Prevalence of skin Neglected Tropical Diseases and superficial fungal infections in two peri-urban schools and one rural community setting in Togo

Abstract

AbstractIntroductionSkin neglected tropical diseases (NTDs), are endemic and under-diagnosed in many lower-income communities. The objective of this study was to determine the prevalence of skin NTDs and fungal infections in two primary schools and a community setting in rural Togo.MethodThis was a cross-sectional study that took place between June-October 2021. The two primary schools are located on the outskirts of Lomé, the capital city. The community setting was Ndjéi, in north-east Togo. The choice of schools and village was random. Dermatologists examined the skin of study participants. Diagnosis of skin NTDs were made clinically.ResultsA total of 1401 individuals were examined, 954 (68.1%) from Ndjéi community, and 447 (31.9%) were children in the schools. Cutaneous skin infections were diagnosed in 438 (31.3%) participants, of whom 355 (81%) were in community settings. There were 105 observed skin NTDs (7.5%), including 20 in schools (6.7% of school participants) and 85 (9.4%) in the community. Across all settings 68 (6.7%) NTDs were in children, and 37 (9.7%) in adults. In addition, there were 333 observed mycoses (23.4% prevalence). The main cutaneous NTDs diagnosed were scabies (n=86; 6.1%) and yaws (n=16, 1.1%). The prevalence of scabies in schools was 4.2%, and 7.2% in the rural community. One case of leprosy was diagnosed in each school and the rural community, and one Buruli Ulcer case in the community. In the school setting, five (6%) children with a skin NTD reported being stigmatised, four of whom had refused to attend school because of their dermatosis. In Ndjéi, 44 (4.6%) individuals reported having experienced stigma and 41 (93.1%) of them missed at least one day of school or work.ConclusionThis study shows that the burden of scabies and other skin infections is high in the school and rural community settings in Togo, with associated presence of stigma. Improved health promotion and education across institutional and community settings may reduce stigma and encourage early reporting of skin infection cases to a health facility.Author summaryThis article is a group of conditions called skin Neglected Tropical Diseases (NTDs). The study takes place in Togo, West Africa. There is very little evidence around how widespread NTDs are in Togo. Local dermatologists carried out skin examinations of students in two schools on the edge of Lomé, the capital city. They also examined skin of community residents in rural Togo, in the north-east of the country. We show how the prevalence of fungal skin disease is very high, and also diagnosed numerous cases of scabies (one of the skin NTDs). Cases of leprosy and Buruli Ulcer were also found. Additionally, there were high levels of reported stigma. Our findings show how addressing this burden of disease is vital to improve individual and population health, but also to reduce the socio-economic consequences of these treatable conditions.