Involvement of non-medical personnel in management of scabies at a boarding school in Indonesia

One of the most common neglected tropical skin diseases in Indonesia is scabies, commonly associated with overcrowding, poor hygiene and poor nutritional status. Boarding schools are at risk of harboring infected populations. As recurrence is common, non-medical personnel need to be involved in management of scabies. This study aimed to investigate how non-medical personnel, in this case, the boarding school teachers, could manage scabies in a boarding school in Indonesia. We trained the teachers using the education module for early scabies detection approach, namely DeSkab program, to be able to identify three major signs of scabies in the students. Impact of this approach was evaluated in 2017 and 2018 at a religious boarding school in Bogor, Indonesia involving 127 and 202 students, consecutively. An education module was given to 16 boarding school teachers expecting them to be able to examine students prior to school admission and before and after mid-semester break. Teachers’ knowledge increased significantly after the training (p <0.001). This knowledge improvement is an important basis for teachers as non-medical personnel to implement independent scabies monitoring process during the educational year to find students with suspected scabies. Those suspected scabies students were directly referred to nearby public health clinic and treated with 5% permethrin and re-treated one week later. Prevalence of scabies decreased from 76% in 2017 to 49% in 2018 in 69 students who can be followed-up in two consecutive years (p-value = 0.014). In conclusion, involvement of non-medical personnel is an essential and effective strategy to improve management of scabies.