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An endemic of scabies in Kahuta, Azad Kashmir. The study shows a lack of awareness of scabies; mass treatment is needed.

Byline: Afaque Ali


The study was planned to find the awareness of scabies in the Forward Kahuta area of Azad Jammu and Kashmir, Pakistan. For this, a questionnaire related to scabies was distributed among the patients at different walk-in clinics in the region from June 2015 to May 2016. Of the 234 participants, 97(41.5%) were males and 137(58.5%) were females. All of them reported with itching, but 120(51.3%) of the participants didn't even know that itching may be due to scabies which was found in 157(67%) patients, and of them, 106(67.52%) knew that scabies was curable and preventable. Scabies was found in common school students (n=39(24.84%), farmers (n=32(2.38%) and laborers (n=31(19.74%). Due to poor awareness, a multi-dimensional approach is suggested to spread the awareness of skin diseases like scabies in the population under study and mass treatment of scabies in the area is recommended.

Keywords: Scabies, Awareness, Itch, Kashmir, Pakistan, Azad Kashmir, Forward Kahuta, District Haveli.


Scabies is an intensely pruritic skin eruption caused by Sarcoptes scabiei, also called itch mite. Though the prevalence of scabies varies around the world, it has been estimated to be in the range of 0.27% to 46%.1 It has been estimated that about 300 million people suffer from scabies every year. Scabies has been found common in many studies conducted in different areas in the northern region of Pakistan.2,3 Resource-poor communities around the world have a prevalence of 20% or even higher.4

Scabies usually presents as severe itching which worsens at night.5 The factor affecting transmission includes poor hygiene, overcrowding and social attitude.4 People of all age groups can get infected, and it can impair quality of life significantly; the indirect effects of complications on the kidney are even greater.6 Azad Jammu and Kashmir (AJK) is a resource-poor region of Pakistan. Most of the population is a daily wager, lies in the low socio-economic group and works in the field or meadows.

The current study was conducted to assess awareness of scabies in the District Haveli region of Azad Kashmir where the disease was endemic.

Patients and Methods

This cross-sectional study was conducted from June 2015 to May 2016 in Nezapir and Mandhar villages, District Haveli of AJK, Pakistan, having a population of about 0.112 million according to the last census. All patients who visited two walk-in clinics of the area were included in the study regardless of gender and age. No such study had been conducted in this part of AJK before. A questionnaire was designed which included questions regarding scabies and was distributed among the patients to be filled by them. A descriptive analysis of the collected data was performed. Informed consent was taken from all participants who were also examined for skin disease. SPSS 22 was used for data analysis.

Results and Discussion

Of the 234 participants, 97(41.5%) were males and 137(58.5%) were females. The mean age was 3115.89 years and mean family size was 6.62.14 years. Also, 151(64.5%) participants were illiterate having no formal education and unable to read or write. All the patients presented with itching and rashes.

It was found that 157(67.1%) participants were suffering from scabies and they mentioned that they had got it diagnosed from the general physician. This incidence rate was approximately close to other documented incidence rates, i.e. above 45%, in different parts of the country.7,8 Of the participants, 198(84.6%) had a family size of five or larger, living in one-or two-room houses. This overcrowding may be a contributory factor,4 though many studies negate this factor.3,9 Further, 120(51.3%) participants didn't even know that itching may be due to scabies. Of the 77(32.9%) participants who were not suffering from scabies at the time of the study, 14(18.2%) claimed that they had suffered from scabies earlier and were given medication at different medical facilities. Scabies was common among participants of all education levels from illiterates to graduates (p>0.05). The majority of the participants had an education level below secondary education.

Besides, 83(35.5%) participants had no formal education; of them, 52(62.65%) were suffering from scabies. Similarly, 140 participants had an education level up to secondary level and had some school education (i.e. able to read or write); of them, 97(69.29%) were suffering from active scabies. Out of the 10(4.3%) participants who had higher secondary education, 7(70%) were suffering from active scabies. The 1(0.4%) participant who was a graduate also had the disease. The most alarming thing we found was that the majority of the patients suffering from scabies didn't know the mode and duration of transmission of scabies, its prevention, and treatment. None of the participants mentioned the mode of spread of scabies. Knowledge about spread was vague as 15(9.6%) patients said scabies only spreads by personal contact and 132(84.1%) mentioned that scabies only spreads by sharing clothes, beddings and towels.

This sharing of clothing, etc. has been found to be a major risk factor in earlier studies.10 None of them mentioned all the modes of spread, showing lack of proper knowledge. Moreover, 106(67.52%) of the participants who had the disease knew that scabies was a preventable and treatable disease. Though scabies was diagnosed in participants having different professions, it was found to be relatively common among school students (n=39(24.84%), farmers (n=32(2.38%) and labourers (n=31(19.74%). Moreover, 104(44.4%) participants mentioned that their family members were also suffering from scabies at the time they were filling the questionnaire. That's probably because of sharing of clothing, beddings, and towels among the people they were living with.

Awareness about the hygiene was satisfactory among the participants, but the knowledge about the spread of scabies was poor and it can be deduced that in the community under observation people didn't know what the main communicable diseases in their area, including scabies, are. Overall, 204(87.2%) participants mentioned that they used to bathe twice a week and 201(85.9%) mentioned that they changed their clothes twice a week. This claim can be questioned on the basis of general observation of the physicians as this problem of unsatisfactory condition of personal hygiene has been documented in other studies conducted in Pakistan.7,9 There was a false belief among 182(77.8%) participants that only those patients who are already suffering from skin disease can suffer from scabies. Only 56(23.9%) participants knew that scabies can cause an epidemic.

Their knowledge about treatment and transmission was also poor. The majority of the patients had poor information about the spread of the disease and their right of being excluded from work. Only 23(9.8%) participants knew that scabies is transmissible as long as the patient is suffering from it, whereas the rest gave wrong answers.

Only 65(27.8%) participants knew that it was necessary that the patient of scabies should be excluded from school or work. Very small number of scabies patients knew how long they could transmit the disease to other healthy individuals, but the majority of them knew that their condition is treatable and preventable. Moreover, 147(62.8%) participants marked that scabies is a treatable and preventable disease.


The participants lacked awareness about scabies, and bad personal hygiene was one of the main problems. It is necessary to conduct multidimensional health awareness programmes in the AJK region.

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.


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Publication:Journal of Pakistan Medical Association
Geographic Code:9PAKI
Date:Sep 28, 2017
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