Retrospective study of epidermal parasitic skin diseases amongst out- patients of skin diseases hospital, Maiduguri, Borno State, Nigeria

A ten year retrospective study (1997-2006) was undertaken to determine the prevalence of Epidermal Parasitic Skin Diseases (EPSD) among out-patients from the skin diseases hospital in Maiduguri, Borno state. Out of 10,000 out-patients examined during the study period, 3527(35.27%) where infected with EPSD. Of this number, 2819(79.9%) were infected with scabies and 708 (20.1%) with Cutaneous Larva Migrans (CLM). Retroprevalence among age revealed 1912(67.83%) for the young and 907 (32.17%) for adults infected with scabies and 418(59.04%) and 290 (40.96%) for adults infected with CLM. Similarly, sex wise prevalence reveals that the males had 2031 (72.05%) and 501 (70.76%) for scabies and CLM scabies (p<0.05), while females had 788 (27.95%) and 207 (29.24%) respectively for scabies and CLM (p<0.05). Based on cumulative monthly distribution, it was most prevalent between May and September for both scabies and CLM out- patients. Adequate attention should be accorded to the risk factors such as lack of adequate sanitation, poor hygiene and overcrowding which when eliminated or reduced will reduce the burden of the disease. Keywords : Epidermal, Parasitic, Skin diseases, Scabies, CLM,

The skin diseases hospital in Maiduguri Borno State was first established in 1978 as a leprosy center, but was later converted to a skin diseases hospital in 1988 and provides health care services to the grass roots particularly on health care education pertaining to personal hygiene and food and nutrition and acquires its funding from non-governmental organizations (NGO's) in collaboration with the Federal Ministry of Health. A great majority of tropical diseases in one way or another are intricately linked with poverty (Traub et al. 2002).
Scabies refers to the various skin lesions produced by female mites, and their eggs and scybala that are deposited in the epidermis, leading to delayed-type hypersensitivity reaction (Hengge et al., 2006). It remains one of the commonest of all skin diseases of all ages in many regions in resource-poor societies. Likewise, cutaneous larva migrans is caused by penetration of hookworm larvae usually from dogs or cats, into the skin of humans. It causes creeping eruption on the skin which is usually self-limited (Heukelbach et al., 2004) Both Scabies and Cutaneous larva migrans are largely common because of the highly conducive eco-climate, human and social factors (Heukelbach et al. 2002), with a high burden particularly in developing countries and amongst resource-poor populations (Hay, et al. 2012). However, these epidermal parasitic skin diseases (EPSD) are rarely acknowledged as public health problems and have been widely neglected by the scientific community and health care providers, hence the study was undertaken to provide relevant data on the retroprevalence of Epidermal Parasitic Skin Diseases (EPSD) among out-patients from the skin diseases hospital in Maiduguri, Borno state.

MATERIALS AND METHODS
Records of out-patients documented between 1997 and 2006 (a span of ten (10) years) were reviewed with particular reference to Scabies and Cutaneous Larva Migrans. Monthly occurrence of the two epidermal parasitic skin diseases (EPDS) was taken down in relation to the age and sex of the outpatients. The data obtained were summarized in table and bar chart. Student t-test was performed to determine significant difference between variables. Table 1 below shows the prevalence of epidermal parasitic skin diseases based on the sex and age of out-patient examined. Out of the 10,000 out-patients examined 3527 (35.27%) were infected with 2819 (79.9%) for scabies and 708 (20.1%) for CLM (p< 0.05). This is similar to that reported by Schuster et. al., (2011). Scabies and CLM are common among impoverished rural and urban communities in countries with hot climates and belong to the category of neglected tropical diseases (NTD) (Hengge et al. 2006). However, EPSD is irregular, and incidence and prevalence vary in relation to area and population. This agrees with Feldmeier and Heukelbach, (2009) and Hay, et al., (2012) that children are the most vulnerable but differs on their findings on sex". However, factors responsible for the high burden of EPSD in resource poor communities are complex and have not been clarified, but it has been suggested that crowding, sharing of beds, frequent population movements, poor hygiene lack of access to health care, inadequate treatment, malnutrition and social attitude are contributors, and it is difficult to disentangle the relative importance of economic, environmental and behavioral factors, since they frequently coexist (Singg, 2015;Jose et al. 2016).

RESULTS AND DISCUSSION
The cumulative monthly distributions of EPSD are shown in Figure 1 and 2 above for scabies and CLM respectively. Furthermore, prevalence was also significantly higher between May and September within which falls the rainy season. This agrees with Heukelbach et al., (2004); Hengge et al., (2006); Feldmeier and Heukelbach, (2009) that scabies and hookworm related cutaneous larva migrans (HrCLM) have seasonal variation of disease occurrence with most cases in the rainy season.

Conclusion:
In conclusion, the burden of EPSD' s are reportedly high in Maiduguri, and this could be attributed to risk factors such as lack of adequate sanitation, poor hygiene and overcrowding.

Months of the Year
Therefore, the existence of these epidermal diseases in the study area necessitates the need for an urgent and comprehensive prevention strategy be put in place to curtail and reduce the prevalence and probable eradication from this area.