A cross-sectional study of the burden and risk factors of impetigo and scabies among children during conflict in the middle area of the Gaza strip

Impetigo and scabies, highly contagious skin infections, proliferate in the overcrowded and unhygienic conditions exacerbated by conflict. This cross-sectional study analyzed the demographic, environmental, and WaSH-related determinants of these infections among children in the middle area of the Gaza strip during its humanitarian crisis. The study was conducted between July and November 2024. Participants were recruited through a mixed non-probability sampling strategy combining systematic screening in displacement shelters and consecutive recruitment from red crescent dermatology clinics. Diagnoses of impetigo and scabies were clinically confirmed by a dermatologist following WHO case definitions for mass emergencies. Data were analyzed using univariate and multivariate logistic regression models to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI). A total of 409 respondents were included in the study; 356 (87%) were diagnosed with impetigo and 150 (36.7%) with scabies, including 99 (24.2%) with co-infection. The majority of participants were from Deir Al-Balah (81%) and reported that they had been displaced at least once since the start of the conflict (91%). Most respondents lived in overcrowded areas (76%) and reported a sleeping-space occupancy exceeding ten individuals (61%). Compared with children aged 0–4 years (reference group), the odds of impetigo were significantly lower among those aged 5–9 years (aOR = 0.30, 95% CI 0.11–0.76, p = 0.013), 10–14 years (aOR = 0.31, 95% CI 0.11–0.82, p = 0.024), and 15–18 years (aOR = 0.11, 95% CI 0.04–0.37, p < 0.001). For scabies, adolescents aged 15–18 years had markedly higher odds compared with the 0–4 year group (aOR = 5.67, 95% CI 2.50–13.31, p < 0.001). Limited access to clean water significantly increased the odds of impetigo (aOR = 2.63, 95% CI 1.12–6.25, p = 0.028), and using public bathrooms independently increased the risk of scabies (aOR = 2.26, 95% CI 1.23–4.29, p = 0.010). The findings highlight an urgent need for coordinated hygiene interventions focused on restoring clean-water access, providing soap and disinfection supplies, and reducing shelter overcrowding. Rapid, targeted treatment and education for high-risk age groups, alongside improved sanitation management in shared facilities, are essential to interrupt transmission. Strengthening disease surveillance and repairing damaged health and water infrastructure should be prioritized to prevent recurrent outbreaks and reduce severe complications.