Paper short abstract:

Large scabies outbreaks have occurred in the Amhara region, Ethiopia since 2015 and our research explored the local scabies management practices. The health-seeking itineraries of people with scabies have been shaped by the prevailing pluricultural scabies management system.

Paper long abstract:

Large scabies outbreaks have occurred in the Amhara region 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 different districts of the Amhara region and our research explored reasons for the persistence of scabies despite efforts. Ethnographic fieldwork was conducted from February to July 2022 and included 57 semi-structured interviews, participant observation, and document analysis.

There are mainly two indigenous healing practices available for the treatment of scabies in Debre Elias: holy water and traditional herbal medicine. The cultural competence and affordability of traditional medicine, the perceived cause of scabies and disease conceptualization, and the lack of access to biomedical health services influenced people to seek treatment from traditional sources. The health-seeking itineraries of people with scabies have been shaped by the prevailing pluricultural scabies management system. Most people with scabies initiate their treatment by visiting traditional treatment centres and finally end up in the biomedical setting. The indigenous scabies treatment served as an initial scabies management option. However, the biomedical actors did not recognize the role of the indigenous healing and often held antagonistic views toward the functions of traditional healers. The existence of pluralistic scabies treatments should be seen as an opportunity not as a liability for scabies control and mechanisms should be devised to bring the traditional healers and biomedical practitioners to collaborate in responding to scabies.