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SCABIES    

Background History  

Since 2006, Margot Whitfeld and her team from St Vincent’s Hospital, Sydney, now partnered with Dr Andrew Steer from the Murdoch Children's Institute in Melbourne and the extended team from the Kirby Institute at UNSW, have been working in Fiji with the Fijian Ministry of Health and the health community, researching and assisting to improve the widespread problem of scabies. Scabies is due to a tiny mite which lives in and on the skin and can cause skin infections including impetigo, boils, cellulitis and even death. Lucia Romani and Aminiasi Koroi have been our long-term project officers on the ground for this. Dr Whitfeld also regularly volunteers at the skin clinic at Tamavua Twomey Hospital in Suva when in Fiji on her regular trips.   

With the help of a grant from the Australian Government’s National Health and Medical Research Council (NHMRC) in 2012, and the backing of Fiji’s Ministry of Health, a 3-year trial on the best way to treat endemic community is complete. The first year’s results were published in the New England Journal of Medicine.  Additional funding for another scabies project has been obtained for the years 2017-2020 and Gates Foundation is financing a trial looking at filariasis and the effect of new treatment regimes on scabies, which we are hoping will commence in 2017,

The first meeting of all the trial staff, local doctors and nurses and researchers was held in 2013, the culmination of years of effort by many people. , Similar meetings have been held at the beginning and end of each of the trials to explain the trials to present the results to the research participants and relevant Ministry of Health personnel, The team includes dermatologists, paediatricians, epidemiologists medical officers, nurses, public health staff and statisticians from Australia and Fiji.   

A new project is the establishment of a new training program for doctors in dermatology including a Diploma of Dermatology in partnership with the Fiji National University. The first participants are planned to be enrolled in 2018 after appropriate final approvals have been obtained.

Currently all funding to the Improving skin Health in Fiji and The Pacific   is primarily used to improve the lives and facilities for adults and children with albinism in Fiji. Both the scabies research and the Dermatology Education projects are now being independently funded through other sources.  All Donations are tax deductible and enquiries can be made on +61 2 9966 9667.

  

2013 Scabies Research Team

  

FIJI AND SCABIES

Dr Whitfeld has been doing work in Fiji, and helping the Fijians carry out research since 2003, and along the way she has been involved in two large trials where they learnt much about scabies, and its domination of the health, sickness and quality of life of children in Fiji and the reasons for trying to do something about it. 

Dr Whitfeld's story on the Scabies Epidemic in Fiji

It began when I went to Fiji, where I had been invited to teach dermatology at a workshop funded by AusAID to a group of 21 doctors and nurses from Fiji and 10 from elsewhere in the Pacific. When I asked generally about their perception of Fijis biggest health problem, I was surprised when one person responded that she believed it was scabies. The echo went around the room, although one participant said she thought it was diabetes.

Surprised, I asked why they believed that. The response was that they believed that 40% of their time in the general health clinic was taken up with scabies, and its serious complications. They had no time to treat anything else.   

 Along the way I have found out 

1. Through a prevalence survey of 13,294 participants in Fiji from 96 villages, that they had and an overall scabies and infected scabies prevalence of 23% documented as one of the highest in the world. Scabies rates were found to be highest in the 4-7 age group (51%) and in the 0-3 age group (37%). 

2. Through a village treatment plan of 800 people that treating scabies with the oral medication of a whole village was equally effective as treating a whole village with benzyl benzoate, but better tolerated.

3. Through work done by Australian paediatrician Dr Andrew Steer, who has been working in Fiji focusing on scabies and infected skin sores, that they are a significant cause of death, especially in children less than 2 years of age.

4. That scabies is a significant cause of morbidity and even death in our Australian Aboriginal population.

5. That the streptococcal and staphylococcal infection of scabies causes death from sepsis, acute kidney failure and rheumatic fever.

6.That infected scabies probably is the cause of the immunologic disease in pacific countries, including our Australian aboriginal population

7. That when a problem such as scabies is present in the any community at such a high level that the only way to get rid of it is to treat everyone.

8. That the Fijian people and their healthcare community at all levels want to do something to improve the problem of scabies, but don’t have the money to do it.

  

  

  

Although scabies has recently been added to the WHO expanded list of neglected tropical diseases, globally nobody has been able to do a study to work out the best and safest way of getting rid of scabies in the long term.

We devised a trial with the Fijians, approved by their national ethics committee, which was reviewed by the St Vincent’s Hospital ethics committee, looking at the safety and efficacy of three  different treatments for scabies . 

The project was funded by the National Health and Medical Research Council (NHMRC) of the Australian Government and commenced in 2012.