Burden of scabies in displacement settings: A systematic review and meta-analysis among forcibly displaced populations.

BACKGROUND: By the end of 2024, an estimated 123.2 million people were forcibly displaced due to conflict and persecution, with 80% residing in low- and middle-income countries. Scabies, a neglected tropical disease affecting around 200 million people globally and causing over 455 million new cases annually, disproportionately affects displaced populations due to overcrowding, poor hygiene, and limited healthcare access. However, global evidence on its prevalence among these groups remains inconsistent. This study aimed to estimate the global pooled prevalence of scabies among forcibly displaced populations. METHODS: Systematic searches were conducted in PubMed, Epistemonikos, ScienceDirect, Scopus, and Embase for studies published up to May 28, 2025, supplemented by hand-searches using Google and Google Scholar to capture any additional relevant studies. Data were extracted using Microsoft Excel 2021 and analyzed with STATA version 17. We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies that met the predefined inclusion criteria were included. The Newcastle-Ottawa Scale assessed study quality. A random-effects model was used to calculate pooled prevalence. Heterogeneity was measured using the Galbraith plot and the I2 statistic, while publication bias with funnel plots and Egger's regression test. The protocol was registered with PROSPERO (CRD420251067217). RESULTS: Fourteen studies with 76,664 participants were included. The global pooled prevalence of scabies was 15% (I2 = 99.87%). Prevalence varies by region, study setting, population group, and data collection method. Prevalence was highest in Asia (25%), followed by Europe (13%) and Africa (7%). Refugees showed the highest prevalence (23%), compared to IDPs (13%), asylum seekers (2%), and refugee-asylum seekers (2%). Among population groups, prevalence was highest in combined adult-child populations (66%), patients (24%), and school-aged children (15%), women and children under 15 years (6%), the general population (2%), and unaccompanied minors (1%). Studies using both clinical exams and Questionnaires reported a higher prevalence (27%) than those using clinical exams alone (14%) and interviews or physical examination only (3% and 2%, respectively). CONCLUSION: Scabies poses a significant health (15%) burden among forcibly displaced populations. Integrated interventions, including screening, treatment, WASH programs, and improved surveillance, are urgently needed to reduce transmission and improve health outcomes in displacement settings.