Burden of Neonatal Skin and Subcutaneous Diseases in Low-Income Countries.

BACKGROUND

Neonates in low-income countries face a high burden of skin and subcutaneous diseases. We evaluated trends, inequalities, and future projections for these conditions from 1990 to 2035.

METHODS

Using data from the Global Burden of Disease 2023 study, we analyzed incidence rates and estimated annual percentage changes (EAPC) from 1990 to 2023 across 50 low-income countries. Inequalities were assessed using the slope and concentration indices, and frontier analysis was applied to identify high-burden outliers relative to the socio-demographic index (SDI). Trends were projected to the year 2035.

RESULTS

Between 1990 and 2023, the overall incidence rate in low SDI regions declined slightly (EAPC = -0.07, 95% CI -0.09 to -0.05). Disease-specific trends varied: scabies (EAPC = 0.45), pruritus (EAPC = 0.31), other skin and subcutaneous diseases (EAPC = 0.29), and bacterial skin diseases (EAPC = 0.06) increased, while fungal skin diseases decreased (EAPC = -0.50). Incidence rates were consistently higher among females. National incidence rates in 2023 ranged from 40,436.75 per 100,000 in Honduras to 98,996.08 in Nigeria. A strong inverse correlation with SDI was observed, and frontier analysis identified Ethiopia, Mali, and Guinea-Bissau as high-burden outliers. Projections to 2035 indicate total annual cases will rise to 2.84 million (95% UI 2.08-3.87 million), with continued increases for bacterial diseases (projected cases: 635,957) and scabies (412,427).

CONCLUSIONS

The burden of neonatal skin diseases in low-income countries is substantial, unequal, and increasing for key conditions. Targeted prevention and management strategies integrated into primary neonatal care are urgently needed.