Descriptive epidemiology
We line listed 2,236 suspected scabies cases in Hoima District from January 2021 to July 2022. The overall attack rate of scabies in Hoima District was 21/1,000 population with no deaths. Children 5 to 14 years old were the most affected (64/1,000), followed by children <5 years (36/1,000), and least affected was persons ≥15 years (8/1,000). Males (27/1,000) were more affected than females (15/1,000).
The epidemic curve of the scabies outbreak in Hoima District showed peaks in the number of scabies cases from January to May in 2021 and February to June in 2022. Although the outbreak in 2022 started in February, the Ministry of Health was alerted on May 28, 2022 (Figure 1).
The epidemic curve for Rwentale village, Buseruka sub-county (the most affected area), Hoima District revealed a propagated outbreak with probable periods of exposure occurring between February 26 to March 5, 2022. This coincided with the peak fishing and trading activity which occurs from early February to April (Figure 2).
In Hoima District, Buseruka Sub-county, which has the principal landing site, had the highest attack rate (97/1,000) (Figure 3A, 3B).
Of the seven villages in Buseruka sub-county, Rwentale landing site village was most affected (A/R 233/1,000 persons), followed by Fofo (205/1,000 persons), Kyakaboga B (111/1,000 persons), Resettlement (50/1,000 persons), Hoimo (11/ 1,000 persons), Tonya B (7/1,000 persons), and Kyakaboga A (6/1,000 persons).
Hypothesis generation interview findings
Key informant interview findings
Three major themes emerged as drivers for the scabies outbreak in Rwentale Village: poor personal hygiene, increased interaction during business seasons, and sharing personal care items.
Increased human interaction during business seasons
The participants provided qualitative information on the link between increased scabies cases and peak fishing and trading months. They said that during this time, there are many people that gather from different areas and this was likely why the cases increased.
A participant noted, “You see, during the business season, when the fishing season comes, many people come here, some come with the disease… people mix a lot… that is why I think the people with this disease are many now.” Village leader
Poor personal hygiene
The participants said that there were increased cases due to poor personal cleanliness. They believed that the illness was from organisms in the soil and dirty water. Thus, persons that did not bathe regularly, wash their clothes, or had dirty hair likely harboured the organism.
A participant noted, “It is this tribe X who do not bathe, they never wash their clothes… even when they bathe, they use water from the lake which has the organism that brings this disease.” Village leader, Rwentale Village
Sharing personal care items
The participants noted that sharing personal care items was likely a driver of the outbreak.
A participant said, “Our people are very communal people, they share everything.. even towels, basins. As they share these things, they pass on the parasite to other people” Healthcare worker
Structured interview findings
Of the 10 case-persons interviewed, 9 (90%) reported sharing personal care items, 8 (80%) had poor personal hygiene, 8 (80%) had been infested with scabies before, and 8 (80%) had visitors during February to March (the peak fishing and trading months).
We hypothesized that having visitors during the peak fishing and trading seasons, poor personal hygiene and sharing personal care items were associated with case status.
Case-control study findings
The case-control study had 101 cases and 99 controls. Among the cases, 40 (39.6%) and compared to 77(78.6%) of controls were 15 years or older. In multivariable analysis, being aged <5 years (OR=4.2, 95%CI: 1.7-10) and 5 to 14 years (AOR=4.9, 95%CI: 2.0-12), having shared four personal items compared to two (AOR=8.9, 95%CI: 2.2-36.2), being male (AOR=2.4, 95%CI: 1.1-5.1), and having a previous scabies diagnosis (AOR=3.1, 95%CI: 1.5-6.2) were associated with case-status (Table 2).
Table 2: Factors associated with Scabies Infestation among residents of Rwentale Village, Hoima District, June 2022
Characteristic
|
Cases (n=101)
|
Controls (n=99)
|
COR
|
CI
|
AOR
|
CI
|
|
n
|
(%)
|
n
|
(%)
|
|
|
|
|
Visitors- Feb to Jun
|
|
|
|
|
|
|
|
No
|
57
|
(56.4)
|
54
|
(55.7)
|
1
|
|
1
|
|
Yes
|
44
|
(43.6)
|
43
|
(44.3)
|
1.0
|
0.6-1.7
|
0.7
|
0.3-1.5
|
Age category
|
|
|
|
|
|
|
|
<5
|
32
|
(31.7)
|
11
|
(11.2)
|
5.6
|
2.6-12.3*
|
4.2
|
1.7-10.2*
|
5 to 14
|
29
|
(28.7)
|
10
|
(10.2)
|
5.6
|
2.5-12.6*
|
4.9
|
2.0-12.0*
|
>=15
|
40
|
(39.6)
|
77
|
(78.6)
|
1
|
|
1
|
|
Sex
|
|
|
|
|
|
|
|
|
Female
|
55
|
(54.5)
|
82
|
(82.8)
|
1
|
|
1
|
|
Male
|
46
|
(45.5)
|
17
|
(17.2)
|
4.0
|
2.1-7.8*
|
2.4
|
1.1-5.1*
|
Personal hygiene
|
|
|
|
|
|
|
|
Good
|
62
|
(61.4)
|
65
|
(65.7)
|
1
|
|
1
|
|
Poor
|
39
|
(38.6)
|
34
|
(34.4)
|
0.8
|
0.5-1.5
|
1.3
|
0.6-2.9
|
Number of shared personal care items
|
|
|
|
|
|
|
<2 items
|
43
|
(42.6)
|
65
|
(65.7)
|
1
|
|
1
|
|
≥3 items
|
52
|
(51.5)
|
28
|
(28.3)
|
2.8
|
1.5-5.1*
|
2.2
|
1.1-4.6*
|
Living with a scabies case-person in the same house
|
|
No
|
41
|
(40.6)
|
74
|
(75.5)
|
1
|
|
1
|
|
Yes
|
60
|
(59.4)
|
24
|
(24.5)
|
4.5
|
2.5-8.3*
|
3.1
|
1.5-6.2*
|
*p<0.05, COR- crude odds ratio, AOR- adjusted odds ratio, Hosmer Lemeshow test, p=0.395