The impact of training front-line health care workers in improving the yield of scabies diagnosis among children under five in a rural community of West Bengal.

introductionScabies, a parasitic infestation, affects individuals of all age groups. This contagious disease might lead to severe secondary bacterial infections, if left untreated. There is sparse literature available in India, especially in rural areas, focusing on the role of front-line health care workers in determining the prevalence of scabies among children under five. Hence, the primary objective of this study was to assess the impact of training front-line healthcare workers in diagnosing scabies among children under five years in rural areas of West Bengal.

methodsThis community based quasi-experimental (pre-post) study was done in the Saguna Gram Panchayat area. Accredited Social Health Activists (ASHA) (n = 25), the primary point of contact with the community at the grass root level of the health care system in India were assessed with a pre-test. A working training module with imaging templates was prepared. ASHA workers were then trained to identify cases of scabies as per International Alliance for Control of Scabies (IACS) guidelines. Complete enumeration was done and a total of 2,119 children under five years residing in the study area were screened for scabies by ASHA workers. The first author of the study examined all the suspected cases of scabies and 10% of the non-suspect cases as reported by each ASHA worker. A post test was conducted on ASHA workers to assess the efficacy of training.

resultsThe mean (±SD) age of ASHA workers was 39.4 (±5.1) years. Most of them were literate up to middle school. There were 2119 children under five years in the study area. Approximately 21 children were suspected of having scabies by ASHA workers. The calculated prevalence of scabies suspect cases was 1%. Most of the family members were unaware of causes, signs, and symptoms of scabies. Data collected by ASHA workers was found to be valid as verified by the first author. There was a significant change in the post-test scores in comparison to pre-test scores of ASHA workers after the training (p-value < 0.05).

conclusionThe prevalence of scabies in the study area was relatively low. High literacy, good hygienic conditions, absence of malnutrition, and age-appropriate immunization might be the favourable factors for the low prevalence reported. With periodic training, ASHA workers can screen children under five during routine house visits, as seen by their improvement in post-test scores. Accurate estimates of burden can aid in developing standard guidelines for the surveillance and management of this neglected tropical disease.