Research Article: Scabies outbreak management in refugee/migrant camps in Europe 2014–2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives
Abstract:
Objectives Provide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014–2017. Design Retrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings. Setting Formal and informal refugee/migrant camps in Europe 2014–2017. Participants Twelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium). Results Participants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid). Conclusions We recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.
Introduction:
Scabies is a stigmatised contagious skin condition caused by infestation with the mite Sarcoptes scabiei . 1 Transmission is mainly skin-to-skin, less commonly via fomites such as bedding. 2 Evidence from epidemiology and experimental trials indicates scabies prevalence is probably not influenced by levels of personal body washing. 3 Symptoms begin 3–6 weeks after first infestation, as early as 1?day after reinfestation. 4 Secondary bacterial infections are common, 5 6 with potential for serious long-term health…
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