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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 248-252

Pediculosis among school children in a primary school in Millij Village, Menoufia Governorate


1 Department of Dermatolgy Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission14-Apr-2015
Date of Decision20-May-2015
Date of Acceptance26-May-2015
Date of Web Publication25-Mar-2020

Correspondence Address:
Walaa S. A El Mowafy
El Santa, El Gharbia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_162_15

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  Abstract 

Objectives
To determine the prevalence of pediculosis among school children and possible risk factors.
Background
Pediculosis capitis is an obligate ectoparasite that only affects the human scalp. Pediculosis (i.e., louse infestation) dates back to prehistory. The oldest known fossils of louse eggs (i.e., nits) are ~10 000 years old.
Patients and methods
This was an analytic cross-section study. The calculated sample size was 355 participants from the children attending the health unit with their families during the period from December 2013 to June 2014 in Millij Village. All students were evaluated through history taking and completing medical examination followed by laboratory investigations, including hemoglobin %, urine, and stool analyses. A full head examination was conducted by using a hand lens. A child was considered infested if alive or dead lice or eggs were found. Children were classified into two groups: group I Shad pediculosis and group II did not have pediculosis. Statistical presentation and analysis of the present study was conducted by using the mean, SD, and Student test for weight and height, as well as number, percentage, and χ2 test by SPSS, version 8.
Results
The prevalence rate of pediculosis among the studied children was 35.8%. There were significant differences (P < 0.05) between group I and group II regarding sociodemographic data, except for age, which exhibited a nonsignificant difference (P > 0.05). There were statistically significant differences (P < 0.05) between group I and group II regarding risk factors such as long hair, poor hygiene, and use of shared combs/brushes. There were nonsignificant differences (P > 0.05) between group I and group II regarding clinical examination, except for pallor or anemia, which exhibited a significant difference (P < 0.05).
Conclusion
Pediculosis affected more than one-third of the studied school children. Prevalence of pediculosis was very high in grade 4, which was 54.7%. Moreover, the percent of anemia was 57.9%.

Keywords: louse infestation, nits, pediculosis, school children


How to cite this article:
Basha MA, El Moselhy HM, El Mowafy WS. Pediculosis among school children in a primary school in Millij Village, Menoufia Governorate. Menoufia Med J 2020;33:248-52

How to cite this URL:
Basha MA, El Moselhy HM, El Mowafy WS. Pediculosis among school children in a primary school in Millij Village, Menoufia Governorate. Menoufia Med J [serial online] 2020 [cited 2020 Aug 14];33:248-52. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/248/281263




  Introduction Top


Pediculosis capitis infestation, commonly known as head lice, is the manifestation of the obligate ectoparasite, Pediculus humanus capitis, which only affects the human scalp. It is an extremely contagious condition and most common among young children aged 3–12 years. It is a worldwide community health problem that affects children in both developed and developing countries[1].

School children aged 6–12 years are most at risk, although adults and children of other ages who have direct or indirect contact with primary-school children are also susceptible[2].

The pattern and prevalence of pediculosis capitis is dependent on many sociodemographic and economic factors such as overcrowding, hair characteristics, and poor hygiene. Lice infestation may lead to psychological distress and may disrupt learning performance of the children because of the social stigma associated with it[3].

The prevalence of head louse among primary students in Fayoum and Bagor districts was 16.7%. Head lice is a common childhood problem related to poor hygiene and socioeconomic status[4].

The prevalence of head lice among primary school students in Assiut City was 60.6%. Female sex, long hair, sharing of beds and combs, and family overcrowding were the main risk factors for the head lice infestation[5]. The prevalence of pediculosis capitis among primary female school students in an Egyptian village was 44.2%. Mass treatment and health education program about nature of head louse infestations, mode of transmission, personal hygiene, healthy behavior risk factors, and the available control measures are crucial to control this problem[6].

There is an association of louse infestation and anemia. Head lice can cause anemia in humans if over a period of time amount of blood sucked overtakes the rate of production of red blood cells[7].

Aim

The aim was to improve the health of school children through determining the prevalence of pediculosis among school children and possible risk factors.


  Patients and Methods Top


The study protocol was approved by the local ethics Committee of the Menoufia University, and The study was conducted in a Family Health Unit of Millij Village by communicating with local health and informing authorities about the objectives and procedures of the study. An oral consent was taken from each parent of participant in the study by explaining the purpose of the study to him/her. The consent form was developed according to the standard in Quality Improvement System in Ministry of Health and Population in Egypt, which is applied in all family centers and units.

The sample

The calculated sample was 350 students according to number of children attended in family health unit during the period from December 2013 to June 2014 and the prevalence of pediculosis among school students, which was 37%, using Epi-Info, version 6 (CDC, 1600 Clifton Road Atlanta, USA) and SPP for Windows, version 8 (Microsoft, Washington, USA). The calculated sample was 350 which increased to 355 students to compensate for potential dropouts or nonresponses.

A suitable room was chosen in the family health unit for history taking and examinations, which were followed up by investigations (hemoglobin %, urine analysis, and stool analysis), which were also performed in the family health unit. Each student was evaluated by the researcher with the help of the family health unit nurses:

  1. History was taken by using a predesigned questionnaire, including sex, age, socioeconomic status, evaluation number of sisters and brothers, having family member with the same condition, sharing of articles in contact with hair (e.g., combs, scarves, and pillows), and using a head cover
  2. A physical examination was conducted and included general hygiene, weight, height, BMI, signs of anemia, and submandibular lymph nodes. The head examination for lice (nymphs, adults, and eggs) was performed by parting hair every 3 cm and examining the scalp for 3–5 min with the naked eye and the aid of a hand lens. A child was considered infested if lice were alive or dead
  3. Laboratory study: urine, faces, and blood samples were collected and analyzed in the Millij Family Health Center. Urine was examined for urinary tract infection. Urine samples were taken from every child for microscopic examination


  1. Feces for parasitic infestation: fresh fecal samples were collected in clean disposable receptacles. The stool was examined by direct smear
  2. Blood was used to determine hemoglobin %.



  Results Top


The prevalence of pediculosis among the studied children was 35.8% [Figure 1]. The infestation with pediculosis was significantly more among female children, having more brothers and sisters, and of low and middle socioeconomic class, and nonsignificant difference between the two groups regarding age (P > 0.05) [Table 1]. There were statistically significant differences (P < 0.05) between group I and group II regarding poor general hygiene (74.9 vs. 25.9%), having long hair (86.6%), using shared tools (97.6%), and using hair cover (74%) [Table 2]. There were nonsignificant differences (P > 0.05) between group I and group II regarding clinical examination and laboratory investigation, except for pallor and pus in urine, which exhibited a significant difference (P < 0.05) [Table 3] and [Table 4].
Table 1: Comparison between the two groups regarding their sociodemographic data

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Table 2: Comparison between two groups regarding important items in history and general examination among the studied children

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Table 3: Comparison between the studied groups regarding weight, height, hair length, and use of head cover

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Table 4: Comparison between studied group regarding laboratory investigations

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Figure 1: Prevalence of pediculosis among studied group.

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  Discussion Top


The present study showed that prevalence of pediculosis (35.8%) among the studied groups was in agreement with Toloza et al.[8], who showed that the rate of pediculosis differs in various countries throughout the world, for example, in the Netherlands with 4.8%, Brazil with 35%, Turkey with 1.2%, Venezuela with 28.8%, and Argentina with 29.7%. On the contrary, in Iran, Moradi et al.[9] showed that infestation rates were 5.1, 4.5, 2.2, 28.5, and 12%, mostly in the primary school children, in Rasht, Tabriz, Babol, Ardabil, and Boushehr, respectively. In Hamadan Provinces, the overall infestation rates were 7.5, 6.85, and 1.3%, correspondingly. The risk of pediculosis is related to different host factors. Pediculosis is increased in areas with poor socioeconomic conditions, high population concentration, lack of personal hygiene, minimum sanitary facilities, and lack of school nurse. Infestation occurs when hair is not washed or clothes are not changed or washed regularly. In addition, it is related with the parental education and occupation, as well as beliefs and attitudes of mothers to health standards[10].

In the present study, the percentage of pediculosis was higher for girls than for boys (74.6 and 24.4%, respectively). The rise in the prevalence of pediculosis for girls is because of the behavioral differences between girls and boys. Girls' longer hair and their use of veil for the coverage of the hair cause them not to realize the prevalence of pediculosis on time. The present study showed 24.5% of those with covered head and 55.5% of those with longer hair had pediculosis.

Rafinejad et al.[11] revealed that the rate of pediculosis was twice more for girls than for boys. The prevalence of pediculosis has been 3.6 times higher for girls than for boys in Babol, North of Iran, whereas it became 3.23 times higher for girls in Amlash, North of Iran. This kind of variation has been reported to be statistically significant. In Korea, Argentina, and Brazil, Toloza et al.[8] confirmed the aforementioned point. In our study, there were significant pediculosis infestations between groups of low and middle socioeconomic status. Sidoti et al.[12] reported that the prevalence of pediculosis has been higher in the schools of the city outskirts, which have poor socioeconomic status. Moreover, a study done in Italy displayed that knowledge and appropriate response to the infestation pertain to it was estimated. Geographical location of the school, student population of the class, weak situation on economy, and social problems had a relationship with the rate of pediculosis. The increases of pediculosis among public schools in comparison with private schools are indicative of the effects of economic conditions on rate of pediculosis. The socioeconomic state is one of the important factors in the outbreak of pediculosis, which afflicts most of the school students and homeless individuals[13].

In the present study, percentage of pediculosis was higher for grade 4 (54.7%) than for other grades. This may be owing to parental negligence and the children in this age start to depend on themselves and neglect their personal hygiene. Children infected with pediculosis were significantly more among female children who have more brothers and sisters and of moderate social class, as there were significant differences (P < 0.05) between group I and group II regarding sociodemographic data.

There were nonsignificant differences between group of pediculosis and group of no pediculosis regarding clinical examination and laboratory investigation except for pallor and presence of pus in urine, which exhibited a significant difference.

Hyperinfestation with head louse can lead to iron-deficiency anemia in school children[14].

As per survey done by few workers, there exists a knowledge gap in understanding of head lice infestation among parents of children as well as a growing trend toward application of natural substances for prevention and treatment. Proper education of the public and health professionals and clear treatment plans are essential in combating pediculosis capitis[15].


  Conclusion Top


Pediculosis affected more than one-third of the studied school children. Prevalence of pediculosis was very high in grade 4, which was 54.7%. Moreover, the percentage of anemia was 57.9%. There were significant differences between group I and group II regarding sociodemographic data except for age, which exhibited a nonsignificant difference. There were nonsignificant differences between group I and group II regarding clinical examination except for hair length, which exhibited a significant difference. There were significant differences between group I and group II regarding hemoglobin % and pus in urine. Being a girl or being poor is not per se the issue, but hair covering/long hair and lack of brushes/combs become the issue. There is a relation between lice and anemia which can cause lethargy and affect overall health. Simple education and supply of grooming materials could decrease this cascade of events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Motovali-Emami M, Aflatoonain MR, Fekri A, Yazdi M. Epidemiological aspects of pediculosis capitis and treatment evaluation in primary school children in Iran. Pak J Biol Sci 2008; 11:260–264.  Back to cited text no. 1
    
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Burgress FI. Head louse developing a practical approach. Practitioner 2008; 2:126–129.  Back to cited text no. 2
    
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Nazari M, Fakoorziba MR, Shobeiri F. Pediculosis capitis infestation according to social factors in Hamedan, Iran. Southeast Asian J Trop Med Public Health 2006; 37:95–98.  Back to cited text no. 3
    
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Abd El Raheem TA, El Sherbiny NA, Elgameel A, El-Sayed GA, Moustafa N, Shahen S. Epidemiological comparative study of pediculosis capitis among primary shcool children in Fayoum and Minofiya Governorates, Egypt. J Comm Health 2015; 40:222–226.  Back to cited text no. 4
    
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El Magrabi NM, El Houfey AA, Mahmoud SR. Screening for prevalence and associated risk factors of head lice among primary school student in Assiut City. Adv Environ Biol 2015; 9:87–95.  Back to cited text no. 5
    
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El-Khawaga G, Abdel-Wahab F, Mohamed W. Mansoura university prevalence of pediculosis capitis among primary female school students in an Egyptian village. Egypt J Commu Med 2012; 30:12.  Back to cited text no. 6
    
7.
Anjay M, Palanivel V, Datta V, Lloyd B, Shute P. 1284 Human Pediculosis and Anaemia: A “Lousy” Association. Pediatr Res 2010;68:636. Available from: https://doi.org/10.1203/00006450-201011001-0128. [Last accessed on 2014 May 15].  Back to cited text no. 7
    
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Toloza A, Vassena C, Gallardo A, González-Audino P, Picollo MI. Epidemiology of pediculosis capitis in elementary schools of Buenos Aires, Argentina. Parasitol Res 2009; 104:1295–1298.  Back to cited text no. 8
    
9.
Moradi A, Zahirnia A, Alipour A, Eskandari Z. The prevalence of pediculosis capitis in primary school students in Bahar, Hamadan Province, Iran. J Res Health Sci 2009; 9:45–49.  Back to cited text no. 9
    
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Silva L, Aguiar Alencar R, Goulart Madeira N. Survey assessment of parental perceptions regarding head lice. Int J Dermatol 2008; 47:249–255.  Back to cited text no. 10
    
11.
Rafinejad J, Nourollahi A, Javadian E, Kazemnejad A, Shemshad KH. [Epidemiology of head louse infestation and related factors in school children in the county of Amlash, Gilan Province, 2003-2004]. Iran J Epidemiol 2006; 2:51–63.  Back to cited text no. 11
    
12.
Sidoti E, Bonura F, Paolini G, Tringali G. A survey on knowledge and perceptions regarding head lice on a sample of teachers and students in primary schools of north and south of Italy. J Prev Med Hyg 2009; 50:141–149.  Back to cited text no. 12
    
13.
Chosidow O, Giraudeau B, Cottrell J. Oral ivermectin versus malathion lotion for difficult-to-treat head lice. N Engl J Med 2010; 362:896–905.  Back to cited text no. 13
    
14.
Burke S, Mir P. Pediculosis causing iron deficiency anaemia in school children. Arch Dis Child 2011; 96:989.  Back to cited text no. 14
    
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Doulgeraki A, Valari M. Parental attitudes towards head lice infestation in Greece. Int J Dermatol 2011; 50:689–692.  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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