Scabies and podoconiosis: Entry points to demonstrate the feasibility of community based interventions for skin neglected tropical diseases

Neglected tropical diseases (NTDs) are poverty related, impactful diseases that are endemic in low and middle income countries. WHO promotes integrated and community-based approaches to control NTDs. Integration is defined as “combining activities aiming at two or more diseases at the same time and in the same communities with the aim of increasing efficiency”. Each region and country may contextualize the approach to the existing regional or local co-endemicity of NTDs. Within the cluster of NTDs, skin NTDs relate to dermatological diseases, either as the primary presentation or as a related clinical feature. Eighteen of the twenty NTDs have well-known skin manifestations. Skin NTDs often present with disfigurement, physical disability, stigmatization, discrimination, and psycho-social suffering. The overall aim of this thesis is to generate critical evidence for community-based interventions of skin NTD. We use scabies as a model that is amenable with Preventive Chemotherapy, and podoconiosis (a genetically determined inflammatory reaction to certainsoils, causing irreversible lymphedema of the legs, and disability) as an NTD that requires a Morbidity Management and Disability Prevention program. In the absence of trained physicians, transfer of clinical tasks to primary health care workers for the commonest skin conditions is essential. We demonstrated that the expansionof dermatological services to primary health care units can facilitate integrated management of NTDs in general. We used the work on scabies and podoconiosis to demonstrate the importance of decentralized dermatology services, and increased community-level capacity to improve access and community-based integrated interventions of skin NTDs.