Scabies is a parasitic disease of the skin that disproportionately affects disadvantaged populations. The disease causes considerable morbidity and leads to severe bacterial infection and immune-mediated disease. Scientific advances from the past 5 years suggest that scabies is amenable to population-level control, particularly through mass drug administration. In recognition of these issues, WHO added scabies to the list of neglected tropical diseases in 2017. To develop a global control programme, key operational research questions must now be addressed. Standardised approaches to diagnosis and methods for mapping are required to further understand the burden of disease. The safety of treatments for young children, including with ivermectin and moxidectin, should be investigated. Studies are needed to inform optimum implementation of mass treatment, including the threshold for intervention, target, dosing, and frequency. Frameworks for surveillance, monitoring, and evaluation of control strategies are also necessary.

Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.

The impact of the severe drought in Ethiopia, attributed to El Niño weather conditions, has led to high levels of malnutrition that have, in turn, increased the potential for disease outbreaks. In 2015, Ethiopia faced a scabies outbreak in drought-affected areas where there was a shortage of safe water for drinking and personal hygiene. Following a house-to-house census to assess the prevalence of scabies, a detailed study was conducted looking at the disease burden. Following the outbreak report, training was provided on scabies identification and management for zonal and district health officials from administrative districts affected by the drought (nutritional hot-spot woredas). The training was cascaded down to the health extension workers in the affected areas. Screening and management guidelines and protocols were also distributed. House-to-house data collection was undertaken by 450 health extension workers (HEWs) to assess the prevalence of scabies. The HEWs used a simplified reporting tool. Subsequently, data were collected and validated in two zones and six woredas from 474 participants who had been diagnosed with scabies using a standardized questionnaire. This was designed to look at the specificity of the diagnosis of scabies, age distribution, severity, duration of illness, secondary infection and other sociodemographic variables as preparation for mass drug administration (MDA). The HEWs screened 1,125,770 people in the 68 districts in Amhara Region and a total of 379,000 confirmed cases of scabies was identified. The prevalence in the different districts ranged from 2% to 67% and the median was 33.5% [interquartile range (IQR) 19–48%]. 49% of cases were school-aged children. The detailed study of 474 individuals who were recorded as scabies cases revealed that the specificity of the diagnosis of scabies by the HEWs was 98.3%. The mean duration of illness was 5 months (SD of ± 2.8). One third of patients were recorded as having severe illness, 75.1% of cases had affected family members, and 30% of affected children were noted to have secondary bacterial infection. Eleven percent of the students had discontinued school due to scabies or/and drought and 85% of these had secondary bacterial infection. These community-based data serve as reliable proxy indicators for community-based burden assessment of the scabies epidemic. This study will also provide a good basis for advocating the use of a community-level clinical diagnostic scheme for scabies using an algorithm with a simple combination of signs and symptoms in resource-poor settings.

Infections by Extended-Spectrum Beta-Lactamase producing Escherichia coli (ESBL-Ec) are on the increase in Ghana, but the level of environmental contamination with this organism, which may contribute to growing Antimicrobial Resistance (AMR), is unknown. Using the WHO OneHealth Tricycle Protocol, we investigated the contamination of E. coli (Ec) and ESBL-Ec in two rivers in Ghana (Odaw in Accra and Okurudu in Kasoa) that receive effluents from human and animal wastewater hotspots over a 12-month period. Concentrations of Ec, ESBL-Ec and percent ESBL-Ec/Ec were determined per 100 mL sample. Of 96 samples, 94 (98%) were positive for ESBL-Ec. concentrations per 100 mL (MCs100) of ESBL-Ec and %ESBL-Ec from both rivers were 4.2 × 10⁴ (IQR, 3.1 × 10³–2.3 × 10⁵) and 2.79 (IQR, 0.96–6.03), respectively. MCs100 were significantly lower in upstream waters: 1.8 × 10⁴ (IQR, 9.0 × 10³–3.9 × 10⁴) as compared to downstream waters: 1.9 × 10⁶ (IQR, 3.7 × 10⁵–5.4 × 10⁶). Both human and animal wastewater effluents contributed to the increased contamination downstream. This study revealed high levels of ESBL-Ec in rivers flowing through two cities in Ghana. There is a need to manage the sources of contamination as they may contribute to the acquisition and spread of ESBL-Ec in humans and animals, thereby contributing to AMR.

### Summary box > “We must become bigger than we have been: more courageous, greater in spirit, larger in outlook.” > > Emperor Haile Selassie It was in the city of Gondar in Ethiopia, one of the highest burden countries for neglected tropical diseases (NTDs)1 and currently home to 16 to 20 recognised NTDs (table 1), that a unanimous desire was expressed by scientists, policy makers and health workers from around the world (the forum was an operational research training on NTDs organised by the Structured Operational Research and Training Initiative (SORT IT). SORT IT is a global partnership coordinated by the Special Programme for Research and Training in Tropical Diseases (TDR) hosted at the WHO. http://www.who.int/tdr/capacity/strengthening/sort/en), for urgent reflection on how to garner support and hasten the pace towards achieving the fast approaching Sustainable Development Goal (SDG) target of eliminating NTDs by 2030.2 Concerns, raised by the group are articulated below: View this table: Table 1 The 20 neglected tropical diseases recognised by the WHO* First, there is the term ‘Neglected Tropical Diseases’, coined by Peter Hotez and colleagues in 2003 with the noble intention of propelling political momentum, catalysing donor funding and making quantum shifts in research and development (R&D).3 The question today is whether designating a specific group of diseases as being ‘neglected’ does not carry with it a negative and disempowering connotation. Populations affected by NTDs already face neglect by being …