Behavioral and Healthcare Determinants of Self-Reported Scabies in Chiwanda Ward, Nyasa District, Tanzania

IntroductionScabies, caused by Sarcoptes scabiei, is a neglected tropical disease that disproportionately affects underserved rural communities, where transmission is commonly sustained through prolonged close contact and sharing of personal items. This study assessed household scabies experience and associated factors during a past outbreak in Nyasa District. MethodsA retrospective community-based cross-sectional study was conducted among 198 households from four villages. Data were collected using an AfyaData-digitized, expert-validated questionnaire aligned with the International Alliance for the Control of Scabies criteria to improve syndromic specificity. Quantitative data were analyzed using univariable and multivariable logistic regression. Open-ended responses (Q24-Q26) were analyzed thematically and triangulated with regression findings. ResultsOverall, 60.6% (120/198) of households reported scabies experience during the outbreak period. In multivariable analysis, higher odds of household scabies experience were associated with sharing personal items (Rarely AOR = 4.059; Frequent AOR = 4.688) and receiving treatment during the outbreak (AOR = 4.705). Non-collaboration with healthcare personnel showed increased odds but was not statistically significant (AOR = 2.035; p = 0.098). Lower odds were observed among households reporting "not sure" responses for prior scabies history (AOR = 0.235) and treatment (AOR = 0.249), suggesting uncertainty-related misclassification. Qualitative themes mapped to these determinants: sharing items aligned with laundry/bedding and clothing hygiene practices ("...kufua... na kuzidisha usafi"); treatment aligned with effectiveness concerns and access/availability barriers ("madawa... hayatibu"; "matibabu mbali"); collaboration aligned with requests for outreach/education and follow-up ("watoa huduma hawakufika..."); and "not sure" responses aligned with misconceptions and uncertainty ("tulifikiri... tumerogwa"). ConclusionThe study demonstrates a substantial household burden of scabies and highlights the need for coordinated outbreak responses that prioritize household-level prevention (reducing sharing of personal items), improved access to effective treatment, and stronger health system-community engagement. Triangulation of regression results with community narratives supports AfyaDatas value for standardized, criteria-informed investigation and targeted public health action in Tanzania. Author SummaryScabies is a contagious skin disease caused by tiny mites that burrow into the skin and cause intense itching and rash. It spreads mainly through prolonged skin-to-skin contact and by sharing personal items such as clothes and bedding. Scabies is common in many low-resource settings, but local evidence is often limited, which makes it difficult to plan effective prevention and outbreak response. We investigated a scabies outbreak that occurred in Nyasa District, southern Tanzania, in September 2022. We interviewed 198 households in four villages using a mobile data collection tool (AfyaData) and a standardized questionnaire informed by international scabies guidance. We found a high household burden of scabies experience. Quantitative analysis showed that households reporting scabies were more likely to report sharing personal items and seeking/receiving treatment during the outbreak, and they also reported weaker collaboration with healthcare personnel. Open-ended responses supported these patterns: participants described the importance of washing clothes and bedding, concerns that medicines were ineffective or difficult to access, and a need for health worker outreach, education, and follow-up. Some responses reflected uncertainty and misconceptions about the cause of illness. Our findings show that scabies outbreak control in rural settings requires household-focused prevention, timely access to effective treatment, and stronger coordination between communities and health services. The study also demonstrates how digital tools can support standardized outbreak investigation and guide targeted public health action aligned to control scabies and other neglected tropical diseases.