Improving Scabies Management for the Internally Displaced In Tigray, Ethiopia

Tigray, Ethiopia - The International Organization for Migration (IOM) has been leading efforts to meet the health needs of internally displaced people (IDPs) and host communities in Northern Ethiopia since conflict broke out in November 2020. 
The Organization’s mobile health and nutrition team (MHNT) provided health services, working closely with the mental health and psychosocial support (MPHSS) services team.  

Between July 2021 and March 2022, IOM’s Health team conducted 70,899 consultations working in nine IDP locations in Tigray. They also conducted health education sessions for 288,420 people and gave 9,730 instances of sexual and reproductive health (SRH) services. A scabies outbreak was observed during this time at the Tsehaye IDP fixed clinic in Shire and the Sabacare IDP site in Mekelle, with 1,794 cases treated. 

Scabies is a parasitic infestation caused by Sarcoptes scabiei var hominis. The contagious skin disease is transmitted by small human itch mites, that cause rash and severe itchiness, with the World Health Organization (WHO) in 2017 listing scabies as one of the Neglected Tropical Diseases (NTDs). Although scabies is a prevalent problem worldwide, it particularly affects populations that are already at risk, such as displaced persons living in camps and other densely populated areas. 

WHO currently recommends administering scabies medications in large quantities when prevalence in a community is greater than 10 per cent. Treatment with either oral ivermectin or topical permethrin 5% is frequently used in mass drug administration (MDA) for scabies regimens. In this case, the population lacked awareness about the disease and how to prevent and control infection. Additionally, infection prevention supplies for scabies were unavailable due to the prolonged blockade of the region due to the armed conflict, with the health regional health bureau in Tigray having approved the use of available, but expired, permethrin 5% in its health facilities. 

The MHNT used a variety of prevention and control measures in the region, including campaigns that disseminated information about the disease to lessen the spread of the scabies infection in all IDPs locations. Representatives of the IDPs participated in open group talks, and door-to-door case tracking was used to isolate infected individuals. 

Linen and clothes belonging to scabies infected individuals and their close contacts were also steamed or boiled. Additionally, scabies-infected people in IDP sites and health centres were closely monitored while receiving treatment and counselling.  

To prevent the further spread of the infection, health and WASH teams also delivered jerricans, blankets, and multipurpose soap to the impacted populations, with 18,550 laundry and bathing soaps distributed in Sabacare in May 2022. Health professionals performed physical inspections throughout the distribution, identifying 203 cases of scabies, and treating them with Benzyl Benzoate acid lotion (BBE).

“During the physical examinations we identified cases that required pyschosocial counseling and referred them to our MHPSS counselors in Sabacare. During the disbribution we also faced the challenge of IDPs requesting extra soap than was available,” said Amelest Geberu, IOM Health Assistant in Mekelle. 
Over 1,960 IDPs also received capacity-building training on how to implement the Mass Drug Administration approach and standard treatment for scabies epidemics. The number of patients visiting the clinic grew, and there was an improvement in community awareness.
Around 1,080 (5%) of the 19,080 suspected cases who underwent skin infection screening in the six months at the Sabacare health centre tested positive for scabies. In the meantime, slightly over 1,700 scabies cases and their contacts were treated at the fixed health clinics in Mekelle and Shire.
IOM's health activities in Tigray were made possible thanks to generous support from the Ethiopia Humanitarian Fund (EHF) and the Centers for Disease Control and Prevention(CDC).

For more information contact Albert Kiprotich Ngetich angetich@iom.int and Eric Mazango emazango@iom.int