Scabies outbreak management in refugee/migrant camps in Europe 2014-2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives
Scabies outbreak management in refugee/migrant camps in Europe 2014-2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives
Objectives: provide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014-2017.
Design: retrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings.
Setting: formal and informal refugee/migrant camps in Europe 2014-2017.
Participants: twelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium).
Results: participants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid).
Conclusions: we recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.
Delivery of Health Care, Disease Outbreaks/prevention & control, Humans, Qualitative Research, Refugees, Retrospective Studies, Scabies/diagnosis, Serbia, Transients and Migrants, INFECTIOUS DISEASES, MANAGEMENT, QUALITATIVE RESEARCH, Neglected Diseases, Mass Drug Administration, HEALTH SERVICES ADMINISTRATION, DERMATOLOGY, Infection control, International health services, infestations, Infectious diseases &
e075103
Richardson, Naomi A.
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Cassell, Jackie A.
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Head, Michael G.
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Lanza, Stefania
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Schaefer, Corinna
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Walker, Stephen L.
8b78787e-d775-4057-a026-ab66179bfcd3
Middleton, Jo
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8 November 2023
Richardson, Naomi A.
69d7754e-bcca-4001-9e3b-21b2e50fa0e5
Cassell, Jackie A.
7e540223-2816-4aae-ab54-5e77e3025f36
Head, Michael G.
67ce0afc-2fc3-47f4-acf2-8794d27ce69c
Lanza, Stefania
8df9d703-d511-40b8-9ea4-0db18b6b3ebe
Schaefer, Corinna
da1dc4ef-d802-4232-aa42-6c2bdfea6ca0
Walker, Stephen L.
8b78787e-d775-4057-a026-ab66179bfcd3
Middleton, Jo
29734087-c55a-402c-860c-7ab50c317e5e
Richardson, Naomi A., Cassell, Jackie A., Head, Michael G., Lanza, Stefania, Schaefer, Corinna, Walker, Stephen L. and Middleton, Jo
(2023)
Scabies outbreak management in refugee/migrant camps in Europe 2014-2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives.
BMJ Open, 13 (11), , [e075103].
(doi:10.1136/bmjopen-2023-075103).
Abstract
Objectives: provide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014-2017.
Design: retrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings.
Setting: formal and informal refugee/migrant camps in Europe 2014-2017.
Participants: twelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium).
Results: participants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid).
Conclusions: we recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.
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Accepted/In Press date: 18 October 2023
e-pub ahead of print date: 8 November 2023
Published date: 8 November 2023
Additional Information:
Funding Information:
This research was financially supported by Brighton and Sussex Medical School from internal funds (N/A). JM is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent, Surrey, Sussex (NIHR200179) and the NIHR Global Health Research Unit on Neglected Tropical Diseases (NIHR131996).
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords:
Delivery of Health Care, Disease Outbreaks/prevention & control, Humans, Qualitative Research, Refugees, Retrospective Studies, Scabies/diagnosis, Serbia, Transients and Migrants, INFECTIOUS DISEASES, MANAGEMENT, QUALITATIVE RESEARCH, Neglected Diseases, Mass Drug Administration, HEALTH SERVICES ADMINISTRATION, DERMATOLOGY, Infection control, International health services, infestations, Infectious diseases &
Identifiers
Local EPrints ID: 485466
URI: http://eprints.soton.ac.uk/id/eprint/485466
ISSN: 2044-6055
PURE UUID: 67fe02a4-c053-45e4-aa57-e5f0b4e0edff
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Date deposited: 07 Dec 2023 17:30
Last modified: 06 Jun 2024 01:54
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Contributors
Author:
Naomi A. Richardson
Author:
Jackie A. Cassell
Author:
Stefania Lanza
Author:
Corinna Schaefer
Author:
Stephen L. Walker
Author:
Jo Middleton
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