Dermatology within the primary health care system. Long-term results of a self-help project for children in rural Kenya

Background and Objective. In spite of the importance of skin diseases in Af rica south of the Sahara, dermatology is insufficiently represented within the established primary health care systems. Aim of this study was to find out whether an integrated dermatology project could reduce the prevalence o f dermatoses. Patients/Methods. Since 1994 trained community health workers have carried out regular weekly visits to schools and nurseries in 10 communities in rur al western Kenya. Epidemiological studies were done in 13 schools in 4 comm unities involving 5780 and 4961 pupils one year before (1993) and 5 yea rs (1999) following the introduction of the dermatology project. Results. Within this period the prevalence of bacterial skin infections fel l from 12.7% to 11.3% (n.s.). Mycoses rose from 10.1% to 13.9% (p<0.05),whi le arthropod infections (mainly scabies) remained unchanged with a prevalen ce of 8.3% in 1993 and 8.0% in 1999 (n.s.). Dermatitis also showed no chang es (1.7% in both years). Conclusions. The prevalence of infective dermatoses depends not only on med ical treatment but also far more on socio-economic factors.