Controlling scabies in madrasahs (Islamic religious schools) in Bangladesh.

OBJECTIVES: To assess the effectiveness of a scabies control programme in reducing the prevalence of scabies in urban Bangladesh madrasahs, where the condition is extremely common. STUDY DESIGN: A controlled trial involving four intervention madrasahs (total students 2359) and four control madrasahs (total students 2465) in Dhaka Metropolitan Area. METHODS: A baseline scabies sample survey was carried out on 40 and 44 students of four intervention and four control madrasahs, respectively. Another 40 students of the intervention madrasahs were administered a pre-intervention test on scabies knowledge. This was followed by mass treatment of all students, teachers and staff of the eight madrasahs with topical 5% permethrin cream. The subsequent intervention involved daily monitoring of students for five key personal hygiene practices, weekly 10-min scabies health education classes, supply of simple and inexpensive products to students to prevent cross-infestation to/from peers (e.g. plastic bags, clothes hangers), and chemotherapy of new students detected with scabies. After 4 months of the intervention, the prevalence of scabies, personal hygiene practices and scabies knowledge were assessed in students of the intervention madrasahs. RESULTS: Before the intervention, the prevalence of scabies was 61% and 62% in intervention and control madrasahs, respectively (P = 1.00). After mass scabies treatment in all eight madrasahs and 4 months of intervention, the prevalence of scabies was reduced to 5% and 50% in intervention and control madrasahs, respectively (P < 0.001). There were significant improvements in all five personal hygiene practices at the intervention madrasahs. Mean test scores for scabies knowledge were 40% before the intervention and 99% after the intervention in the four intervention madrasahs. The cost of this programme was US$1.60 per student, and primarily included products such as plastic bags and clothes hangers, and health education material. CONCLUSIONS: This programme demonstrates a pragmatic and cost-effective way to control scabies in a residential institutional setting. It is recommended that this programme should be scaled up to all residential madrasahs in Bangladesh.

Intervention to increase detection of childhood tuberculosis in Bangladesh.

BACKGROUND: Despite a well-functioning adult tuberculosis (TB) control programme, children with TB remain grossly under-detected in Bangladesh. It is conservatively estimated that annually around 21,000 children with TB go undetected, due to an almost exclusive focus on sputum smear-positive TB and the absence of training or guidelines in paediatric TB. OBJECTIVE: To double child TB detection by increasing general awareness and training of health care workers at microscopy centres supported by the Damien Foundation (DF) Bangladesh. METHODS: A cluster-randomised trial was carried out with provision of child TB guidelines, training and logistics support to staff of 18 microscopy centres, while 18 non-adjacent microscopy centres continued their usual practice and served as controls. Paediatric data on TB suspect referral and case detection were collected at baseline and during the intervention at both control and intervention sites. RESULTS: Child TB case detection increased in both intervention and control microscopy centres, but the increase was three times the baseline in the intervention centres (from 3.8% to 12%) in comparison to less than double the baseline in the control centres (from 4.3% to 7%, P = 0.001). CONCLUSION: Simple guidelines and training on child TB case detection, together with basic logistics support, can be integrated into the existing National TB Control Programme and improve service delivery to children in TB-endemic areas.