-82c9-e2028a522cb9","order_by":8,"name":"Jennifer Yan","email":"","orcid":"","institution":"Charles Darwin University","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Yan","suffix":""},{"id":472151312,"identity":"221f4b41-f16c-47ae-9670-abfc66ac11ce","order_by":9,"name":"Daniel Engelman","email":"","orcid":"","institution":"Murdoch Children’s Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Engelman","suffix":""},{"id":472151315,"identity":"8f22ec5d-153c-4c92-8063-6dcb6c8d3d47","order_by":10,"name":"Bart J Currie","email":"","orcid":"","institution":"Charles Darwin University","correspondingAuthor":false,"prefix":"","firstName":"Bart","middleName":"J","lastName":"Currie","suffix":""},{"id":472151316,"identity":"b27bf860-ca23-4e02-b7fa-9e0cf3a337d4","order_by":11,"name":"Joshua R Francis","email":"","orcid":"","institution":"Charles Darwin University","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"R","lastName":"Francis","suffix":""}],"badges":[],"createdAt":"2025-06-06 02:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6832896/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6832896/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84783882,"identity":"ffb7d462-4bd5-48af-aa42-67f127bc3ac2","added_by":"auto","created_at":"2025-06-17 10:07:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1115080,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6832896/v1/3393b337-99fb-4bd7-8674-a847b31ff745.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High prevalence of scabies and common skin disease in an Aboriginal community in the Northern Territory: results of a population-based screening study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSkin disease is common in limited-resource settings globally (1), and as much as 22% of health presentations in remote Aboriginal communities are skin-related (2, 3). Scabies is one of the most prevalent Neglected Tropical Diseases (NTDs) recognised by the World Health Organisation (WHO) (4-7). Scabies is an infectious skin disease caused by the parasitic mite \u003cem\u003eSarcoptes scabiei\u003c/em\u003e after direct skin contact with an infected person\u003cem\u003e\u0026nbsp;\u003c/em\u003e(8). It can lead to a breakdown in usual skin barrier function from itching and scratching the skin surface (8). Secondary sequelae of scabies cause significant morbidity and mortality for Aboriginal and Torres Strait Islander children in northern Australia (8-10). Scabies is a public health concern in Australia with a very high prevalence previously reported in the Northern Territory (NT) (11-14).\u003c/p\u003e\n\u003cp\u003eSkin surveys conducted in remote Aboriginal communities in the NT between 1994 and 2010 reported a scabies prevalence as high as 28.8% across a community and 35% in children (13-16). There is an increased risk of impetigo with scabies infestation in children (17) with a prevalence between 22.5% and 46.0% previously reported in the NT (12-14, 16). Few studies have reported the prevalence of other skin conditions; 12\u0026ndash;18% affected by tinea (15) and an overall prevalence of skin disease in young children of 28% (18) and 36% (19) in prior studies.\u003c/p\u003e\n\u003cp\u003eMovement between communities, seasonal variation and demographic factors may impact the prevalence of scabies in communities in northern Australia. It is unclear whether historical prevalence assessments represent the current disease burden. Prior prevalence assessments utilised a full-body skin examination. However, a targeted skin examination may be less resource-intensive and more culturally acceptable in a community setting (20). Recent research suggests that a simplified approach to skin assessment, focusing on exposed regions achieves adequate sensitivity for detection of scabies (82.6%), when compared to the IACS consensus criteria (21, 22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study aimed to determine the prevalence of scabies, impetigo and other common skin disease using a simplified skin assessment in a remote Aboriginal community in the Northern Territory, and to explore potential associations with scabies with sociodemographic demographic factors. This was done in the context of a Healthy Skin Week community health program, led by the local Aboriginal Community-Controlled Health Organisation (ACCHO), Mala\u0026rsquo;la Health Service Aboriginal Corporation (MHAC). This study provides baseline data that will be useful in evaluating the impact of community-led initiatives.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eEthics statement\u003c/h2\u003e\n\u003cp\u003eThis study was endorsed by the MHAC Board and granted ethics approval by the Northern Territory Department of Health Human Research Ethics Committee (HREC 2022-4276). Study participants provided verbal informed consent. Children aged under 16 years were required to be accompanied by a consenting parent and/or guardian and provide age-appropriate assent to participate.\u003c/p\u003e\n\u003ch2\u003eStudy aim\u003c/h2\u003e\n\u003cp\u003eThis study aimed to determine the prevalence of scabies, impetigo, and other common skin conditions using a simplified skin assessment in a remote Aboriginal community in the Northern Territory, and to explore factors associated with scabies through multivariate analysis.\u003c/p\u003e\n\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eAn observational cross-sectional prevalence assessment was conducted to determine the prevalence of skin disease in Maningrida. This study occurred during a one-week visit in November 2022 as part of Healthy Skin Week, during which numerous household-level activities were undertaken, comprising of individual and household level education, provision of cleaning equipment, availability of skip bins to facilitate a community-wide clean up and community education activities that were conducted in the local school and healthcare centre. This occurred in parallel with a mass drug administration (MDA) treatment program using ivermectin (or permethrin if ivermectin contraindicated). All community residents and visitors present in the community during the study period were eligible to be enrolled after providing verbal informed consent. There were no other exclusion criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResidential households in Maningrida and two remote outstations, allocated by major sub-divisions, were visited by field teams. Participant enrolment occurred throughout the day and continued into the early evening during the study period. If no individuals were present at a household during the first visit from the allocated field team, two further visits were attempted (with at least one visit on a subsequent day) before the house was recorded as empty and excluded from the study.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc177751576\"\u003eStudy setting\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in Maningrida, a remote Aboriginal community in West Arnhem Land (23). It is one of the largest remote Aboriginal communities in the Northern Territory approximately 500km east of the nearest tertiary referral centre at Royal Darwin Hospital, with more than 9 primary languages spoken in the region (24). Census data from 2021 suggests that Maningrida has 2523 community residents, with 91.2% of the population identifying as Aboriginal or Torres Strait Islander (23). Healthcare records from MHAC indicate there are approximately 3200 community residents, with as many as 3800 people residing in Maningrida and surrounding homelands at times.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc177751577\"\u003eTraining for study teams\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eEach field team included at least one local Aboriginal Community Worker (ACW), one Remote Area Nurse (RAN) from MHAC, and a medical practitioner. The study team underwent 4-hours of standardised teaching which was delivered virtually and focused on identifying common skin conditions from a reference bank of clinical images previously collected for training purposes (25). Each medical practitioner achieved more than 90% on a written examination that included 50 clinical cases.\u003c/p\u003e\n\u003ch2 id=\"_Toc177751579\"\u003eDemographic data\u003c/h2\u003e\n\u003cp\u003eDemographic data, including participant name, age, hospital record number and residential lot number were recorded for each study participant. When available, information on the number of children (below and above 2 years of age) and the total number of people living in each household was recorded.\u003c/p\u003e\n\u003ch2 id=\"_Toc177751580\"\u003eSimplified skin assessment\u003c/h2\u003e\n\u003cp\u003eA simplified skin assessment tool was used to identify typical skin lesions following examination of exposed regions on the head and neck, arms (including hands), legs (including feet) and the trunk in children aged under 2 years and others with the trunk exposed already (22). Evidence of any skin disease (including scabies, impetigo, tinea, pityriasis versicolor, boils, cellulitis, crusted scabies or another skin condition) was recorded on a hard-copy Case Report Form for each study participant. The presence of 3 or more typical skin lesions in a typical body region was considered diagnostic for scabies, and body regions that exhibited typical lesions were recorded for all participants. The number or severity of lesions was not formally documented. Impetigo was diagnosed for all active and healing skin lesions of any size with features of erythema, yellow crusting, or pus. Data were checked and transcribed into the electronic medical records system of the MHAC (Communicare), and Research Electronic Data Capture (REDCap) tool hosted by the Menzies School of Health Research (26, 27).\u003c/p\u003e\n\u003ch2 id=\"_Toc177751581\"\u003eTreatment\u003c/h2\u003e\n\u003cp\u003eTreatment of skin disease was according to national clinical guidelines (28, 29). All participants were offered one dose of ivermectin (or permethrin, if ivermectin contraindicated) as part of the MDA treatment program associated with Healthy Skin Week, regardless of whether or not they had scabies. People with scabies identified in the medical record system were treated with a second dose by MHAC clinicians after 7 \u0026ndash; 14 days.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eThe prevalence of scabies, impetigo, tinea/fungal disease, pityriasis versicolor, boils, cellulitis and crusted scabies was determined as a percentage of the total number of consenting participants who underwent a simplified skin assessment. Multivariate logistic regression assessed whether scabies was associated with underlying sociodemographic factors (including sex, age and household demographics) or co-infection with another skin disease. Variables were not included as predictors of scabies in the logistics regression if the prevalence was zero. Adjusted Odds Ratios (aOR) were calculated with binomial 95% confidence intervals and statistical significance was achieved when p\u0026lt;0.05. Deidentified data were extracted from REDCap and statistical analysis was performed using STATA SE (18.5, StataCorp LLC, College Station, TX, USA).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eParticipant demographics\u003c/h2\u003e\n\u003cp\u003eThere were 1390 people approached during Healthy Skin Week, from a total of 3800 community residents; 1372 (98.7%) consented and 1353 (97.3%) simplified skin assessments were completed. There were 344 people diagnosed with scabies in the community (25.4%). Most participants were female (724/1353, 53.5%) and the median age was 27 years (interquartile range 13 \u0026ndash; 41 years) with a total range of 0-92 years. Residents from 306 (67.8%) residential households in the community were screened. Many households had 13 or more community residents living together (378/1353, 27.9%) with a median of 8 residents in each household (interquartile range 5 to 10 people). Most residential households had no children under 2 years of age (692/1000, 68.5%) living in the house, with a range of 0 to 6 children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 1:\u003c/u\u003e Demographic information for participants enrolled in the cross-sectional prevalence assessment (n=1353).\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2 \u0026ndash; 4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e5 \u0026ndash; 9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e10.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e10 \u0026ndash; 19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e20 \u0026ndash; 29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e30 \u0026ndash; 39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e40 \u0026ndash; 49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e50+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSize of residential household\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 \u0026ndash; 3 people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e5.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4 \u0026ndash; 6 people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e24.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e7 \u0026ndash; 9 people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e23.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e10 \u0026ndash; 12 people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e13+ people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e27.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2 id=\"_Toc177751584\"\u003ePrevalence of scabies and common skin disease\u003c/h2\u003e\n\u003cp\u003eOverall, 51.6% (698/1353) of participants had at least one skin disease identified (see \u003cu\u003eTable 2\u003c/u\u003e). Of participants who underwent a simplified skin assessment, 25.4% had scabies (344/1353, 95%CI=23.1-27.7), 23.4% had tinea/fungal disease (317/1353, 95%CI=21.2-25.8), 7.2% had impetigo (97/1353, 95%CI=5.9-8.7), 5.8% had headlice (78/1353, 95%CI=4.6-7.1), 4.6% had pityriasis versicolor (62/1353, 95%CI=3.6-5.8) and 0.9% had boils (12/1353, 95%CI=0.5-1.6). No cases of crusted scabies were diagnosed during the study period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 2:\u003c/u\u003e Skin disease prevalence in a remote Aboriginal community during a cross-sectional prevalence assessment (n=1353).\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkin disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% confidence interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScabies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e25.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e23.1 \u0026ndash; 27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTinea/fungal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e23.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21.2 \u0026ndash; 25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImpetigo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e5.9 \u0026ndash; 8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeadlice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4.6 \u0026ndash; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePityriasis versicolor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3.6 \u0026ndash; 5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoils\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCellulitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.0 \u0026ndash; 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrusted scabies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least one skin disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;51.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc177751585\"\u003eFactors impacting the prevalence of skin disease\u003c/h2\u003e\n\u003cp\u003eThere was no significant difference in scabies prevalence between male and female community residents (aOR=1.29, p=0.103, 95%CI=0.95-1.74). Children aged 0\u0026ndash;1 year had the highest scabies prevalence (59.4%, aOR=6.22, p\u0026lt;0.001; 95%CI=2.41-16.09) compared to adults aged more than 50 years (see \u003cu\u003eTable 3\u003c/u\u003e). Children aged 2\u0026ndash;4 years (37.7%, aOR=3.16, p=0.002; 95%CI=1.50-6.68), 5-9 years (45.0%, aOR=4.01, p\u0026lt;0.001; 95%CI=2.13-7.56), and 10\u0026ndash;19 years (36.6%, aOR=2.67, p=0.001; 95%CI=1.53-4.66) also had higher scabies prevalence. There was a non-significant finding of higher scabies prevalence in households with 10\u0026ndash;12 residents (aOR=1.74, p=0.157; 95%CI=0.81-3.76). The presence of two young children (aged under 2 years) in the household was associated with an increased scabies prevalence (aOR=2.59, p=0.025; 95%CI=1.13-5.95). Impetigo was the only skin disease that was associated with a higher prevalence of scabies (aOR=2.76, p\u0026lt;0.001; 95%CI=1.59-4.80).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 3:\u003c/u\u003e Associations with presence of scabies from multivariate analysis (n=1353).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScabies prevalence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e173/629 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e171/724 (23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.29 (0.95 \u0026ndash; 1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 \u0026ndash; 1 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e19/32 (59.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6.22 (2.41 \u0026ndash; 16.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 \u0026ndash; 4 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e26/69 (37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.16 (1.50 \u0026ndash; 6.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 \u0026ndash; 9 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e63/140 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.01 (2.13 \u0026ndash; 7.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10 \u0026ndash; 19 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e89/243 (36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.67 (1.53 \u0026ndash; 4.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20 \u0026ndash; 29 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e35/251 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.92 (0.51 \u0026ndash; 1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 \u0026ndash; 39 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e49/250 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.19 (0.66 \u0026ndash; 2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40 \u0026ndash; 49 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e31/169 (18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.21 (0.62 \u0026ndash; 2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50+ years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e32/199 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidential household size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 \u0026ndash; 3 people\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10/68 (14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 \u0026ndash; 6 people\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e79/337 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.34 (0.63 \u0026ndash; 2.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7 \u0026ndash; 9 people\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e85/316 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.65 (0.78 \u0026ndash; 3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10 \u0026ndash; 12 people\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e79/254 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.74 (0.81 \u0026ndash; 3.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13+ people\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e91/378 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.29 (0.45 \u0026ndash; 3.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildren in household (under 2-years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e167/692 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e79/279 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.01 (0.70 \u0026ndash; 1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12/18 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.59 (1.13 \u0026ndash; 5.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4/11 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.56 (0.40 \u0026ndash; 6.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkin disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTinea/fungal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e69/317 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.86 (0.68 \u0026ndash; 5.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImpetigo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e56/97 (57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.76 (1.59 \u0026ndash; 4.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeadlice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30/78 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.04 (0.80 \u0026ndash; 5.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePityriasis versicolor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e9/62 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.58 (0.17 \u0026ndash; 1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoils\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2/12 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.36 (0.06 \u0026ndash; 2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eDuring Healthy Skin Week, over half of the people who had a skin check (51.6%) had at least one skin disease, which is higher than previously reported in studies conducted in the NT (15, 18, 19). However, the very high prevalence of common skin disease is consistent with case-mix reviews profiling primary healthcare presentations in northern Australia (2, 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScabies was present in a quarter of participants (25.4%) which is comparable to the figure of 28.1% reported in the first prevalence survey conducted in 1994, albeit in a different remote Aboriginal community in the NT (13). This highlights that scabies persists in northern Australia, emphasising the urgent need for renewed public health efforts to reduce the primary and secondary burden of scabies in the Northern Territory. Scabies prevalence was highest in children aged 0-1 year (59.4%) in this study. Previous studies have similarly reported a high prevalence in infants and young children; however, this is the highest prevalence reported across all prior studies (12, 14, 16, 19, 30, 31). It has been suggested in international literature that this high prevalence may be linked to an increased prevalence of impetigo in younger age groups (32). Only one study conducted in 2010 showed no increase in the prevalence of scabies in young children. A possible explanation for this may be a low overall scabies prevalence following the East Arnhem Healthy Skin Program (15).\u003c/p\u003e\n\u003cp\u003eHouseholds with two young children aged under 2 years had an increased prevalence of scabies, which is consistent with larger studies conducted in Pacific island nations (33). Maintaining a broader focus on health infrastructure and optimising housing and environmental health measures for scabies control in endemic regions is essential (34). There was a strong correlation between impetigo and scabies co-infection, with 57.7% of residents with impetigo also having scabies. This relationship has previously been described in Australia (31) and Pacific island nations (25, 32, 35), but this is the highest co-infection rate reported in Australia to date (31, 36). Interestingly, this contrasts with the overall prevalence of impetigo in the community; which at 7.2% is much lower than previous reports (12, 13, 30, 37).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\n\u003cp\u003eThis study enrolled a large number of participants as part of a community-wide prevalence assessment that was conducted in one of the largest remote Aboriginal communities in the Northern Territory. The research team supported the ACCHO to implement a community-led health initiative to address local health priorities after an extended period of consultation. The simplified skin assessment was standardised and undertaken by trained medical practitioners. Undertaking an observational cross-sectional prevalence assessment has generated robust baseline data at one time-point. Changes to the disease burden can be assessed at future time-points to consider the impact of community health interventions and the utility of different scabies surveillance methods. This study was attached to a community health initiative, which has the potential to be replicated in other remote settings in northern Australia, recognising that a different methodological approach may be used in different community settings to reflect local health priorities. It was the first study in Australia to utilise a simplified skin assessment which has been validated against the IACS Consensus criteria which may have impacted scabies prevalence in the community (21, 22, 38).\u003c/p\u003e\n\u003cp\u003eDespite a high rate of consent (98.7%) among community residents approached during the study period, only one-third of the total population was screened (1390/3800, 36.5%) from two-thirds of residential households (306/450, 68%) in the community, in part due to time and human resource limitations, and the focus on engagement and education at each household visit. While standardised teaching was undertaken for all study team members, inter-observer validation to assess the diagnostic accuracy of different examiners in the study team was not performed. A confirmation bias may have led to an over-diagnosis of scabies by study team members when undertaking a simplified skin examination. Other factors may have influenced the reported scabies prevalence. Field teams conducted recruitment primarily during business hours, which may have limited the enrolment of residents who were at work or school during these times. Routine health service delivery may have been impacted during COVID-19 (39). Seasonal variations in scabies prevalence may not be apparent from this cross-sectional assessment.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc177751587\"\u003eFuture research\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eOngoing longitudinal surveillance is planned in conjunction with future Healthy Skin Week activities led by MHAC. Prevalence surveys conducted in other remote Aboriginal communities in the NT would also help understand whether the high prevalence of scabies is present throughout the region. Simplified approaches to scabies surveillance may increase feasibility of performing regular and repeated estimates of disease burden.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of scabies in this remote Aboriginal community was very high, especially in infants and young children. Community-led strategies are required to address the burden of scabies, impetigo and their sequelae.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eInternational Alliance for Control of Scabies (IACS)\u003c/li\u003e\n \u003cli\u003eNeglected Tropical Diseases (NTDs)\u003c/li\u003e\n \u003cli\u003eNorthern Territory (NT)\u003c/li\u003e\n \u003cli\u003eAboriginal Community-Controlled Health Organisation (ACCHO)\u003c/li\u003e\n \u003cli\u003eMala\u0026rsquo;la Health Service Aboriginal Corporation (MHAC)\u003c/li\u003e\n \u003cli\u003eAboriginal Community Worker (ACW)\u003c/li\u003e\n \u003cli\u003eRemote Area Nurse (RAN)\u003c/li\u003e\n \u003cli\u003eMass drug administration (MDA)\u003c/li\u003e\n \u003cli\u003eResearch Electronic Data Capture (REDCap)\u003c/li\u003e\n \u003cli\u003eAdjusted Odds Ratios (aOR)\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study was endorsed by the Mala\u0026rsquo;la Health Board, and granted ethics approval by the Northern Territory Department of Health Human Research Ethics Committee (HREC 2022-4276).\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eConsent for publication\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and following approval from the MHAC board.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eCompeting interests\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eFunding\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eVC and JF were principal investigators in receipt of a project grant from the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (ACE-NTDs) to support a scabies control project in northern Australia. VC was in receipt of funding from the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (ACE-NTDs) through a PhD scholarship, the Commonwealth Government with a Research Training Program (RTP) scholarship and a PhD scholarship from the HOT NORTH Centre for Research Excellence. The funding source had no involvement in the conceptualisation, study design, data collection, analysis, decision to publish, or preparation of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eVictoria RV Cox:\u0026nbsp;\u003c/strong\u003eData curation, Funding acquisition, Formal analysis, Investigation, Methodology, Resources, Writing \u0026ndash; original draft preparation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJessica Gatti:\u0026nbsp;\u003c/strong\u003eConceptualisation, Funding acquisition, Resources, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValda Bokmarkarry:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKurt Brown:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJayden Smith:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNatasha Bond:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEileen Gunaburra:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAna Malupo:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJennifer P Yan:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDaniel Engelman:\u0026nbsp;\u003c/strong\u003eConceptualisation, Funding acquisition, Resources\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBart J Currie:\u0026nbsp;\u003c/strong\u003eConceptualisation, Funding acquisition, Supervision, Methodology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJoshua R Francis:\u0026nbsp;\u003c/strong\u003eConceptualisation, Data curation, Funding acquisition, Investigation, Methodology, Resources, Supervision, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eAcknowledgements\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe acknowledge the contribution of key community members, healthcare workers from the Mala\u0026rsquo;la Health Service Aboriginal Corporation, and the Mala\u0026rsquo;la Health Board for their cultural leadership and guidance, as well as the clinic manager and Director of Medical Services for their support of this project and ongoing collaboration. We acknowledge the importance of work conducted by One Disease, in particular Michelle Dowden and Meg Scolyer. We would also like to recognise the effort of medical practitioners in the study team who undertook skin checks and data entry: Daniel Cordas, Tayler Cosentino, Charlotte Cox, Robert Duguid, Catherine Fowler, Alexander Matthews, Nerida Moore and James White. We thank Dr Austen Anderson and Dr Crystal Williams for their support of Healthy Skin Week and the Australasian College of Dermatologists through the FATES program. We are grateful for use of the training materials and written clinical exam provided by the World Scabies Program. We thank Zhiqiang Wang for his advice and support in developing the statistical methods and methodological approach for this project.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eAuthors\u0026apos; information\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eCorresponding author: Dr Victoria RV Cox\u003c/p\u003e\n\u003cp\u003eMenzies School of Health Research, JMB Building,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRoyal Darwin Hospital, 105 Rocklands Drive TIWI NT 0810\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organisation. Recognizing neglected tropical diseases through changes on the skin: a training guide for front-line health workers. Geneva, Switzerland: World Health Organisation; 2018 1st June.\u003c/li\u003e\n\u003cli\u003eThomas L, Bowen AC, Ly M, Connors C, Andrews RM, Tong SY. 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British Journal of Dermatology. 2020;183(5):808-20.\u003c/li\u003e\n\u003cli\u003eTsoi SK, Lake SJ, Thean LJ, Matthews A, Sokana O, Kama M, et al. Estimation of scabies prevalence using simplified criteria and mapping procedures in three Pacific and southeast Asian countries. BMC Public Health. 2021;21(1):2060.\u003c/li\u003e\n\u003cli\u003eAustralian Bureau of Statistics. Maningrida. Canberra: Australian Bureau of Statistics; 2023 [20th June 2023]. Available from: https://www.abs.gov.au/census/find-census-data/quickstats/2021/ILOC70400301.\u003c/li\u003e\n\u003cli\u003eWest Arnhem Regional Council. Maningrida. Jabiru, Northern Territory: West Arnhem Regional Council; 2024 [Available from: https://www.westarnhem.nt.gov.au/our-communities/maningrida.\u003c/li\u003e\n\u003cli\u003eMatthews A, Le B, Amaral S, Arkell P, Monteiro M, Clarke N, et al. Prevalence of scabies and impetigo in school-age children in Timor-Leste. Parasites \u0026amp; Vectors. 2021;14(1):156.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u0026apos;Neal L, et al. The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics. 2019;95:103208.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)\u0026mdash;A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics. 2009;42(2):377-81.\u003c/li\u003e\n\u003cli\u003eCentral Australia Rural Practitioners Association (CARPA). CARPA Standard Treatment Manual. 8th Edition ed. Alice Springs, Northern Territory: Flinders University; 2022. 548 p.\u003c/li\u003e\n\u003cli\u003eThe Australian Healthy Skin Consortium. National Healthy Skin Guideline: for the Diagnosis, Treatment and Prevention of Skin Infections for Aboriginal and Torres Strait Islander Children and Communities in Australia - 2nd edition. Perth, Western Australia: Telethon Kids Institute; 2023.\u003c/li\u003e\n\u003cli\u003eShelby-James TM, Leach AJ, Carapetis JR, Currie BJ, Mathews JD. Impact of single dose azithromycin on group A streptococci in the upper respiratory tract and skin of Aboriginal children. Paediatric Infectious Diseases Journal. 2002;21:375-80.\u003c/li\u003e\n\u003cli\u003eTasani M, Tong SYC, Andrews RM, Holt DC, Currie BJ, Carapetis JR, et al. The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo. The Pediatric Infectious Diseases Journal. 2016;35(4):347-8.\u003c/li\u003e\n\u003cli\u003eRomani L, Koroivueta J, Steer AC, Kama M, Kaldor JM, Wand H, et al. Scabies and Impetigo Prevalence and Risk Factors in Fiji: A National Survey. PLoS Neglected Tropical Diseases. 2015;9(3):e0003452.\u003c/li\u003e\n\u003cli\u003eRomani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, et al. The Epidemiology of Scabies and Impetigo in Relation to Demographic and Residential Characteristics: Baseline Findings from the Skin Health Intervention Fiji Trial. The American Journal of Tropical Medicine and Hygiene. 2017;97(3):845-50.\u003c/li\u003e\n\u003cli\u003eCurrie BJ. Scabies and Global Control of Neglected Tropical Diseases. New England Journal of Medicine. 2015;373(24):2371-2.\u003c/li\u003e\n\u003cli\u003eOsti MH, Sokana O, Phelan S, Marks M, Whitfeld MJ, Gorae C, et al. Prevalence of scabies and impetigo in the Solomon Islands: a school survey. BMC Infectious Diseases. 2019;19(1):803.\u003c/li\u003e\n\u003cli\u003eWiegele S, McKinnon E, van Schaijik B, Enkel S, Noonan K, Bowen AC, et al. The epidemiology of superficial Streptococcal A (impetigo and pharyngitis) infections in Australia: A systematic review. PloS ONE. 2023;18(11):e0288016.\u003c/li\u003e\n\u003cli\u003eCarapetis JR, Johnston F, Nadjamerrek J, Kairupan J. Skin sores in Aboriginal children. Journal of Paediatrics and Child Health. 1995;31(6):563.\u003c/li\u003e\n\u003cli\u003eEngelman D, Fuller LC, Steer AC. Consensus criteria for the diagnosis of scabies: A Delphi study of international experts. PLoS Neglected Tropical Diseases. 2018;12(5):e0006549.\u003c/li\u003e\n\u003cli\u003eCommonwealth of Australia. National Indigenous Australians Agency, National Partnership on Northern Territory Remote Aboriginal Investmen: End of Term Review. Canberra: Commonweatlh of Australia; 2022.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-global-and-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Global and Public Health](https://bmcglobalpublichealth.biomedcentral.com/)","snPcode":"44263","submissionUrl":"https://submission.springernature.com/new-submission/44263/3","title":"BMC Global and Public Health","twitterHandle":"@BMC_GPH","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Scabies, impetigo, skin disease, neglected tropical diseases, northern Australia, disease mapping, surveillance","lastPublishedDoi":"10.21203/rs.3.rs-6832896/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6832896/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Scabies is a Neglected Tropical Disease with skin manifestations caused by a parasitic mite. It can lead to secondary complications which cause significant morbidity and mortality. The prevalence of scabies in remote Aboriginal communities is believed to be among the highest in the world but no recent prevalence assessments have been conducted in northern Australia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An observational cross-sectional prevalence assessment was conducted in a remote Aboriginal community in the Northern Territory, as part of a community health initiative led by the local Aboriginal Community-Controlled Health Organisation. Community residents and visitors of all ages were eligible to undergo a simplified skin assessment following verbal consent. Scabies was diagnosed when residents had 3 or more typical skin lesions in a typical body distribution, based on International Alliance for Control of Scabies (IACS) consensus criteria. Treatment of skin disease was according to national clinical guidelines with support from the local healthcare centre.The prevalence of scabies and other skin disease was estimated. To consider whether scabies prevalence was associated with underlying sociodemographic factors or co-infection with another skin disease, adjusted odds ratios were calculated with binomial 95% confidence intervals based on multivariate logistic regression with robust standard errors. Statistical significance was achieved when p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 1353 people from a remote Aboriginal community of approximately 3800 residents underwent a complete simplified skin assessment. The prevalence of scabies was 25.4% (344/1353, 95%CI=23.1-27.7) and 698 people (51.6%, 95%CI=48.4-53.8) had at least one skin disease identified during the study period. On multivariate analysis, young children aged 0–1 year had the highest prevalence of scabiesand an increased risk of scabies (59.4%, aOR=6.22, p\u0026lt;0.001; 95%CI=2.41-16.09).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The prevalence of scabies in this remote Aboriginal community was very high, especially in young infants. Community-led strategies are required to address the burden of scabies, impetigo and their sequelae.\u003c/p\u003e","manuscriptTitle":"High prevalence of scabies and common skin disease in an Aboriginal community in the Northern Territory: results of a population-based screening study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 09:59:11","doi":"10.21203/rs.3.rs-6832896/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-17T15:37:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-15T09:45:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90385990374438402823409884579089988043","date":"2025-06-30T08:28:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-28T17:22:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199168355044249243025037579319414963485","date":"2025-06-22T08:48:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T22:38:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-06T06:08:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-06T06:06:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Global and Public Health","date":"2025-06-06T02:30:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-global-and-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Global and Public Health](https://bmcglobalpublichealth.biomedcentral.com/)","snPcode":"44263","submissionUrl":"https://submission.springernature.com/new-submission/44263/3","title":"BMC Global and Public Health","twitterHandle":"@BMC_GPH","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c6d32ffe-8241-49af-a9bc-788d671d0194","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2025-07-17T15:53:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 09:59:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6832896","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6832896","identity":"rs-6832896","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}