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 to eliminate scabies as a national public health problem throughout the country.
Scabies is highly prevalent throughout Fiji, in 2007 a national prevalence survey found 23% of Fijians has scabies at any given time. Moreover, scabies disproportionately affects children with 45% of children aged 5-9 years old, almost one in every two children, being affected by the disease. In 2016, the Fiji Government released its annual Health Status Report revealing skin and soft tissue infections (SSTIs) to be the fifth most common cause of mortality within the country.
WSP works in close collaboration with the Ministry of Health through the Fijian Centre of Disease Control, P.J. Towmey Hospital and all Divisional Health Teams to implement mass drug administration to eliminate the spread of scabies throughout communities. The program works towards the establishment of a long-term program within the Ministry of Health by strengthening health system capacity to adequately monitor and manage scabies. Additionally, MCRI will work closely with the Fiji WSP Country Team to engage the community and support community health workers in rolling out the WSP and raise community awareness about scabies.
World Scabies Program Fiji Team
Front left to right - Raijeli Vuniduvu (Divisional Project Officer Northern), Aminiasi Tavui (Fiji Program Manager) and Sr Rosa Varanisese (Divisional Project Officer Western)
Back right to left - Kelera Matavesi (Project Assistant), Aminiasi Koroi (Research Officer) and Mareta Vuki (Divisional Project Officer Central/Eastern)
Our work
Health Systems Strengthening project commenced in Fiji
Recently, the WSP team have been working on a Health System Strengthening (HSS) project in Fiji. HSS is designed by the WHO, focusing on six health systems building blocks. WSP’s focus is on health service delivery, health information systems, essentials medicines, and leadership and governance.
The project in Fiji is aiming to build the capacity of the health service to recognise and treat scabies through training for community health workers and nurses, as well as community awareness campaigns. WSP is also looking into avenues to improve surveillance and reporting on scabies and increasing access to essential medicines, such as ivermectin and permethrin cream throughout the health system.
In April, the WSP HSS team held community consultations to gather more information on scabies, particularly relating to misconceptions, addressing local knowledge gaps, and testing if the resources that have been developed are culturally competent to ensure the approach meets the needs of Fiji’s population.
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 has kicked off 2024 with a post-MDA scabies prevalence survey, to assess the ongoing impact of scabies following the national MDA completed last year. Northern Division launched the national survey in February, closely followed by Western Division in March, with Central and Eastern divisions about to commence in May.
In each Division, before the survey, nurses are trained to perform skin examinations for scabies and bacterial skin infections, and data officers are trained to use the data collection tool REDCap on electronic tablets. On the last day of training, the survey teams travel 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 spend approximately two weeks travelling to randomly selected communities within their subdivision, where they respectfully ask 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 Ministry of Health and Medical Services. 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 community health workers 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 in mainly 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 mass drug administration can not only reduce scabies and impetigo but also reduce serious bacterial complications. The study was a before-after intervention trial of ivermectin-based mass drug administration 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 World Health Organization 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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