Skin diseases, including skin NTDs, identified through community-based integrated skin screening: Findings from the PEP4LEP study in Tanzania

Background

Skin diseases, including skin-related neglected tropical diseases (NTDs), contribute substantially to the global disease burden, particularly in low- and middle-income countries. Strengthening community health programmes to promote early diagnosis and treatment of skin conditions is essential. This study describes skin diseases identified during community-based integrated skin screening events conducted as part of the PEP4LEP project in three districts in Tanzania. A second objective is to use prevalence data to inform integrated skin health and NTD strategies within Tanzania and in similar contexts beyond.

Methodology

A cross-sectional study was conducted within the PEP4LEP implementation research project between December 2019 and March 2024. Community ‘skin camps’ were organised near leprosy index patients – without disclosing their disease status – to screen contacts from the 20 nearest households and administer preventive medication to those eligible. A dermatologist screened participants and provided medical advice, medication (prescriptions) and/or referrals. Demographic data and diagnoses were registered. A subset of participants also completed an additional questionnaire. Paper-based data were entered into REDCap and Microsoft Excel, and analysed in SPSS and Stata using descriptive statistics and Chi-square tests.

Results

Of the 4,501 persons screened during 44 community skin camps, 2,527 (56.1%) were diagnosed with one or more skin diseases, of whom 392 (15.5%) had multiple conditions. Among 2,959 recorded diagnoses, 92 distinct skin diseases were identified. The most common conditions were tinea capitis (24.0% of diagnoses), pityriasis versicolor (13.0%), and scabies (7.3%). Five skin NTDs were seen among 280 participants, accounting for 6.2% of all screened individuals and 9.5% of all diagnoses: scabies, leprosy (1.5% of diagnoses), onchocerciasis (0.5%), lymphatic filariasis (0.1%), and chromoblastomycosis (0.03%). Of the 1,841 dermatological patients who completed the additional questionnaire, 28.3% had previously sought medical care, with over half (54.6%) consulting drug-selling shops.

Conclusion

Over half of the community members screened in Tanzanian skin camps had at least one skin condition, with skin NTDs accounting for almost 10% of diagnoses. Strengthening integrated, community-based dermatological and NTD control approaches is vital to improve early detection and treatment, particularly in underserved areas.