From co-existence to collaboration: The need to move towards an inclusive (pluricultural) scabies management approach in Debre Elias (Ethiopia)
4 affiliations
- 1Department of Social Anthropology, Faculty of Social Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- 2Department of Global Health, Brighton and Sussex Medical School (BSMS), University of Sussex and University of Brighton, Brighton, United Kingdom
- 3Department of Sociology and Social Anthropology, College of Social Sciences, Arts and Humanities, Addis Ababa University, Addis Ababa, Ethiopia
- 4School of Global Studies, University of Sussex, Brighton, United Kingdom
Abstract
Several large scabies outbreaks have occurred in the Amhara region of Ethiopia since 2015, and biomedical interventions focused on mass drug administration are often deployed to contain the disease. However, there is a persistent scabies incidence in the Amhara region. To understand this, we sought to explore how people living in Debre Elias understand and seek to manage scabies in their everyday lives. We collected data via a rapid ethnographic approach which included observations and semi-structured interviews. Fieldwork was conducted from February to July 2022 and involved 57 interviews with individuals who had experienced scabies and those who hadn’t but were at risk, as well as local health workers, traditional healers, and government officials. It also included participant and non-participant observation of persons with and without scabies in their homes and public spaces such as workplaces, social events, and treatment facilities. Critical analysis of scabies control and policy documents was also used to fully understand the local dynamics around scabies in Debre Elias. People living in Debre Elias commonly navigate both biomedical and traditional healing systems to manage various health problems, including scabies. However, this practice remains largely informal, as traditional healing is often marginalised in official scabies control strategies. Most individuals affected by scabies initially seek care from traditional healers, often turning to biomedical services only afterwards. Health-seeking and treatment decisions are shaped by the perceived causes of scabies, the cultural relevance and affordability of traditional medicine, and limited access to biomedical services. We conclude that traditional healing plays a central role in local scabies management. Recognising and engaging with existing medical pluralism may improve the acceptability, reach, and effectiveness of scabies programmes. Supporting pluralistic treatment pathways should therefore be considered an opportunity rather than a liability for scabies control. Author summary: Scabies remains a significant public health problem in the Amhara region of Ethiopia despite repeated control efforts, including mass drug administration campaigns. To better understand the frequent scabies occurrence, we explored how people in Debre Elias perceive and manage scabies in their everyday lives. Using a rapid ethnographic approach, we conducted interviews with community members, traditional healers, health workers, and government officials, alongside observations and analysis of local policy documents. We found that people commonly move between traditional and biomedical healthcare systems when seeking treatment for scabies. Most individuals initially consult traditional healers, often accessing biomedical services only later. Decisions about treatment are influenced by local understandings of scabies, the cultural relevance and affordability of traditional medicine, and challenges in accessing biomedical care. Despite its widespread use, traditional healing remains largely excluded from official scabies control strategies. Our findings show that traditional healing plays a central role in local scabies management. Scabies control programmes may be more effective if they recognise and engage with existing systems of traditional healing rather than focusing exclusively on biomedical interventions. Integrating and working alongside trusted local healing systems could improve the acceptability, reach, and sustainability of scabies control efforts.
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BibTeX
@article{wonde2026from,
title = {{From co-existence to collaboration: The need to move towards an inclusive (pluricultural) scabies management approach in Debre Elias (Ethiopia)}},
author = {Dereje Wonde and Kibur Engdawork and Anne Roemer-Mahler and Getnet Tadele and Mei Trueba},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014773},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014773},
note = {CC BY},
}
RIS
TY - JOUR
TI - From co-existence to collaboration: The need to move towards an inclusive (pluricultural) scabies management approach in Debre Elias (Ethiopia)
AU - Dereje Wonde
AU - Kibur Engdawork
AU - Anne Roemer-Mahler
AU - Getnet Tadele
AU - Mei Trueba
PY - 2026
DA - 2026/10/01
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014773
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014773
AB - Several large scabies outbreaks have occurred in the Amhara region of Ethiopia since 2015, and biomedical interventions focused on mass drug administration are often deployed to contain the disease. However, there is a persistent scabies incidence in the Amhara region. To understand this, we sought to explore how people living in Debre Elias understand and seek to manage scabies in their everyday lives. We collected data via a rapid ethnographic approach which included observations and semi-structured interviews. Fieldwork was conducted from February to July 2022 and involved 57 interviews with individuals who had experienced scabies and those who hadn’t but were at risk, as well as local health workers, traditional healers, and government officials. It also included participant and non-participant observation of persons with and without scabies in their homes and public spaces such as workplaces, social events, and treatment facilities. Critical analysis of scabies control and policy documents was also used to fully understand the local dynamics around scabies in Debre Elias. People living in Debre Elias commonly navigate both biomedical and traditional healing systems to manage various health problems, including scabies. However, this practice remains largely informal, as traditional healing is often marginalised in official scabies control strategies. Most individuals affected by scabies initially seek care from traditional healers, often turning to biomedical services only afterwards. Health-seeking and treatment decisions are shaped by the perceived causes of scabies, the cultural relevance and affordability of traditional medicine, and limited access to biomedical services. We conclude that traditional healing plays a central role in local scabies management. Recognising and engaging with existing medical pluralism may improve the acceptability, reach, and effectiveness of scabies programmes. Supporting pluralistic treatment pathways should therefore be considered an opportunity rather than a liability for scabies control. Author summary: Scabies remains a significant public health problem in the Amhara region of Ethiopia despite repeated control efforts, including mass drug administration campaigns. To better understand the frequent scabies occurrence, we explored how people in Debre Elias perceive and manage scabies in their everyday lives. Using a rapid ethnographic approach, we conducted interviews with community members, traditional healers, health workers, and government officials, alongside observations and analysis of local policy documents. We found that people commonly move between traditional and biomedical healthcare systems when seeking treatment for scabies. Most individuals initially consult traditional healers, often accessing biomedical services only later. Decisions about treatment are influenced by local understandings of scabies, the cultural relevance and affordability of traditional medicine, and challenges in accessing biomedical care. Despite its widespread use, traditional healing remains largely excluded from official scabies control strategies. Our findings show that traditional healing plays a central role in local scabies management. Scabies control programmes may be more effective if they recognise and engage with existing systems of traditional healing rather than focusing exclusively on biomedical interventions. Integrating and working alongside trusted local healing systems could improve the acceptability, reach, and sustainability of scabies control efforts.
SN - 1935-2735
SN - 1935-2727
ER -