Background
Skin infections affect physical and, through stigma, social-emotional health. When untreated, they can cause life-threatening conditions. We aimed to assess the effect of a holistic, co-designed, region-wide skin control program.
Methods
The SToP Trial was a cluster-randomised, stepped-wedge Trial, involving participants aged 0-18 years in nine remote Kimberley communities (Western Australia). SToP involves programmatic interventions in three domains: ‘See’ (skin checks, skin infection recognition training), ‘Treat’ (skin infection treatment training, cotrimoxazole for impetigo, ivermectin for scabies), and Prevent (co-designed health promotion and environmental health). Four community clusters were randomised in two steps to receive activities over 10 visits. The primary outcome was the proportion of school-aged children (5-9 y/o) with impetigo.
Results
915 children were consented and 777 (85%) had skin checks. A decline in impetigo was observed across all clusters, with the greatest decline during the observational period prior to commencement of activities. The mean (95% credible interval) for the conditional posterior odds ratio for observing impetigo in the intervention compared to the control period was 1.13 (0.72-1.72). The probability that the intervention reduced the odds of observing impetigo was 0.33.
Conclusion
Decreased impetigo prevalence during the observational period was sustained across the trial, attributable to the trimodal skin health initiative. While impetigo prevalence reduced, there is no direct evidence to attribute this to the individual effects of the activities. Routine surveillance was perceived as one of the most impactful activities, pointing to a need for the integration of skin assessments where impetigo burden is high.