Daniel Engelman

Aim: To develop consensus on the priorities for multi‐centre, inpatient general paediatrics research in Australia and New Zealand. Methods: The Children's Inpatient Research Collaboration of Australia and New Zealand (CIRCAN) conducted a three‐stage modified Delphi study consisting of three anonymous survey rounds followed by a Hanlon Process of Prioritisation. Results: Participants included paediatricians, paediatric trainees, nursing, allied health staff, and academics. A moderator group (10 members) oversaw the process. In the first survey, 124 participants submitted 306 research questions which were refined to a list of 89 by the moderator group. Eighty‐one respondents took part in the second and third survey rounds, leading to identification of 19 priority research questions, which were then anonymously ranked by 18 CIRCAN members through a facilitated Hanlon Process of Prioritisation. The highest ranked topics included asthma (six questions), bronchiolitis (five questions), sepsis/meningitis (four questions), as well as single questions on cellulitis, eating disorders, rehabilitation, and coordination of complex care. Conclusion: This prioritisation study established a consensus list of research questions. Research topics regarding respiratory conditions were most highly ranked. These results will inform multicentre inpatient general paediatric research in Australia and New Zealand.

Acceptability of treatment choice may pose challenges

: Scabies is endemic in many resource-poor tropical areas, causing significant morbidity. However, our understanding of the true burden of scabies in Africa is limited, partly owing to limited capacity and challenges accessing the currently recommended diagnostic tools. The primary objective of this study was to assess the diagnostic accuracy of scabies assessments made by minimally trained field-workers. We trained field-workers with a minimum of secondary school education in the diagnosis of scabies. After the training, we assessed the diagnostic accuracy of assessments made by nine field-workers compared with the reference standard. In all, 193 individuals were assessed for scabies. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, as well as agreement (κ coefficients) between medical doctors and between field-workers. Of the 193 participants, 26% had scabies according to the reference standard. The sensitivity of field-worker diagnosis compared with the reference standard was 94% (95% CI: 90–99%), and the specificity was 96% (95% CI: 90–97%). The determination of severity by field-workers was less accurate; the sensitivity for severe scabies was 61% (95% CI: 48–74%), and the mean specificity was 97% (95% CI: 93–100%). This study demonstrated that field-workers without medical qualifications were capable of diagnosing scabies to a similar level of accuracy as experienced medical doctors after a short period of focal training. This may facilitate rapid assessments of scabies prevalence for public health purposes and decisions about mass drug administration implementation in similar settings.

Introduction Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste. Methods and analysis Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the ‘Single Parasternal Long Axis view with a Sweep of the Heart’ (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs. Ethics and dissemination Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication. Trial registration number NCT06002243.

Background: Scabies and impetigo cause direct health effects and contribute to severe infectious and immune-mediated complications. Ivermectin-based mass drug administration can reduce scabies and impetigo prevalence in island settings with high prevalence, but the effectiveness in moderate-prevalence settings is not known. Methods: We conducted a single-arm, before–after community intervention trial. Mass drug administration was offered to the entire population of 4 villages in Uttarakhand, India. The treatment consisted of 2 doses, given 7 days apart, of oral ivermectin (∼200 μg/kg), or topical 5% permethrin if ivermectin was contraindicated. The primary outcome was the prevalence of scabies at 12 months compared with baseline, as diagnosed using clinical assessment and the 2020 International Alliance for the Control of Scabies criteria. Secondary outcomes included the prevalence of impetigo at each time point. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12619001712190). Results: In January 2020, 1211 participants were enrolled (100% of the estimated village population). Treatment coverage was high—1204 (99.4%) and 1177 (97.2%) received 1 and 2 doses, respectively. Scabies was diagnosed in 91 participants (7.5%) and impetigo in 15 (1.2%). In February 2021, 1190 (98.3% of baseline) participants re-enrolled, and of these 11 had scabies (0.9%; relative risk reduction, 87.7%; 95% CI, 77.1%–93.4%) and 5 had impetigo (0.4%; relative risk reduction, 66.1%; 95% CI, 7.0%–87.6%). Conclusions: A single round of ivermectin-based mass drug administration substantially reduced the prevalence of scabies and impetigo in this setting with moderate scabies prevalence in northern India.

Background: Scabies is endemic in many tropical, resource-poor areas, causing significant morbidity. Our understanding of the true burden of scabies in Africa is very limited, and we lack tools to accurately assess its prevalence, given our reliance on highly qualified doctors and microscopy for diagnosis. The primary objective of this study was to assess the accuracy of minimally trained fieldworker diagnosis of scabies, compared to diagnosis by experienced medical doctors. Methodology: We trained 62 fieldworkers with a minimum of secondary school education in the diagnosis of scabies (categorized as either clinical or suspected), and in terms of severity, based on lesion count. Immediately after the training, we assessed their knowledge based on written assessments. We also assessed the diagnostic accuracy of a sub-sample of the fieldworkers in the field compared to the reference standard (experienced medical doctors). 193 individuals were assessed for scabies. The sensitivity, specificity, PPV and NPV were calculated, as well as agreement (kappa coefficients) between medical doctors and between fieldworkers. Results: The overall median results in written assessments were around 80%. Of the 193 people assessed for scabies, 27% were classified as having scabies according to the reference standard. The sensitivity of fieldworker diagnosis compared to the reference standard was 95% (95%CI 93 -100), and the specificity was 99% (95%CI 99-100). The sensitivity for severe scabies was lower at 64% (95%CI 51-75), and the mean specificity was 100%. Kappa coefficients were 1.00 between medical doctors and 0.95 between fieldworkers. Conclusions: Fieldworkers without medical qualifications were capable of diagnosing scabies to a similar level of accuracy as experienced medical doctors, after a short period of focal training. This may facilitate rapid assessments of scabies prevalence for public health purposes and decisions about MDA implementation in similar settings. Author summary: What is already known on this topic: Scabies is a disease that causes intense itchiness which can affect people’s wellbeing and ability to attend work or school, and if left untreated it can lead to further, more severe complications. Typically, scabies is diagnosed by specialist medical doctors using microscopy. However, many countries lack these resources and therefore there is a paucity of data on scabies prevalence. What this study adds-: In our study, we trained people with no previous medical training in the diagnosis of scabies over a few days through presentations and assessments. We demonstrated that they were able to diagnose scabies to a similar degree of accuracy compared to experienced medical doctors. How this study might affect research, practice or policy-: Understanding that minimally trained fieldworkers are able to diagnose scabies to a similar degree of accuracy as medical doctors, may facilitate the collection of data for survey purposes in resource-poor areas, which in turn may promote advocacy for the disease.

Aim: Here, we present results of a survey of scabies prevalence in childcare centres and primary schools in Auckland.Methods: Children whose parents agreed to take part in participating centres in the Auckland region were examined for scabies by general practitioners and given questionnaires of relevant symptoms. Diagnoses of clinical or suspected scabies were made according to the International Alliance for the Control of Scabies (IACS) criteria. The survey was a stratified random sample of schools and early childcare centres. A quantitative polymerase chain reaction (PCR) test was also used to complement the IACS criteria.Results: A total of 181 children were examined, with 145 children with history information, 16 of whom (11.0%) met the criteria for ‘clinical’ or ‘suspected’ scabies. Weighted analysis, accounting for the survey design, indicated that the prevalence of scabies in early childcare centres was 13.2% (95% CI: 4.3 to 22.1), with no school‐aged children fulfilling these criteria. A higher proportion had clinical signs of scabies with 23 (12.7%) having typical scabies lesions and a further 43 (23.8%) had atypical lesions. A total of 64 PCR tests were taken and 15 (23%) were positive. None of these cases were receiving treatment for scabies. Five were undergoing topical skin treatment: three with topical steroid and two with calamine lotion.Conclusions: The prevalence of children with scabies is high in early childcare centres in Auckland. Misdiagnosis is suggested by several PCR positive cases being treated by topical agents used to treat other skin conditions.