Beliefs, attitudes and practices towards scabies in central Ghana.

Background: Scabies commonly affects poor populations in low-middle-income countries. The WHO has advocated for country-driven and country-owned control strategies. Knowledge of context specific issues will be important for design and implementation of scabies control interventions. We aimed to assess beliefs, attitudes and practices towards scabies in central Ghana. Methodology/Principal findings: Data was collected via semi-structured questionnaires for people who had active scabies or scabies in the past year and people who never had scabies in the past. The questionnaire covered several domains: knowledge about the causes and risk factors; perceptions towards stigmatisation and consequences of scabies in daily life; and treatment practices. Out of 128 participants, 67 were in the (former) scabies group and had a mean age of 32.3 ± 15.6 years. Overall scabies group participants less often indicated a factor to predispose to scabies than community controls; only 'family/friends contacts' was more often mentioned in the scabies group. Scabies causation was attributed to poor hygiene, traditional beliefs, heredity and drinking water. Individuals with scabies delay care seeking (median time from symptom onset to visiting the health centre was 21 [14 – 30] days) and this delay is enhanced by their beliefs (like witchcraft and curses) and a perception of limited disease severity. Compared to past scabies participants in the dermatology clinic, participants with past scabies in the community tended to have a longer delay (median [IQR] 30 [14–48.8] vs 14 [9.5–30] days, p = 0.002). Scabies was associated with health consequences, stigma, and loss of productivity. Conclusion/Significance: Early diagnosis and effective treatment of scabies can lead to persons less frequently associating scabies with witchcraft and/ or curses. There is the need to enhance health education to promote early care seeking, enhance knowledge of communities on impact and dispel negative perceptions about scabies in Ghana. Author summary: Scabies, a skin Neglected Tropical Disease (NTD) characteristically causes an intensely pruritic rash. Scabies commonly affects individuals living in poor, overcrowded communities with limited access to healthcare. Integrated control of skin NTDs requires an understanding of local context issues. We explored understanding, beliefs and care seeking behaviours towards scabies in central Ghana. We found that individuals with scabies delay care-seeking and this delay is enhanced by their beliefs and a perception of limited disease severity. Compared to past scabies participants in the dermatology clinic, participants with past scabies in the community tended to have a longer delay. Participants in the scabies group recruited from community were more likely to associate the disease with curses, witchcraft, heredity or drinking water, than those recruited from the dermatology clinic. Scabies was associated with health consequences, stigma, and loss of productivity. Early diagnosis and effective treatment of scabies can lead to persons less frequently associating scabies with supernatural forces and promote care-seeking in the formal health system. Health education to promote awareness and early care-seeking is essential to dispel negative perceptions about scabies in Ghana. Further, health systems should be capacitated to adequately treat affected individuals and their contacts to facilitate scabies control. [ABSTRACT FROM AUTHOR]