While Malawian authorities downplay scabies as a minor ailment, a local non-governmental organisation is determined to ensure no child stays out of school due to a preventable but neglected tropical disease.
A Malawian non-governmental organisation works to ensure no child misses school due to scabies. Photo: Govati Nyirenda
The arrival of a white Land Cruiser, modified into an ambulance, brings hope to the people of Chilawo and surrounding villages in Kasungu district in central Malawi.
Dickson Saka, for instance, was spared an hour’s walk to the nearest public health facility to have his 12-year-old daughter, Virginia, treated for scabies. The young girl has already missed school for a week due to the disease.
“I believe she contracted scabies from friends. She likes to bathe with them in the nearby river,” Saka says.
Scabies is an infestation caused by tiny mites that burrow into the skin and lay eggs, causing intense itching and a rash. The contagious disease spreads through skin-to-skin contact. If left untreated, it can lead to skin sores and serious complications like septicaemia—blood poisoning by bacteria—heart disease, and kidney problems.
Children are especially susceptible to scabies. In low-income, tropical countries like Malawi, scabies is one of the most common dermatological conditions.
Malawi is grappling with a particularly acute outbreak that has been deemed a major public health issue in parts of the country, with the rates of infection highest among children.
Beyond the health impact, scabies can significantly hinder children’s access to education and, as a result, employment prospects and financial security in adulthood.
Mobile clinics bring healthcare to communities
As soon as Saka’s daughter developed scabies, she stayed home from school and was unable to play with friends. “The child needs to play, but no one wants to play with her,” Saka says. “She plays alone under a tree in our yard.”
Another parent from nearby Genezesi village, Malita Mapili, says her son also became socially isolated after developing scabies, and his education suffered. “Although others isolate him, I have accepted his condition. He has been absent from school for some time and complains that he finds it difficult to hold a pen to write,” Mapili says.
Mapili believes her son caught scabies at school, explaining that it is his second infection within six months. “The health workers have advised us to observe hygiene practices like bathing with soap, using clean clothes and bedding, among other things,” she says.
“The mobile clinics treat patients in their localities. We also educate communities on scabies and best hygiene practices. We are complementing the treatment provided at public health facilities.”
Saka initially tried over-the-counter medications from a nearby pharmacy for his daughter’s scabies infection, but they did not work. His daughter missed school until the mobile outreach clinic, run by Orant Charities Africa, arrived in Chilawo. The medical staff, who also provide services like tests for malaria, HIV, and pregnancy, treated Saka’s daughter, Mapili’s son, and other schoolchildren for scabies. They were given medication and had to pay a small fee.
Saka and Mapili are relieved that they do not have to walk all the way to the public health facility, where there was no guarantee of finding medication either. They are happy that their children can return to school.
Orant Charities Africa is an African non-governmental organisation (NGO) funded by Orant Charities United States working with African communities. In Malawi, the organisation has provided health, business, education, water, and sanitation services to communities in the central districts of Kasungu and Dowa. It has been operating outreach clinics to treat various ailments since 2016, especially in remote locations with limited access to healthcare.
Mobile outreach clinic coordinator Thomas Grey says the focus over the past two years has been the scabies outbreak. “The mobile clinics treat patients in their localities. We also educate communities on scabies and best hygiene practices. We are complementing the treatment provided at public health facilities,” he says.
Grey says the mobile outreach clinics often travel to areas near primary schools to give the children and their families access to treatment. “We conduct mobile clinics twice a month in a given area,” he says. “We hope this outbreak will end soon.”
Scabies affects school attendance and deepens poverty
Praises Padambo, communications and marketing officer at Orant Charities Africa, says the scabies outbreak has greatly affected education as children are missing school.
“For schoolchildren, it means missing classes for a week or even a month. This affects their class performance, and some children even end up dropping out of school.”
“Scabies is a contagious disease and patients are required to isolate as a precautionary measure,” she says “For schoolchildren, it means missing classes for a week or even a month. This affects their class performance, and some children even end up dropping out of school.”
Padambo also points out that the psychological impact of scabies can be severe. “It brings stigma. No one, not even the child’s best friend, would want to associate with an infected child for fear of contracting the disease,” she says.
Then there is the financial impact on the family. “The disease can affect family finances,” Padambo says. “If it spreads to the whole family, they are all required to get treatment. Most rural areas have limited access to healthcare services, so they have to travel long distances to get treated. This becomes costly and they often end up staying home without treatment.”
Because of the stigma, most parents do not inform the school authorities when their children have scabies.
Kasungu district’s education manager Joseph Chioza confirms that the disease has disrupted the education of many children in the district but adds that the real extent of the problem remains unknown as only a few cases are reported to school authorities. According to the WHO, scabies prevalence among children in resource-poor areas like these may vary from 5% to 50%, and recurrence is common.
Public health expert Elizabeth Mkutumula says the itching and distinct skin rash is very uncomfortable and can affect children emotionally. “Learners may be bullied by peers for having scabies,” she says. “The itching and mistreatment can affect a child’s concentration on schoolwork, leading to school absence and poor performance.”
Mkutumula says school absenteeism and poor grades resulting from scabies further exacerbates poverty as one’s earning power in adulthood is linked to education level.
“Scabies and education are connected in a way. The disease spreads aggressively in crowded environments with poor access to treatment. Malawi’s classrooms are often crowded. High-risk children are likely to contract or spread scabies at school,” she says. “If scabies is not addressed it can have dire consequences on literacy levels. Schoolchildren bear the greatest burden.”
Barriers to maintaining hygiene
Professor Adamson Muula, head of community and environmental health at Kamuzu University of Health Sciences, says schoolchildren are at most risk for scabies when there is no adult supervision of their personal hygiene.
“Their parents leave it to them to bathe. They may not bathe. During school holidays, they may likely not bathe at all since they are not going to school,” he says.
For many families, financial challenges could prove a barrier to maintaining personal hygiene practices. A government-appointed health surveillance assistant for the Kawelele and Khombe areas in rural Kasungu, William Chiteya, says scabies is widespread in his assigned areas.
“Scabies is prevalent in this rural area due to poor sanitation. For many people, bathing and maintaining cleanliness is a luxury. People prioritise looking for food instead,” he says.
Chiteya says scabies management is costly as people must bathe with soap, wash their clothes frequently, and observe general hygiene. “A household with a scabies patient needs to find a basin, soap, bedding, and utensils for the patient’s use… It becomes hard for them due to limited resources,” he says.
Unequal access to treatment prolongs outbreak
Chiteya says scabies spreads all the more quickly when treatment is delayed or inaccessible. “The mobile clinics help promote the wellbeing of communities… [But] they need to cover more areas. Many communities in need of health services are left out,” he says.
Unlike Kasungu, Nsanje district, in Malawi’s southern region bordering Mozambique, remains beyond the reach of the mobile clinics despite recording many scabies cases.
The district usually records less than 300 scabies cases a year. But during 2023, data from Nsanje District Health Office shows that the district registered more than 4,000 scabies cases. The office attributes the outbreak to lack of safe water and unhygienic practices.
“Of the 4,000 cases detected, 1,500 were in schools... Aside from the discomfort experienced due to the itching, [students] were also seen to be embarrassed to face [their peers].”
George Mbotwa, a spokesperson for Nsanje District Health Office, says a mass scabies screening was launched after Nsanje district recorded new scabies cases every month last year, with the numbers peaking in October.
“Of the 4,000 cases detected, 1,500 were in schools,” he says. “Treatment was provided. Aside from the discomfort experienced due to the itching, [students] were also seen to be embarrassed to face [their peers].”
Mbotwa says that while Unicef Malawi supported the office with drugs to treat scabies, no other organisations or NGO has supported the district in any way. Nsanje is now running out of some of the drugs used to treat scabies.
“We are still recording scabies cases because our spread control campaign wasn’t intensive enough,” Mbotwa says.
Mobilising resources for effective treatment
In 2017, WHO added scabies to the list of neglected tropical diseases—those that can be easily managed but remain endemic in low-income countries with limited access to treatment or medication.
NGOs help raise awareness and mobilise resources to provide timely and effective treatment for scabies. Photo: Orant Charities Africa
Public health experts note that in countries where scabies is common, resources are often not readily available or directed to scabies research or management. “It is therefore important for NGOs and the government to raise awareness and mobilise resources to provide timely and effective treatment to stem the spread of the disease,” Mkutumula says.
She calls on the Malawi government to adopt the recommendations made at the 2019 WHO meeting on scabies control. “The government should consider available evidence and include neglected tropical diseases in its health strategy, so that treatment can be budgeted for accordingly, and also provide direction to health implementing partners like Orant Charities Africa for the benefit of the citizenry,” Mkutumula says.
The Malawi Ministry of Health, however, appears to downplay the impact of scabies. Ministry of Health spokesperson Adrian Chikumbe says scabies is an issue mainly during the dry season, when people bathe in stagnant water. “While scabies is an irritant, the case fatality rate is less than one. This means that no one is expected to die from it,” he says.
But NGOs like Orant Charities Africa are determined to ensure that Malawian children do not miss out on school due to scabies. “We are always happy to serve and save the lives of people who can otherwise not afford healthcare,” Padambo says.