Fiji
MCRI has developed a long and productive research collaboration with Fiji to work towards understanding how scabies affects the Fijian population. This successful collaboration in research has been translated into a working relationship with the implementation of the World Scabies Program (WSP) to eliminate scabies as a national public health problem throughout the country.
Scabies has had historically high prevalence in Fiji. In 2007, a national prevalence survey found 23% of Fijians had scabies at any given time. Moreover, the survey found that scabies disproportionately affected children, with 45% of children aged 5-9 being affected by the disease. In 2016, the Fiji Government released its annual Health Status Report revealing skin and soft tissue infections to be the fifth most common cause of mortality within the country.
A national prevalence survey was carried out in 2021-2022, led by the Fiji Ministry of Health and Medical Services (MHMS), supported by WSP, to determine if a mass drug administration (MDA) for scabies control was necessary. The need was confirmed following the prevalence estimate. WSP worked in close collaboration with the Fiji MHMS through the Fijian Centre of Disease Control, P.J. Twomey Hospital and all Divisional Health Teams to implement MDA to eliminate the spread of scabies in 2022-2023. WSP Fiji engaged the community and supported health workers in rolling out the MDA, and also raised community awareness about scabies.
The MDA campaign successfully reduced scabies prevalence to a level where it can be controlled within Fiji's health systems. In 2024, WSP Fiji focused on strengthening the health systems to manage scabies, through actions including health workforce training on identifying and treating scabies, and successfully advocating for ivermectin to be added to the essential medicines list. These activities are working to ensure the gains from the MDA are maintained, and to sustain low scabies prevalence. WSP Fiji is now focused on working towards the establishment of a long-term scabies program within the MHMS.
Our work
Health Systems Strengthening Projects in Fiji
Health Systems Strengthening (HSS) projects are activities, policies and strategies designed to enhance the performance of a health system and improve health outcomes. Since 2024, the WSP team have been working on HSS activities in Fiji. HSS, designed by the World Health Organization (WHO), focuses on six health systems building blocks. WSP’s work is currently focusing on the following building blocks: Health Service Delivery, Health Information Systems, Access to Essentials Medicines, and Leadership and Governance.
In 2024, the WSP HSS Team trained 600 Community Health Workers (CHWs) to recognise and refer cases of scabies. The CHWs were all provided with a flipchart in order to deliver training to their community, providing information on scabies, particularly relating to misconceptions and addressing local knowledge gaps.
WSP has also been working with the Fijian MHMS on the development of guidelines relating to scabies, support with information for ivermectin to be available on the essential medicines list, and guidance on health information and surveillance relating to scabies. Towards the end of 2024, we established the Scabies Joint Transition Committee to manage the transition of scabies control into the responsibility of the MHMS and develop a national scabies strategy in Fiji.
Community consultation in Central Division, WSP 2024
WSP team member Tuli during a community consultation in Central Division, WSP 2024
Post-MDA scabies prevalence survey
WSP Fiji kicked off 2024 with a post-MDA scabies prevalence survey, to assess the ongoing impact of scabies following the national MDA completed in 2023. Northern Division launched the national survey in February, closely followed by Western Division in March, with Central and Eastern divisions in May.
In each Division, before the survey, nurses were trained to perform skin examinations for scabies and bacterial skin infections, and data officers were trained to use the data collection tool, REDCap, on electronic tablets. On the last day of training, the survey teams travelled to a village for a mock exercise to put their skin examination training into action.
To conduct the surveys, the survey teams split up into subdivisions and spent approximately two weeks travelling to randomly selected communities within their subdivision, where they respectfully asked randomly selected households to participate in the skin examination survey. WSP is very grateful for the survey teams for their hard work, and to the Fijian communities for participating in this prevalence survey.
Conducting a skin examination on a child in Western Province, WSP 2024
Northern Division survey team in the field, WSP 2024
A scabies survey skin examiner visiting a household in the Western Division of Fiji, WSP 2024
Conducting household randomisation in Northern Division, WSP 2024
The integrated scabies and LF MDA in Northern and Eastern Divisions
The WSP team in the North of Fiji have worked in partnership with the Lymphatic Filariasis team at the MHMS. The scabies program is integrating with the Lymphatic Filariasis Unit to administer triple therapy to address both diseases. The teams completed the last day of MDA in February 2023, and were able to come together to celebrate their success.
Over 100 nurses and 300 CHWs were involved with rolling out the MDA to the 130,000 people living in the Northern Division. WSP would like to express a big thank you to every person involved in the MDA and for making sure Fiji has a healthy community, free of scabies.
The MDA teams also worked hard to collect the remaining MDA materials and supplies from all areas in the North to send back to the headquarters in Suva, Fiji. The remaining supplies have been redistributed to complete the MDA in other Divisions in Fiji.
The MDA was next carried out in the Eastern Division, also integrated with the Lymphatic Filariasis Unit. The Eastern division is the largest by area (including the sea). The MDA teams travelled long distances, mainly via boats, in order to reach remote areas and islands to undertake the MDA.
Medicines being dispensed, WSP 2022
The team in Labasa undertaking MDA, Northern Division
MDA Training in the Eastern Division, WSP 2023
MDA nurses walking house to house to complete the MDA, Northern Division 2022
A nurse completing the MDA register form, Northern Division 2022
A typical morning before the nurses head out to the communities to undertake MDA in the Northern Division of Fiji
The Eastern Division Rotuma Health Team undertaking MDA, WSP 2023
Staff discussing the MDA outside a home, WSP 2022
Man drinking the tablets during the MDA, WSP 2022
Administering medicines during MDA, WSP 2022
Fiji Baseline Prevalence Survey
The national baseline prevalence survey was conducted in the Western, Central and Eastern divisions of Fiji from November 2021 to March 2022. Skin examiners were trained to identify suspected scabies-like lesions and impetigo in typical exposed sites on the body. Each team included a skin examiner (nurse), a data officer and a driver. 30 villages were randomly selected in the Western and Central Divisions and ten villages in the Eastern Division, which has a much smaller population. In each village 25 households were randomly selected and all households members were invited to participate in the survey. The survey teams crossed flooded rivers, took long boat rides and tolerated hot conditions to reach households in remote villages and urban areas alike to conduct skin examinations. Many of the communities warmly welcomed the WSP survey teams into their households.
A 6 month old baby found with scabies by a survey skin examiner in the Western Division of Fiji, 2021 World Scabies Program
The Prevalence Survey Team, Fiji 2022
The Fiji survey team in the Ba Subdivision walking to a settlement located near a mangrove and swampy area, 2021 World Scabies Program
A scabies survey skin examiner visiting a household in the Western Division of Fiji, 2021 World Scabies Program
The BIG SHIFT study in Fiji finds ivermectin reduces the incidence of bacterial complications of scabies
A 2019 study known as The Big Skin Health Intervention Fiji Trial (Big SHIFT) found that ivermectin-based MDA can not only reduce scabies and impetigo but also reduce serious bacterial complications. The study was a before-after intervention trial of ivermectin-based MDA delivered to the whole population of the Northern Division of Fiji.
The research found the incidence of hospitalisations with skin and soft tissue infections was 17% lower after the intervention compared to baseline. The researchers stated the findings represent a big step forward in scabies control and would help inform international policymakers on their scabies control strategy.
As the world’s first study explicitly designed to investigate how ivermectin impacts on bacterial conditions associated with scabies, the findings provide key information to policymakers, including the WHO who have identified scabies control with ivermectin as a high research priority.
Overall, the researchers have stated the findings represent a big step forward in scabies control and would help inform international policymakers on their scabies control strategy.
The study was recently published in The Lancet Regional Health Western Pacific. It is open access and can be found here: https://doi.org/10.1016/j.lanwpc.2022.100433
BIG SHIFT survey team undertaking the study
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