Establishing Telepathology in Africa: Lessons From Botswana

Few reports of telepathology in Africa exist in the medical literature. With the strong need for improvement in health care infrastructure and personnel training in many African nations, telepathology provides a rapid and versatile tool to improve clinical care and foster educational and research opportunities. We describe the challenges faced in establishing robotic telepathology (RT) services at a government referral center in Botswana and reflect on conditions under which such initiatives may be most likely to succeed in sub-Saharan Africa and other parts of the developing world

Scabies and Bacterial Superinfection among American Samoan Children, 2011–2012

<div><p>Background</p><p>Scabies, a highly pruritic and contagious mite infestation of the skin, is endemic among tropical regions and causes a substantial proportion of skin disease among lower-income countries. Delayed treatment can lead to bacterial superinfection, and treatment of close contacts is necessary to prevent reinfestation. We describe scabies incidence and superinfection among children in American Samoa (AS) to support scabies control recommendations.</p><p>Methodology/Principal Findings</p><p>We reviewed 2011–2012 pharmacy records from the only AS pharmacy to identify children aged ≤14 years with filled prescriptions for permethrin, the only scabicide available in AS. Medical records of identified children were reviewed for physician-diagnosed scabies during January 1, 2011–December 31, 2012. We calculated scabies incidence, bacterial superinfection prevalence, and reinfestation prevalence during 14–365 days after first diagnosis. We used log binomial regression to calculate incidence ratios for scabies by age, sex, and county. Medical record review identified 1,139 children with scabies (incidence 29.3/1,000 children aged ≤14 years); 604 (53%) had a bacterial superinfection. Of 613 children who received a scabies diagnosis during 2011, 94 (15.3%) had one or more reinfestation. Scabies incidence varied significantly among the nine counties (range 14.8–48.9/1,000 children). Children aged <1 year had the highest incidence (99.9/1,000 children). Children aged 0–4 years were 4.9 times more likely and those aged 5–9 years were 2.2 times more likely to have received a scabies diagnosis than children aged 10–14 years.</p><p>Conclusions/Significance</p><p>Scabies and its sequelae cause substantial morbidity among AS children. Bacterial superinfection prevalence and frequent reinfestations highlight the importance of diagnosing scabies and early treatment of patients and close contacts. Investigating why certain AS counties have a lower scabies incidence might help guide recommendations for improving scabies control among counties with a higher incidence. We recommend interventions targeting infants and young children who have frequent close family contact.</p></div

Scabies^* among American Samoan children aged 0–14 years by age category, sex, and county, 2011–2012.

<p>CI = confidence interval.</p><p>*Physician-diagnosed scabies among patients aged ≤14 years at the time of diagnosis, during January 1, 2011─December 31, 2012. Children had ≥1 scabies diagnosis.</p><p>^†American Samoan population from the 2010 US Census Bureau report [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139336#pone.0139336.ref021" target="_blank">21</a>].</p><p>^‡Average annual incidence of scabies during 2011 and 2012.</p><p>**Ratio of incidence of specified group compared with reference group.</p><p>^††Age at which diagnosis of scabies was received.</p><p>^‡‡Only includes children with known village who reside on Tutuila Island.</p><p>Scabies^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139336#t002fn002" target="_blank">*</a>} among American Samoan children aged 0–14 years by age category, sex, and county, 2011–2012.</p

Scabies incidence by month among American Samoan children aged ≤14 years.

<p>Scabies incidence by month among American Samoan children aged ≤14 years.</p

Scabies^* and bacterial superinfection among American Samoan children, 2011–2012.

<p>*Physician-diagnosed scabies cases among patients aged ≤14 years at the time of diagnosis, during January 1, 2011─December 31, 2012. Children had received one or more scabies diagnoses.</p><p>^†Age at which diagnosis of scabies was received.</p><p>^‡American Samoan population from the 2010 US Census [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139336#pone.0139336.ref021" target="_blank">21</a>].</p><p>**Average annual incidence of scabies during 2011 and 2012.</p><p>^††Among all children with scabies during 2011–2012.</p><p>Scabies^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139336#t001fn001" target="_blank">*</a>} and bacterial superinfection among American Samoan children, 2011–2012.</p