The Epidemiological Aspect of Pediculusis in Primary School of Qeshm, South of Iran
The purpose of the present study was to determine prevalence of Pediculus humanus capitis and assess risk factors associated it among the primary school pupils of Qeshm, south of Iran. In this descriptive analytical study, 515 pupils were selected randomly. Presence of nit, nymph or adult louse in pupil`s hair was characteristic for diagnosis of head louse infection. The results of the physical examination were recorded in the pre-designed questionnaires for each pupil. The overall prevalence of the infection was found to be 23.9%. Head lice infections were much more commonly in girls than boys with prevalence of 35.27% and 11.07%, respectively. There was significant relationship between head louse infection with sex, grade, number of family members, the education level of parents and job of fathers (p<0.05), but there was no significant relationship between head louse infection with job of mothers. The peak of infection rate was 27.3% in 5th grade. Present study demonstrated a high prevalence of head lice among primary school children of Qeshm. Health education about ways of infection, methods of prevention, personal hygiene and providing suitable hygienic living place for them are important to decrease head louse infection in pupils.
Head lice infection caused by Pediculus humanus capitis, which has existed for more than 10, 000 years, is a common and worldwide problem (Sim et al., 2003; Service, 2004). It is transmitted directly by close contact with an infected individuals head or indirectly via fomites such as hair, hats, or combs (Bartels et al., 2001). Head lice feed by sucking blood and cause purities to host due to sensitization to louse saliva and subsequent skin excoriation may lead to secondary bacterial infections. In addition, chronic irritation and secondary infection may disrupt behavior and school performance (Baily et al., 2000). Also human louse infection may cause psychological distress (Mumcuoglu, 1999). It is not considered to be a serious health problem. Nevertheless, human louse infection consumes considerable time and attention of the public and private health communities (Sim et al., 2003). Infestation with head lice is usually detected by three types of evidence: itching and inflammation of the scalp and neck, sighting of lice and detection of eggs attached to hair shafts (Spear and Buetter, 1999).
The eggs of head lice are laid within 1 cm of the scalp and are firmly bound
to the shafts of hairs. Hatching occurs about 7 days after deposition, but most
eggs remain in site after the larvae have escaped. The empty egg shell (nit)
can remain on the hair for many months, even after the infection has been eradicated
(Service, 2004). Consequently, although finding nits is evidence of past infection,
it is not diagnostic of current infection. The threat of transmission to other
people is only posed by active infection, which can be confirmed exclusively
by finding lice, or viable un-hatched eggs, on the hair shafts. When this ecto-parasite
is associated with poor social conditions and inadequate diet, the infestation
may even lead to anemia (Spear and Buetter, 1999; Service, 2004). There are
many factors related to the host such as race, age, sex, socio-economical conditions
and hair characteristics that can be associated with head lice prevalence (Borges
and Mendes, 2002). Overcrowded living conditions and the arising of resistance
to insecticides have contributed to the increase of head lice in the last few
years (Lee et al., 2000). Head lice infection should be investigated
regionally because its prevalence may vary according to social situation, genetic
and cultural characteristics of a population. Studies on head lice in populations
with different socioeconomic levels have encountered significant differences
between prevalence rates in different populations and regions (Chunge, 1986).
This is partially due to the existence of many factors influencing its prevalence.
In some regions, association to some factors is predominant in relation to others
that in turn may be epidemiologically more important in other ones (Lee et
al., 2000). In a survey of 1879 pupils in primary schools in Victoria (Australia)
were found 13% had an active head lice infection and 3.3% had inactive head
lice infestation (Counahan and Andrews, 2004). In another survey on head lice
infestation among 7495 children in primary schools of Korea the prevalence of
head lice infestation was found to be 5.8%. Head lice were much more commonly
detected in girls than boys with prevalence of 11.2 and 0.9%, respectively (Sim
et al., 2003). The present study was conducted to provide data on prevalence
of head lice in primary school pupils and factors associated with it in Qeshm,
south of Iran.
MATERIALS AND METHODS
This is a cross-sectional study. The study population consisted of primary schools children in Qeshm island that is located in Hormozgan province in south of Iran with warm and humid weather. Five hundred and fifteen children was selected randomly from six schools in different parts of the city. The hair and scalp were examined for head lice, eggs, or nits by two experts of medical entomology. If any evidence of head lice was detected, the child was classified as infested with head lice. After each exam, an individual form with age, sex, grade, parent's education and family size was filled. The collected louse samples were investigated and identified in the laboratory using identification characters. Data were analyzed using Minitab software program and Chi-square test was used.
RESULTS AND DISCUSSION
A total of 515 children including 246 boys and 269 girls examined for head lice infestation. 45.5% of fathers students were illiterate or primary school, 31.1% secondary school, 15.53% high school and 7.96% had higher education. Seventy percent mothers students were illiterate or primary school, 21.4% secondary school, 8.2% high school and 0.98% had higher education. 88.9% mothers' students were housewife and 11.1% office worker. 53.4% fathers' students were day-labor, 12.4% worker, 27.84% employed and 6.46% unemployed.
The overall prevalence of Head lice infestation was 23.9%. Head lice were much more commonly detected in girls than boys with prevalence of 35.3 and 11.1%, respectively (p = 0.000). There was a significant difference between head lice infestation and grade of students (X2 = y2), (p<0.05), (Fig. 1).
There was relationship between head lice infestation with educational levels
of students' fathers (p = 0.003), educational levels of students' mothers (p
= 0.000), family size (p = 0.008) and fathers' job (p = 0.003) but there was
no significant relationship between head lice infestation with mothers' job
(p = 0.39) (Table 1).
The purpose of this study was to determine prevalence of head lice infestation
in primary school pupils and factors associated with it in Qeshm. According
to the results of the study, the prevalence of pediculosis in primary school
students is 23.9%. One possible explanation for the high prevalence of pediculosis
capitis among students in this survey is poor hygiene. Other investigations
in different parts of the country showed the rate of infection 11% in Yasooj,
27.1% in Iranshahr (Aempour-salemi et al., 2003). Similar studies in
other countries represent the prevalence rate of head lice 2.4% Demis, 1998;
Courtiade et al., 1993; Sim et al., 2003; Borgs et al.,
2002; Shakkoury and Abu-wandy, 1999).
||Prevalence of head lice infestation by school grade in primary
school of Qeshm
||Related factors on prevalence of head lice among primary school
pupils of Qeshm
According to the standard of the international in England, 13% in Australia,
3% in United States, 4.87% in France, 5.8% in South Korea, 35% in Brazil and
11.01% in Jordan (Champion et al., 1998; Counahan et al., 2004;
collaboration institute for head lice control, the prevalence of head lice infestation
more than 5% is considered as epidemic (Graz, 1997), our results show the high
prevalence of head lice infestation.
In this study the infestation rate in girls was much more than boys (p = 0.000). Some possible explanations for this are due to hair length and using scarf in girls that prepares a good place for the lice activities, blood-feeding, reproduction and transmitting. This result is in agreement with the results of previous studies (Aempour-salemi et al., 2003; Counahan et al., 2004; Sim et al., 2003; Borges and Mendes, 2002).
Family size was one of the factors related to head lice infestation (p = 0.008) and in crowded homes the rate of it was high. One explanation for this is that if one member of a family is infested, other family members have a greater risk of infestation.
This study showed significant relationship between educational levels of parents and the infection rate. This may be due to knowledge and positive attitude of educated parents towards health. Other studies have supported our finding (Shakkoury and Abu-wandy, 1999; Sim et al., 2003).
To decrease head lice infestation health education for students, teachers and
parents about head lice and the ways of prevention is necessary. Also regular
visit of student's hairs, especially the hairs of girls by the health tutors
The authors would like to appreciate very much for kind collaboration of Qeshm Health Center staff in the field work.
This study was financially supported by the Research Deputy or Hormozgan University of Medical Sciences.
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