Determinants of scabies among households in Fagita Lekoma district, Northwest Ethiopia: a mixed–method study

Abstract

Scabies is a major global public health problem affecting over 300 million people worldwide. In Ethiopia, most studies on scabies have focused solely on quantitative aspects, with limited exploration of perceived causes, impacts, and health-seeking behaviors. No previous study has investigated determinants of scabies in Fagita Lekoma District. To identify determinants of scabies among households in Fagita Lekoma District, Awi Zone, Amhara Regional State, Northwest Ethiopia, 2025. A community-based unmatched case-control study with a mixed-methods approach was conducted from February 20 to May 30, 2025. Cases were individuals diagnosed with scabies infestation based on the International Alliance for the Control of Scabies diagnostic criteria, while controls were individuals without scabies selected from the same source population. A total of 492 participants (99 cases and 393 controls) were included using consecutive sampling for cases identified through active household-level community screening and simple random sampling for controls. Data were collected using a structured questionnaire, and additionally, 25 participants took part in in-depth interviews. Quantitative data were entered into EpiData 4.6 and analyzed using Stata/MP 17. Variables with p ≤ 0.25 in bivariable logistic regression were entered into the multivariable logistic regression model. Statistical significance was declared at p < 0.05. Cluster-robust standard errors were used to account for intra-household correlation, and adjusted odds ratios with 95% confidence intervals were reported. Qualitative data were transcribed, translated, and thematically analyzed using ATLAS.ti 9.1.3. The mean age of participants was 24.5 ± 11.8 for cases and 33.52 years ± 12.993 for controls. Multivariable analysis showed that participants aged 5-14 years had higher odds of scabies infestation compared with those aged ≥ 45 years (AOR = 4.14; 95% CI: 2.10-8.03). Similarly, higher odds were observed among participants from households with ≥ 5 members compared with those with < 5 members (AOR = 3.08; 95% CI: 1.68-5.71), those living in crowded households compared with uncrowded households (AOR = 4.42; 95% CI: 2.23-8.73), participants with poor knowledge compared with those with good knowledge (AOR = 4.33; 95% CI: 2.04-9.17), and those with a history of contact with scabies cases compared with those without contact (AOR = 9.01; 95% CI: 4.52-17.51). Qualitative findings revealed poor awareness of scabies, severe itching, sleep disturbances, social stigma, and low health-seeking behavior due to financial constraints and disbelief in modern treatment. Scabies infestation was associated with younger age, large family size, overcrowding, and contact with infected individuals. Qualitative findings showed low awareness, misconceptions, and psychosocial effects. Health-seeking was limited by financial and access barriers. Strengthening health education and improving treatment access are essential.