Scabies prevalence and risk factors in internally displaced persons in Hargeisa, Somaliland: a cross-sectional survey

Résumé

Background Scabies is a major public health concern in displaced populations due to overcrowding and poor sanitation. Despite high prevalence in neighboring countries, no epidemiological data exist from Somaliland. This study aimed to determine scabies prevalence and identify risk factors among internally displaced persons (IDPs) in Hargeisa, Somaliland. Methods A community-based cross-sectional survey was conducted among 362 residents of three IDP settlements, selected via stratified random sampling. Cases were classified using the 2020 International Alliance for the Control of Scabies (IACS) consensus criteria: laboratory confirmation (microscopy), probable (clinical signs plus history), suspected (clinical signs or contact), and non-case. Data on sociodemographics, living conditions, and behaviors were collected via interviews. Multivariable logistic regression identified factors associated with clinically significant scabies (confirmed + probable cases). Results The prevalence of laboratory-confirmed scabies was 0.8% (3/362). Using clinical criteria, an additional 18.2% (66/362) were probable and 32.9% (119/362) suspected cases, indicating a substantial hidden burden. Factors independently associated with scabies included direct contact (sharing a bed with an infested person: aOR 16.42, 95% CI 5.99–45.00; sharing clothes: aOR 9.85, 4.24–22.89), household crowding (≥3 persons/room: aOR 2.74, 1.44–5.23), environmental deprivation (distant water source: aOR 3.41, 1.86–6.24), and financial/transport barriers to healthcare (aOR 11.24, 5.78–21.85). A novel, strong association with anemia was also observed (aOR 3.68, 1.89–7.16). Personal hygiene practices were not significantly associated. Conclusion Scabies is a significant public health problem among Somaliland IDPs, driven by structural and poverty-related factors rather than hygiene. The low rate of laboratory confirmation highlights a major gap in surveillance. Integrated interventions must address overcrowding, improve healthcare access, and consider nutritional support alongside case management to achieve sustainable control.

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