Hrev_master Healthcare in Low-resource Settings 2025; volume 13:13605 Prevalence and determinants of scabies among children in Ethiopia: a systematic review and meta-analysis Abayeneh Girma, Indiris Abdu Department of Biology, College of Natural and Computational Science, Mekdela Amba University, Tulu Awuliya, Ethiopia Abstract Scabies is a major neglected tropical disease affecting children in deprived communities like Ethiopia. This study aims to evalu- ate the prevalence and determinants of Sarcoptes scabiei infesta- tion among Ethiopian children under 15 years. Studies were sourced from PubMed, Scopus, ScienceDirect, and African Journals Online through a systematic search, following PRISMA- 2020 guidelines. The Joanna Briggs Institute’s tool was used to appraise study quality. A random-effects model was used for anal- ysis. Subgroup and sensitivity analyses were conducted to assess heterogeneity using I² statistics. Publication bias was assessed using a funnel plot and Egger’s test. A total of 9,126 children from 14 studies were included, with a pooled prevalence of 14.94% (95% CI: 11.32-18.57). Being male, having a family size of more than five members, children with an education level below grade five, history of sharing clothes within the family, infrequent wash- ing of clothes, lack of formal family education, poor family wealth or income status, using unimproved water sources, personal hygiene issues like untrimmed fingernails, sharing clothes with individuals diagnosed with scabies, poor knowledge about scabies among family members or caregivers, history of contact with indi- viduals experiencing skin itching or scabies, sharing common sleeping beds or fomites, washing hands with water only, having family members with signs of itching or scabies, and infrequent bathing were factors significantly associated with Sarcoptes sca- biei infestation among children under the age of 15 in Ethiopia. Therefore, policymakers and health planners should put a great deal of emphasis on the implementation of relevant prevention and control measures. Introduction Scabies is a contagious skin disease caused by the Sarcoptes scabiei mite, characterized by severe itching and rashes, often worsened at night.1 The condition can lead to secondary bacterial infections, causing complications like septicemia, rheumatic fever, and renal failure.2 It significantly impacts individuals’ phys- ical, emotional, and social well-being, including stigma, isolation, and disruptions in daily life.3 The economic burden on families and healthcare systems is equally notable.4 Prevalence of scabies varies widely, from 0.2% to 71.4% globally, with school-based studies reporting higher rates, such as 31% in Malaysia and up to 87.3% in Thailand.5, 6 African countries report diverse prevalence rates: 4.4% in Egypt, 5.2% in Guinea- Bissau, and up to 78.4% in Ethiopia.7-9 The factors that increase the chances of scabies include shar- ing beds or clothes, low income, younger age, large family size, lack of knowledge about scabies, parental illiteracy, seasonal con- ditions, and residency in rural areas.10,11 In Ethiopia, prevalence of scabies can also be associated with conflict, civil war, drought, flooding, poor water supply and sanitation, and overcrowding liv- ing conditions.12 Ethiopia’s unique geography and socio-economic challenges create a conducive environment for scabies outbreaks.13 Scabies remains a major yet neglected public health concern in Ethiopia. A systematic review and meta-analysis conducted in Ethiopia and across Africa revealed that the prevalence of scabies among school children was 14.71% and 10.81%, respectively.14,15 However, comprehensive data on the prevalence of scabies and associated risk factors among all Ethiopian children under the age of 15 remain scarce in Ethiopia. This systematic review and meta- analysis aim to provide updated estimates and identify critical risk factors to guide effective interventions. Correspondence: Abayeneh Girma, Department of Biology, College of Natural and Computational Science, Mekdela Amba University, P.O. Box 32, Tulu Awuliya, Ethiopia. E-mail: gabayeneh2013@gmail.com Key words: children, Ethiopia, meta-analysis, neglected diseases, risk factors, scabies. Contributions: AG, conceptualization, data curation, software, formal analysis, investigation, validation, visualization, project administration, supervision, writing— review and editing; IA, Methodology, resources, data curation, investigation, validation, visualization, writing—original draft. All authors have read and approved the final version of the manu- script and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest, and all authors confirm accuracy. Ethics approval and consent to participate: not applicable. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Received: 9 January 2025. Accepted: 14 June 2025. Early access: 3 September 2025. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2025 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2025; 13:13605 doi:10.4081/hls.2025.13605 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [page 224] [Healthcare in Low-resource Settings 2025;13:13605] Materials and Methods Systematic review protocol and registration This systematic review and meta-analysis were conducted fol- lowing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-2020) guideline 16 (Supplementary Materials). Furthermore, the study protocol is registered in International Prospective Register of Systematic Reviews (PROS- PERO) with an identification number of CRD42024530761. Search strategy Databases including PubMed, Scopus, ScienceDirect, and African Journals Online were searched without language or time restrictions. Boolean operators “AND” and “OR” were used with keywords such as “prevalence”, “associated factors”, “determinant factors”, “predictors”, “scabies”, “child”, “children”, “children under 15”, and “Ethiopia”. Reference lists of selected articles were also reviewed using Google search engine. Inclusion and exclusion criteria Studies were included if they i) reported prevalence of scabies among Ethiopian children under 15, ii) employed observational study designs, and iii) were published between June 2015 and January 2023. Studies were excluded if they: Lacked original data or focused on other skin conditions; did not report prevalence; or had inaccessible full texts. Study selection and quality appraisal All retrieved articles were imported into EndNote X8 (Thomson Reuters, USA), and duplicates were excluded. Hereafter, the titles and/or abstracts of articles were independently screened by two authors (AG and IA). The articles that met the eli- gibility criteria and were quality appraised underwent full-text appraisal. The Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence,17 and case-control18 studies was used for quality appraisal using 9, and 10 criteria, respectively. For each question, a score was assigned (no for ‘not reported or not appro- priate’ and yes ‘for reported’); the scores were summarized across the items to achieve a total score of 0 to 9, and 0 to 10, for preva- lence and case-control studies, respectively. Studies were cate- gorised as ‘high risk of bias’ (low quality), ‘moderate risk of bias’ (moderate quality) or ‘low risk of bias’ (high quality) when the overall score was ≤49%, 50-69% or ≥70%, respectively19 (Supplementary Materials). All disagreements between authors were resolved through conversation. Data extraction Relevant studies that met the eligibility criteria were subjected to data extraction and summarized in an excel spreadsheet. The information extracted from the included studies were; the name of the first author, publication year, region, study design, study set- ting, sample size, cases, the magnitude of scabies, response rate, and risk factors (Tables 1 and 3). Data analysis STATA version 14/SE software was used for meta-analysis. A random effects model was used to determine the pooled magnitude and risk factors of scabies along with 95% Confidence Interval (CI). For risk factors, if the 95% CI does not include 1, the result is considered statistically significant. The I2 statistics were used to assess the magnitude of heterogeneity of the included articles and values of <25% indicate low, 25-50% moderate, and >50% sub- stantial heterogeneity.20 I2 p-value tests whether the observed het- erogeneity is statistically significant or not. Subgroup and sensitiv- ity analysis was performed to explore the possible source of het- erogeneity. Egger’s, test, and funnel plot were used to check the presence of publication bias among the included articles. Publication bias was assessed using Egger’s test, with a p<0.05 indicating statistical significance.21 Results Selection of studies A total of 461 articles were identified through the databases mentioned. After 225 duplicates were removed, another 153 stud- ies were also excluded from the remaining articles after evaluating the title and/or abstract. Furthermore, 69 articles were also exclud- ed during the full text assessment for reasons mentioned in the eli- gibility criteria. Finally, only 14 of the articles met the eligibility Article Table 1. Characteristics of included studies. Study Region Study design Study setting Sample size Cases Prevalence (%) Response rate (%) 22 Oromia Cross-sectional Hospital based 324 44 13.6 - 23 SNNPR Cross-sectional Institutional based 343 19 5.5 - 24 Amhara Cross-sectional Institutional based 494 46 9.3 91.84 25 Amhara Cross-sectional Community based 583 139 23.84 96.4 26 Amhara Case-control Institutional based 300 100 33.3 - 27 Tigray Cross-sectional Institutional based 495 64 12.93 100 28 SNNPR Cross-sectional Community based 825 135 16.4 97.6 29 SNNPR Cross-sectional Institutional based 864 46 5.3 - 30 Amhara Cross-sectional Community based 850 92 10.82 98.04 31 SNNPR Cross-sectional Community based 590 98 16.6 97.7 32 Amhara Cross-sectional Community based 1437 192 13.4 - 33 Amhara Cross-sectional Institutional based 622 55 8.8 98 34 Amhara Cross-sectional Community based 942 202 21.5 97.4 35 Oromia Cross-sectional Community based 457 88 19.26 99.13 SNNPR, Southern Nations, Nationalities, and Peoples’ Region. [Healthcare in Low-resource Settings 2024;12:13605] [page 225] criteria and were included in the systematic review and meta-anal- ysis (Figure 1). Characteristics of included studies Table 1 provides a summary of the specific features found in the studies that were included. The 14 eligible studies22-35 were conducted in 4 regions. Amhara region had the highest number of eligible studies (seven studies), followed by Southern Nations, Nationalities, and Peoples’ Region (SNNPR) (four studies) and Oromia (two studies). One study was conducted in Tigray region. Thirteen studies were cross-sectional and the remaining one was case-control. Seven, six, and one were community-based, institu- tional-based, and hospital-based studies. A total of 9126 children were examined for the presence of scabies. The sample size among children in included studies ranged from 300 to 1437. Pooled prevalence of scabies An overall prevalence of 14.94% (95% CI: 11.32, 18.57) was obtained from 1,328 children under 15 years of age infested with scabies. High heterogeneity was observed across studies (I²= 96.3%, p<0.001) (Figure 2). Subgroup analysis With evidence of substantial heterogeneity, a subgroup analy- sis was performed. The results are shown in Table 2. The pooled prevalence of scabies among studies conducted using sample sizes Article Table 2. Subgroup analysis of the magnitude of scabies among children in Ethiopia. Variables Characteristics Included studies Sample size Prevalence (95% CI) I2, p Sample size <384 3 967 17.38 (95% CI: 1.99, 32.77) 98.5, p<0.001 >384 11 8159 14.35 (95% CI: 10.78, 17.92) 95.4, p<0.001 Region Oromia 2 781 16.58 (95% CI: 11.04, 22.12) 83.1, p=0.015 SNNPR 4 2622 10.87 (95% CI: 4.85, 16.88) 96.7, p<0.001 Amhara 7 5228 17.18 (95% CI: 11.75, 22.62) 96.1, p<0.001 Tigray 1 495 12.93 (95% CI: 9.53, 16.33) 100, –––––– Study design Cross-sectional 13 8826 13.60 (95% CI: 10.31, 16.88) 95.4, p<0.001 Case-control 1 300 33.30 (95% CI: 29.00, 37.60) 0.0, –––––– Study settings Hospital 1 324 13.60 (95% CI: 9.90, 17.30) 0.0, –––––– Institutional 6 3118 12.35 (95% CI: 6.02, 18.68) 96.8, p<0.001 Community 7 5684 17.28% (95% CI: 13.98, 20.59) 91.8, p<0.001 Sampling method Systematic random 4 1424 17.82 (95% CI: 7.03, 28.61) 98.1, p<0.001 Simple random 10 7702 13.86% (95% CI: 10.14, 17.57) 95.4, p<0.001 Publication year 2016-2020 7 3364 16.32 (95% CI: 9.84, 22.80) 96.7, p<0.001 2021-2023 7 5762 13.64 (95% CI: 9.07, 18.22) 96.4, p<0.001 Overall 14 9126 14.94% (95% CI: 11.32, 18.57) 96.3, p<0.001 SNNPR, Southern Nations, Nationalities, and People’s Region. [page 226] [Healthcare in Low-resource Settings 2024;12:13605] Figure 1. Flow diagram summarizing the selection of eligible studies. Figure 2. Forest plot displaying the pooled magnitude of scabies among children under 15 years of age in Ethiopia. of less than 384 (17.38%; 95% CI: 1.99, 32.77) was higher than that of studies with sample sizes >384 (14.35; 95% CI: 10.78, 17.92). Among Ethiopian regions, the highest prevalence was reported in Amhara (17.18%), followed by Oromia (16.58%), Tigray (12.93%), and SNNPR (10.87%). A high overall estimate was observed in case-control studies (33.30%; 95% CI: 29.00, 37.60) than in cross-sectional studies (13.60%; 95% CI: 10.31, 16.88). The highest pooled prevalence of scabies among study set- tings was reported from community studies at 17.28% (95% CI: 13.98, 20.59), followed by hospital studies at 13.60% (95% CI: 9.90, 17.30) and institutional study settings at 12.35% (95% CI: 6.02, 18.68). The prevalence estimate of scabies was higher in the studies using systematic random sampling method, with a pooled prevalence estimate of 17.82% (95% CI: 7.03, 28.61), than in the studies using the simple random sampling method at 13.86% (95% CI: 10.14, 17.57). The prevalence of scabies decreased gradually from 16.32% during the period between 2016 and 2020 to 13.64% in the next three years (2021-2023). Quality assessment and publication bias Information on the quality assessment of individual studies is presented in Supplementary Materials. Briefly, all of the included studies were of high quality. The asymmetry of the funnel plot indicated the existence of publication bias among the included studies (Figure 3A). Similarly, the regression-based Egger test (S7 Figure) revealed statistically significant publication bias (p=0.001). Since there is a high level of heterogeneity in the included studies, a sensitivity analysis was performed by removing each study one at a time to assess the impact of each study on the pooled effect size. During the sensitivity analysis, two studies, Walker at al.24 and Dagne et al.,29 had relatively determinant effects on the overall magnitude of scabies among children under 15 years of age in Ethiopia. 13.45 (12.74-14.17) and 14.37 (13.61- 15.13) were estimates after removing each study one at a time, namely Walker et al.24 and Amare and Lindtjorn,30 respectively. After completely removing those two studies, as indicated in Figure 3B, the estimate becomes 15.70 (14.88-16.51). Factors associated with Sarcoptes scabiei infestation In this systematic review and meta-analysis; the frequency of cloth washing, family education, and the habit of washing hands with water, sex, family size, educational status of children, cloth sharing with family, wealth or income status of the family, sharing clothes with scabies cases, and bath frequency were reported in three articles. In addition, two articles reported the water source, fingernail trimming, and family or caregiver knowledge of scabies. Furthermore, a history of contact with skin itching cases/scabies, sharing of sleeping beds/fomites and family members with itchy signs/scabies were reported in five articles, and all above men- tioned factors were significantly associated with Sarcoptes scabiei infestation (Table 3). Discussion Scabies poses a substantial health burden for children under 15, especially in Low- and Middle-Income Countries (LMICs). Understanding the pooled prevalence and determinants of scabies is crucial for informing evidence-based policies and guiding inter- ventions in detection, management, and prevention efforts. This systematic review and meta-analysis focused on estimating the pooled prevalence of scabies and its associated factors among Ethiopian children under 15 years. The analysis incorporated data from 14 studies, encompassing a total of 9,126 participants. The pooled prevalence of Sarcoptes scabiei infestation among children under 15 years of age was 14.94%. This finding was con- sistent with surveillance studies conducted in Australia (16.5%),36 and Cameroon (17.8%)37 and meta-analysis among school children in Ethiopia (14.71%).14 On the other hand, studies that showed a higher prevalence than our findings were done in Malaysia (31%),5 Turkey (33%),38 Solomon Islands (54.3%),39 Bangladesh (61- 62%),40 Sierra Leone (67%),41 and Thailand (87.5%).6 However, our result was higher than those of studies conducted in Taiwan (1.4%),42 Egypt (4.4%),7 Australia (8.2%),43 and Nigeria (10.5%) 44 and meta-analysis among school children in Africa (10.81%).15 These variations could be due to sociodemographic characteristics, the season of data collection, study population, sample sizes, methodology used, and economic status. In the present study, demographic factors include being male, having a family size of more than five members, and having chil- dren with an education level below grade five, which were associ- ated with 2.04, 3.86, and 3.45 times higher odds of encountering scabies, respectively, compared to their counterparts. This finding is in agreement with studies conducted elsewhere.14,15,39,45,46 Males have been observed to engage in less frequent personal hygiene practices, potentially contributing to higher scabies transmission. Conversely, females are generally more concerned about cleanli- Article Figure 3. a) Funnel plot representing evidence of publication bias; b) sensitivity analysis result of the included studies that assessed the impact of each study on the overall magnitude of scabies. [Healthcare in Low-resource Settings 2024;12:13605] [page 227] ness and beauty so they take better care of themselves and maintain cleanliness compared to males.47 Additionally, increased physical contact during play or sports may facilitate transmission among boys.15 The possible explanation for family size could be related to sharing habits of bed and cloths in large family are high within a household and outside the household.48 Finally, lower educational levels may correlate with poorer access to health information, including preventive measures and hygiene practices and delayed treatment, increasing the likelihood of scabies infestation. Environmental factors, such as meaning Environmental fac- tors, such as the use of the use unimproved water sources, were associated with 1.65 times higher odds of scabies among children under the age of 15 who used them compared to those who did not. Unimproved water sources and insufficient water supplies are sig- nificant contributors to the burden of scabies in low- and middle- income countries as documented from elsewhere.49 This associa- tion might be attributed to the limited accessibility of water sources caused by factors such as lengthy water collection times, poor water quality, intermittent supply or scarcity, low socioeco- nomic conditions in rural areas, and unequal distribution of improved water sources by local administrations. These challenges often result in poor personal hygiene, a direct contributing factor to scabies infestation. Moreover, a community-based study conduct- ed in drought-affected regions of Ethiopia found a high prevalence of scabies.50 Household and interpersonal factors include a history of shar- ing clothes within the family, sharing clothes with individuals diagnosed with scabies, and sharing common sleeping beds or fomites. Individuals exposed to these factors were 3.17, 10.51, and 3.40 times more likely to develop scabies, respectively, compared to their counterparts. This finding is consistent with meta-analysis conducted elsewhere.14,15,45,46 The possible explanations for the above significant risk factors might be due to sharing beds or cloth- ing with someone infected with scabies enables the mites to move directly from the infected individual to an uninfected person. Moreover, when one person in a bed-sharing situation has scabies, the close proximity can promote continuous transmission and rein- fection.51 Close contact or sleeping near someone with scabies is one of the main ways the infection spreads from an affected person to a healthy individual. The findings of this study reveal a signifi- cant association between the level of knowledge and awareness about scabies among caregivers and the likelihood of children con- tracting the condition. Children from families with poor knowl- edge were 2.65 times more likely to experience scabies compared to those from families with good knowledge. This reinforces the importance of targeted health education programs as a primary tool for scabies prevention. The observed odds ratio aligns closely with prior research.53 This might be because limited knowledge may be linked to unhealthy behaviors, such as inadequate personal hygiene, sharing beds or clothing with others, and not seeking proper healthcare for scabies treatment. These consistent findings across diverse contexts underline the universal importance of edu- cation in disease prevention. This meta-analysis revealed that behavioral and hygiene-relat- ed factors, including infrequent bathing, untrimmed fingernails, infrequent washing of clothes, and washing hands with water only, were associated with 3.85, 3.55, 6.15, and 2.68 times higher odds of developing scabies, respectively, compared to their counter- parts. This finding was supported by different surveillance studies in different areas37,52-54 and meta-analysis.14,15,45,46 This could be because the respondents were less aware of the importance of per- sonal hygiene, and poor personal hygiene could be a risk factor for the spread of scabies mites. The other reasons might be the inade- quate supply of water for household consumption, including main- taining personal hygiene, especially during the dry season among rural and overcrowded areas of the community as a result the longer clothes and the body remain unwashed, the greater the opportunity for scabies mites to survive on them. This raises the risk of transmission to anyone who comes into contact with the contaminated items or skin.14,15,45 Socioeconomic factors include poor family wealth or income status, which was significantly associated with 2.26 times higher odds of acquiring scabies, and lack of formal family education, which was significantly linked to 1.91 times higher odds, com- pared to wealthy and literate families. The current result is in line with several previous surveillance studies conducted else- Article [page 228] [Healthcare in Low-resource Settings 2024;12:13605] Table 3. Factors associated with the magnitude of scabies among children under 15 years of age in Ethiopia. Variables Number of articles Pooled odds ratio (95% CI) I-squared (%) I2 p Male 3 2.04 (1.09,3.00) 0 0.594 Family size above five 3 3.86 (1.44,6.28) 0 0.590 Children education less than grade five 3 3.45 (1.61,5.29) 0 0.918 Sharing history of cloth with family 3 3.17 (1.23,5.11) 1.4 0.363 Infrequent cloth wash 3 6.15 (2.41,9.88) 68.3 0.043 No formal family education 3 1.91 (0.41,2.79) 91.5 <0.001 Poor wealth or income status of the family 3 2.26 (1.33,3.18) 0 0.449 Unimproved water source 2 1.65 (1.08,2.22) 0 0.708 Untrimmed finger nail 2 3.55 (1.02,8.12) 48.4 0.164 Sharing clothes with scabies case 3 10.51 (5.38,15.64) 0 0.788 Family or caregiver poor knowledge about scabies 2 2.65 (1.22,4.07) 8.3 0.296 Having history of contact with skin itching cases/scabies 5 4.94 (2.37,7.52) 38.4 0.165 Sharing common sleeping beds/fomites 5 3.40 (1.93,4.87) 0 0.965 Habit of washing hand with water only 3 2.68 (0.97,4.39) 80.8 <0.001 Family member with itchy signs / scabies 5 5.92 (3.02,8.83) 0 0.704 Infrequent bath 3 3.85 (1.33,6.36) 0 0.789 where.7,52,53,55-58 This could be explained by the fact that children from educated families have better opportunities to earn more money and better personal and environmental sanitation, in addi- tion to better health-seeking behavior than others.58 Finally, health and contact-related factors include children who have a history of contact with individuals experiencing skin itching or scabies, who were 4.94 times more likely to acquire scabies. Additionally, children with family members showing signs of itch- ing or scabies were 5.92 times more likely to develop scabies than their counterparts. This finding also supported by previous stud- ies.7,14,15 Scabies spreads easily through close physical contact. If children aged under15 frequently interact with siblings and par- ents, they are more likely to contract it if another family member is infected.59 Strengths and limitations A key strength of this systematic review and meta-analysis is the pooled prevalence and risk factors associated with scabies infestation were identified among children under 15 years of age in Ethiopia. Even though, this review did not consider all regions in Ethiopia due to the lack of availability of articles this may limit the generalizability of the findings. Conclusion Sarcoptes scabiei infestation remains a critical issue among Ethiopian children, with community-based settings exhibiting the highest prevalence. Health programs should prioritize improved water access, community hygiene education, and targeted inter- ventions for high-risk groups such as large households and chil- dren with low health literacy. Future research should expand to underrepresented Ethiopian regions and focus on long-term sca- bies control measures, including sustainable hygiene interventions and health education programs. References 1. Stamm LV, Strowd LC. Ignoring the “Itch”: the global health problem of scabies. Am J Trop Med Hygiene 2017;97:1647. 2. Hay R, Steer A, Engelman D, et al. Scabies in the developing world -its prevalence, complications, and management. Clin Microbiol Infection 2012;18:313-23. 3. Jannic A, Bernigaud C, Brenaut E, et al. Scabies itch. Dermatol Clin 2018;36:301-8. 4. Hay R, Castanon RE, Hernandez HA, et al. Wastage of family income on skin disease in Mexico. BMJ 1994;309:848. 5. Zayyid MM, Saadah RS, Adil A, et al. Prevalence of scabies and head lice among children in a welfare home in Pulau Pinang, Malaysia. Trop Biomed 2010;27:442-6. 6. Pruksachatkunakorn C, Wongthanee A and Kasiwat V. Scabies in Thai orphanages. Pediatr Internat 2003;45:719-23. 7. Hegab DS, Kato AM, Kabbash IA, et al. Scabies among prima- ry schoolchildren in Egypt: sociomedical environmental study in Kafr El-Sheikh administrative area. Clin Cosmetic Investigatiol Dermatol 2015:105-111. 8. Marks M, Sammut T, Cabral MG, et al. The prevalence of sca- bies, pyoderma and other communicable dermatoses in the Bijagos Archipelago, Guinea-Bissau. PLoS Neglected Trop Dis 2019;13:e0007820. 9. Wochebo W, Haji Y and Asnake S. Scabies outbreak investiga- tion and risk factors in Kechabira district, Southern Ethiopia: unmatched case control study. BMC Res Notes 2019;12:1-6. 10. Nazari M and Azizi A. Epidemiological pattern of scabies and its social determinant factors in west of Iran. Health 2014;2014. 11. Sanei-Dehkordi A, Soleimani-Ahmadi M, Zare M, et al. Risk factors associated with scabies infestation among primary schoolchildren in a low socio-economic area in southeast of Iran. BMC Pediatr 2021;21:249. 12. Balcha F, Bizuneh H and Hunduma F. Scabies Outbreak Investigation and Its Risk Factors in Gumbichu District, East Shewa Zone, Central Ethiopia: Unmatched Case-Control Study. J Clin Rheumatol Res 2022;2:20-9. 13. Girma A and Genet A. Magnitude and determinants of intesti- nal parasites among children under five in Ethiopia during 2010-2023: a systematic review and meta-analysis. Fetal Pediatric Pathol 2024;43:47-65. 14. Girma A, Abdu I. Prevalence and determinants of scabies among schoolchildren in Ethiopia: a systematic review and meta�analysis. Health Sci Rep 2024;7:e70199. 15. Girma A, Abdu I, Teshome K. Prevalence and determinants of scabies among schoolchildren in Africa: A systematic review and meta-analysis. SAGE Open Medicine 2024;12:205031 21241274757. 16. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 17. Munn Z, Moola S, Lisy K, et al. Systematic reviews of preva- lence and incidence. Joanna Briggs Institute reviewer’s manual 2017:5-1. 18. Moola S, Munn Z, Tufanaru C, et al. Chapter 7: Systematic reviews of etiology and risk. JBI manual for evidence synthe- sis JBI 2020;10. 19. Hajissa K, Islam MA, Sanyang AM, et al. Prevalence of intestinal protozoan parasites among school children in africa: A systematic review and meta-analysis. PLoS neglected Trop Dis 2022;16:e0009971. 20. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics Med 2002;21:1539-58. 21. Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34. 22. Ramos JM, Molés-Poveda P, Tessema D, et al. Skin problems in children under five years old at a rural hospital in Southern Ethiopia. Asian Pacific J Trop Biomed 2016;6:625-9. 23. Walker SL, Lebas E, De Sario V, et al. The prevalence and association with health-related quality of life of tungiasis and scabies in schoolchildren in southern Ethiopia. PLoS Neglected Trop Dis 2017;11:e0005808. 24. Dagne H, Dessie A, Destaw B, et al. Prevalence and associated factors of scabies among schoolchildren in Dabat district, northwest Ethiopia, 2018. Environ Health Preventive Med 2019;24:1-8. 25. Haile T, Sisay T and Jemere T. Scabies and its associated fac- tors among under 15 years children in Wadila district, Northern Ethiopia, 2019. Pan Afr Med J 2020;37:224. 26. Reta MW, Derseh BT and Sahilu BY. Determinants of scabies among primary school children in Habru district: A case-con- trol study. 2020. Available from: https://doi.org/10. 21203/rs. 2.20670/v1 27. Tefera S, Teferi M, Ayalew A, et al. Prevalence of scabies and associated factors among primary school children in Raya Alamata District, Tigray, Ethiopia, 2017/2018. J Infect Dis Epidemiol 2020;6:154. Article [Healthcare in Low-resource Settings 2024;12:13605] [page 229] 28. Tunje A, Churko C, Haftu D, et al. Prevalence of scabies and its associated factors among school age children in Arba Minch zuria district, Southern Ethiopia, 2018. bioRxiv 2020: 2020.2003.2016.993576. 29. Amare HH and Lindtjorn B. Risk factors for scabies, tungiasis, and tinea infections among schoolchildren in southern Ethiopia: A cross-sectional Bayesian multilevel model. PLoS Neglected Trop Dis 2021;15:e0009816. 30. Misganaw B, Nigatu SG, Gebrie GN, et al. Prevalence and determinants of scabies among school-age children in Central Armachiho district, Northwest, Ethiopia. Plos One 2022;17: e0269918. 31. Marmara D, Mulugeta H, Thygerson S, et al. Scabies among children in Ethiopia. Internat J Public Health 2022;11:989-97. 32. Yirgu R, Middleton J, Fekadu A, et al. Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of preva- lence, determinants, clinical presentation and community knowledge. BMJ Open 2023;13:e075038. 33. Ferede TAWaAJ. Prevalence of scabies and associated factors among Governmental Elementary School Students in Gondar town Northwest Ethiopia. J Practical Professional Nurs 2023;7:046. 34. Melese F, Malede A, Sisay T, et al. Cloth sharing with a scabies case considerably explains human scabies among children in a low socioeconomic rural community of Ethiopia. Trop Med Health 2023;51:52. 35. Ararsa G, Merdassa E, Shibiru T, et al. Prevalence of scabies and associated factors among children aged 5-14 years in Meta Robi District, Ethiopia. Plos One 2023;18:e0277912. 36. Tasani M, Tong SY, Andrews RM, et al. The importance of sca- bies coinfection in the treatment considerations for impetigo. Pediatric Infect Dis J 2016;35:374-8. 37. Kouotou EA, Nansseu JRN, Kouawa MK, et al. Prevalence and drivers of human scabies among children and adolescents living and studying in Cameroonian boarding schools. Parasites Vectors 2016;9:1-6. 38. Öztürkcan S, Özçelik S and Saygi G. Spread of scabies and pediculus humanus among the children at Sivas orphanage. Indian Pediatr 1994;31:210-3. 39. Osti MH, Sokana O, Phelan S, et al. Prevalence of scabies and impetigo in the Solomon Islands: a school survey. BMC Infect Dis 2019;19:803. 40. Talukder K, Talukder M, Farooque M, et al. Controlling sca- bies in madrasahs (Islamic religious schools) in Bangladesh. Public Health 2013;127:83-91. 41. Terry B, Kanjah F, Sahr F, et al. Sarcoptes scabiei infestation among children in a displacement camp in Sierra Leone. Public Health 2001;115:208-11. 42. Wu Y-H, Su H-Y and Hsieh Y-J. Survey of infectious skin dis- eases and skin infestations among primary school students of Taitung County, eastern Taiwan. J Formosan Med Assoc = Taiwan yi zhi 2000;99:128-34. 43. Yeoh DK, Anderson A, Cleland G, et al. Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections. PLoS Neglected Trop Dis 2017;11:e0005726. 44. Kalu EI, Wagbatsoma V, Ogbaini-Emovon E, et al. Age and sex prevalence of infectious dermatoses among primary school children in a rural South-Eastern Nigerian community. Pan Afr Med J 2015;20:182. 45. Demoze L, Gubena F, Akalewold E, et al. Burden and determi- nants of scabies in Ethiopian school age children: A systematic review and meta-analysis with public health implications. PloS One 2024;19:e0314882. 46. Gupta S, Thornley S, Morris A, et al. Prevalence and determi- nants of scabies: A global systematic review and meta�analy- sis. Trop Med Inter Health 2024;29:1006-17. 47. Trasia RF. Scabies in Indonesia: Epidemiology and prevention. Insights Public Health J 2020;1:30-8. 48. Azene AG, Aragaw AM and Wassie GT. Prevalence and asso- ciated factors of scabies in Ethiopia: systematic review and Meta-analysis. BMC Infect Dis 2020;20:380. 49. Prüss-Ustün A, Wolf J, Bartram J, et al. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: an updated analysis with a focus on low-and middle-income countries. Int J Hygiene Environ Health 2019; 222:765-77. 50. Enbiale W and Ayalew A. Investigation of a scabies outbreak in drought-affected areas in Ethiopia. Trop Med Infect Dis 2018;3:114. 51. Banerji A. Scabies. Paediatr Child Health 2015;20:395-8. 52. Feldmeier H, Jackson A, Ariza L, et al. The epidemiology of scabies in an impoverished community in rural Brazil: pres- ence and severity of disease are associated with poor living conditions and illiteracy. J Am Academy Dermatol 2009;60: 436-43. 53. Ejigu K, Haji Y, Toma A, et al. Factors associated with scabies outbreaks in primary schools in Ethiopia: a case-control study. Res Rep Trop Med 2019;10:119-27. 54. Raza N, Qadir S and Agha H. Risk factors for scabies among male soldiers in Pakistan: case-control study. EMHJ-Eastern Mediterranean Health J 2009;15:1105-10. 55. Karim S, Anwar K, Khan M, et al. Socio-demographic charac- teristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education insti- tutes) in Dhaka, Bangladesh. Public Health 2007;121:923-34. 56. Stanton B, Khanam S, Nazrul H, et al. Scabies in urban Bangladesh. J Trop Med Hygiene 1987;90:219-26. 57. Hassen YK, Ame MM, Mummed BA, et al. Magnitude and Factors associated with scabies among primary school children in Goro Gutu Woreda, East Hararghe Zone, Ethiopia. Int J Med Parasitol Epidemiol Sci 2022;3:84. 58. Lulu Y, Tolesa G, Cris J. Prevalence and associated factors of skin diseases among primary school children in Illuababorzone, Oromia Regional State, South West Ethiopia. Indo Am J Pharm Res 2017;7:7374-83. 59. FitzGerald D, Grainger RJ and Reid A. Interventions for pre- venting the spread of infestation in close contacts of people with scabies. Cochrane Database of Systematic Reviews 2014. Article [page 230] [Healthcare in Low-resource Settings 2024;12:13605] Online supplementary materials PRISMA-2020 checklist. JBI critical appraisal checklist for cross-sectional (prevalence) and case-control studies.