Prevalence and associated factors of scabies among school going children in Khulna division: a comparative cross-sectional study between schools and madrasahs (Islamic religious schools)

Abstract

Scabies is a neglected tropical disease mostly affecting children in low-resource environments causing bodily and mental suffering, social stigma and school absenteeism. 394 randomly chosen school and madrasa-going children in Bangladesh’s Kushtia District, ages 5–17, participated in this cross-sectional study. The International Alliance for the Control of Scabies criteria were used to diagnose scabies. Overall, the prevalence was (40.35%; 159/394). Madrasa students had higher prevalence (51.3%; 90/176) than school students (31.65%; 69/218). Poverty, overcrowding, poor housing, irregular bathing, sharing personal items and close contact with affected individuals were key associated factors. Targeted context-specific interventions are urgently needed.

Scabies is an infestation of the skin by the mite Sarcoptes scabiei var. hominis, affecting more than 200 million people globally and ranking among the most prevalent ectoparasitic skin diseases worldwide.¹ Scabies is recognised by WHO as a neglected tropical disease in resource-limited settings. Therefore, the International Alliance for the Control of Scabies was established in 2013, and scabies were included in the list of Neglected Tropical Diseases by the WHO in 2017 due to their very high public health burden.^{2 3} Beyond itching and skin lesions, scabies contributes to sleep disturbance, secondary bacterial infections, social stigma, impaired mental well-being and loss of school days, ultimately affecting children’s educational performance and quality of life. In Bangladesh, scabies remains highly prevalent, particularly among children living in overcrowded and resource-poor environments. Previous studies have largely focused on single educational settings, especially madrasas and orphanages,^{4 5} limiting comparative understanding. We therefore assessed scabies prevalence and associated factors among children attending both schools and madrasas in Kushtia district.

We conducted a cross-sectional study between April and May 2024 using a two-stage random sampling technique. First, 5 schools and 5 madrasas were selected from Khulna division (3 rural and 2 urban in each group), followed by random selection of 394 students aged 5–17. Scabies was identified using the International Alliance for the Control of Scabies (IACS) diagnostic criteria.² Sociodemographic, environmental and hygiene-related variables were collected via face-to-face interviews. Bivariate associations were tested using χ², and variables with p value <0.05 were entered into multivariable logistic regression to estimate adjusted odds ratio (aORs) and 95% CIs.

The overall prevalence of scabies was (40.35%; 159/394), with markedly higher prevalence among madrasa students compared with school students (51.3%; 90/176 vs 31.65%; 69/218) (Figure). Among the participants, 66.8% were male and 56.1% were older than 12 years. Slightly more than half studied in schools (55.3%) and lived in rural areas (53.3%). Most were in secondary education (64.5%), belonged to middle-income families (51.5%) and lived in nuclear families (71.6%). Tin-shed houses were common (60.7%), as was animal presence (51.0%). Shared sleeping and household crowding were also frequent. Regarding hygiene, 59.6% bathed once daily, 61.2% used soap and 63.5% shared personal items. Notably, 50.8% reported having a family member with skin rash, suggesting substantial household-level exposure to skin conditions (online supplemental file 1). Overall, scabies risk was higher among students from poorer households (aOR=3.07, 95% CI 1.48 to 6.36) and was associated with close contact with individuals with skin rashes (aOR=1.84, 95% CI 1.13 to 3.01), living in tin-shed houses (aOR=1.91, 95% CI 1.13 to 3.24), animal presence around the living place (aOR=1.67, 95% CI 1.02 to 2.73), irregular bathing (aOR=2.82, 95% CI 1.72 to 4.60) and sharing personal items (aOR=1.85, 95% CI 1.10 to 3.09). Among madrasa students, male sex (aOR=2.41, 95% CI 1.02 to 5.93), tin-shed housing (aOR=3.07, 95% CI 1.39 to 6.75), animal presence (aOR=2.46, 95% CI 1.19 to 5.08), irregular bathing (aOR=2.12, 95% CI 1.02 to 4.51) and close contact with skin rash cases (aOR=2.97, 95% CI 1.41 to 6.23) were significant. Among school students, scabies was strongly associated with poverty (aOR=6.06, 95% CI 2.12 to 20.60), irregular bathing (aOR=2.24, 95% CI 1.03 to 4.83), sharing personal items (aOR=3.37, 95% CI 1.48 to 7.71), rural residence (aOR=2.32, 95% CI 1.10 to 4.95) and household size >4 members (aOR=2.20, 95% CI 1.04 to 4.74) (table 1).

Table 1. Factors associated with scabies.

Overall		Madrasa		School
Variable	aOR (LL-UL)	Variable	aOR (LL-UL)	Variable	aOR (LL-UL)
Wealth Index		Gender		Age group
Poor vs rich*	3.07† (1.48–6.36)	Male vs female*	2.46† (1.02–5.93)	≤12 vs >12*
Middle class vs rich*	0.97 (0.51–1.86)
Skin rash in close people		Father’s education		Sleeping status
Yes vs no*	1.84† (1.13–3.01)	Illiterate vs HSC & higher*	1.911 (0.779–4.691)	Alone vs two or more*	0.66 (0.281–1.584)
Education type		Primary & SSc vs HSC & higher*	1.206 (0.416–2.531)	With one vs two or more*	1.18 (0.468–3.02)
School vs madrasa*	0.68 (0.41–1.14)
Sleeping status		Wealth Index		Wealth Index
Alone vs two or more*	0.91 (0.50–1.67)	Poor vs rich*	2.28 (0.751–6.977)	Poor vs rich*	6.606† (2.116–20.604)
With one vs two or more*	0.96 (0.52–1.17)	Middle class vs rich*	1.067 (0.407–2.802)	Middle class vs rich*	1.078 (0.395–2.942)
Building type		Building type		Building type
Tin vs roof*	1.91† (1.13–3.24)	Tin vs roof*	3.07† (1.39–6.75)	Tin vs roof*	1.115 (0.507–2.452)
Animal presence		Animal presence		Toilet usage
Yes vs no*	1.6† (1.02–2.73)	Yes vs no*	2.46† (1.194–5.077)	>4 vs ≤4*
Bathing frequency		Bathing frequency		Bathing frequency
Irregularly vs regularly*	2.82† (1.72–4.60)	Irregularly vs regularly*	2.12† (1.018–4.512)	Irregularly vs regularly*
Sharing stuff		Skin rash in close people		Sharing stuff
Yes vs no*	1.85† (1.10–3.09)	Yes vs no*	2.97† (1.41–6.23)	Yes vs no*
Place of residence				Place of residence
Urban vs rural*	0.64 (0.98–1.09)	–	–	Rural vs urban*
Number of family members				Education level
≤4 vs >4	0.85 (0.51–1.42)	–	–	Primary vs secondary*	1.58 (0.495–5.04)
Toilet usage		–	–	Number of family members
≤4 vs >4	0.60 (0.35–1.02)	–	–	>4 vs ≤4*	2.20† (1.04–4.74)
Hosmer-Lemeshow: χ2=1.862, p value=0.985	Negelkerke R2=0.349	Hosmer-Lemeshow: χ2=9.306, p value=0.317	Negelkerke R2=0.330	Hosmer-Lemeshow: χ2=2.53, p value=0.960	Negelkerke R2=0.435

^*Reference case.

^†5% level of significance.

aOR, adjusted odds ratio; HSC, Higher Secondary Certificate; LL, lower limit; SSc, Secondary School Certificate; UL, upper limit.

The higher burden observed in madrasas likely reflects dense living conditions, shared facilities, and limited access to health education and preventive services. Evidence from other endemic settings suggests that school-based screening, health education and community-level treatment strategies can reduce transmission.⁶ Unfortunately, currently there is no government programme in place to eliminate scabies in Bangladesh. This study is limited by its cross-sectional design and reliance on point-prevalence diagnosis, which may underestimate mild or transient cases. Nevertheless, by comparing two major educational settings, it provides insights into inequities in scabies burden among Bangladeshi children. In conclusion, scabies remains highly prevalent among school-aged children in Bangladesh, particularly in madrasas. Addressing poverty, overcrowding and hygiene practices through targeted public health interventions could substantially reduce disease burden and its adverse educational and health consequences.