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Research Article

Assessment of the Prevalence of Pediculosis capitis among Primary School Girls in Riyadh, Saudi Arabia

Wafa A.I. AL-Megrin
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The prevalence of Pediculosis capitis human head lice, among children is a worldwide public health alarm. The study aimed to assess the prevalence of head lice and associated risk environmental and personal factors among primary school girls. Study sample included 590 students from different primary school grades. The results showed that (12.2%) 72/590 of students were infected with Pediculosis capitis. A high rates of infestation was observed among students, who had a long hair, poor family and illiterate mother’s (30.2, 28.6 and 28.6%, respectively). However, association of pediculosis capitis with socioeconomic and personal factors showed that pediculosis capitis had a significant association with place of residence, school grade, hair length, previous infection, sharing of instruments, income of parents and education of parents level. While no significant differences could be found between infestation and nationality, frequency of hair washing, cleaning materials for hair washing, mother’s occupation, number of children in family and number of people sharing room. The study recommended that the parents and teachers should receive training about the danger of infection and its distribution in family and school in order to prevent it.

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Wafa A.I. AL-Megrin , 2015. Assessment of the Prevalence of Pediculosis capitis among Primary School Girls in Riyadh, Saudi Arabia. Research Journal of Environmental Sciences, 9: 193-199.

DOI: 10.3923/rjes.2015.193.199

Received: March 30, 2015; Accepted: May 15, 2015; Published: July 16, 2015


Head lice infestation caused by Pediculus humanus var. capitis De Geer, 1778, are wingless, worldwide prevalent human parasites (Falagas et al., 2008; Toloza et al., 2009) which responsible for distress to affected children and their families (Tebruegge et al., 2010; Parison et al., 2013). Head lice obligate ectoparasites of humans, which generally affect millions of children primary school especially girls, aged 3-12 year, in both the developed and the developing countries, generally (Burgess, 2004; Motovali-Emami et al., 2008). It is a globally public health concern, in some developed countries, invasion head lice also consume important resources from public health organizations (Jahnke et al., 2008; Rukke et al., 2011). Head-to-head contact is the main route of head lice transmission (Mumcuoglu et al., 2009; Heukelbach, 2010). Generally, Elementary school children showed the highest spread of head lice (Leung et al., 2005; Rukke et al., 2011). In addition, when students are intermingled in classes, they have high contact rates (Mossong et al., 2008), prevalence of head lice occurs frequently. Consequently, when close friends or schoolmates are infested, the checking frequency and thoroughness should be intensified (Rukke et al., 2012). The role of head lice in transmitting human disease is not well understood but it has received increased concern due to bioterrorism threats (Robinson et al., 2003).

Moreover, some studies of head lice have primarily concentrate on aspects of insect biological, epidemiological and efficacy of head lice (Heukelbach, 2010). This is necessary for quantifying and understanding the character of head lice infestation for developing effective treatments. There are many factors related to the host that can be associated to head lice prevalence: race, age group, sex, social-economical conditions and hair characteristics. Over crowded living conditions and the arising of resistance to insecticides have contributed to the increase of head lice in the last few years (Nazari et al., 2006).

In addition, to decrease the prevalence of pediculosis, it is also important to know what people in a community actually do, when they face head lice (Counahan et al., 2007; Heukelbach and Ugbomoiko, 2011; Rukke et al., 2012). Checking routines are important for controlling head lice infestations, includes, both checking frequency and carefulness. The head lice infestation can be asymptomatic or remain undetected for several weeks (Heukelbach and Feldmeier, 2010), which influences the length of the infectious period. In Norway, where most people successfully treat Pediculosis, these factors might be the primary determinants of infestation time (Rukke et al., 2012).

The present study was conducted to assess the head lice infestation rate and some risk factors among the primary school girls in Riyadh, Kingdom of Saudi Arabia.


Study place: The study was conducted in Riyadh city, Kingdom of Saudi Arabia.

Study design and sample: This descriptive, analytical study was conducted between September and December 2013. The study was carried out in 10 primary girls schools which, were selected randomly, according to the most clusters. A total of 590 girls students in grades from 1-6 were observed and examined. All students were examined individually and privately under the flashlight for all stages of lice or their nits. Presence of adult lice or immature stages of them (nymphal stage or eggs) were considered infested.

Data collection (Questionnaire): Before examining the students, they were asked to complete a questionnaire to evaluate the influence of risk factors on the prevalence of head lice. We gathered detailed information of questionnaire including: nationality, place of residence, school grade, hair length, previous infection of head lice, frequency of hair washing, cleansing material for hair washing, sharing of articles in contact with hair (e.g. combs, scarves, towels, pillows), income of parents, education level of the father, education level of the mother, occupation of the mothers, number of children in family and number of people sharing one room.

Statistics analyses: Chi-Square test was used to compare the difference in proportions for the variables included p was less than 0.05 were considered statistically significant.


As shown in Table 1, the overall prevalence of Pediculosis capitis infestation among primary school girls in Riyadh was 12.2% (72/590). The socioeconomic and personal factors associated with head lice infestation show up the prevalence of head lice was higher in non-Saudi students (14.6%) more than Saudi students (10.9%) (p>0.05). The infestation rate was significantly higher in rural (19.2%) (p<0.001). In addition, the infestation rate in the first, second and third grade were higher (17.6, 17.9 and 14.1%, respectively), it was a significant difference (p<0.01). A high significant difference was found between long haired (30.2%) as compared with shorthaired students (8.2%) (p<0.001). Students, who had been infested in the past with Pediculosis capitis were more infested (21.8%) than those, who had not been infested before (10.7%) (p<0.05).

Table 1: Association between socioeconomic, personal factors and Pediculosis capitis in Riyadh
Image for - Assessment of the Prevalence of Pediculosis capitis among Primary School Girls in Riyadh, Saudi Arabia
*Significant different, **Such as combos, scarves, towels, pillows, bed

However, the frequency of hair washing and cleansing material for hair washing were not significant difference between infested and non-infested students (p>0.05). The infestation rate was significant among students, who shared instruments such as combos, scarves, towels, pillows and bed (16.3%) (p<0.05). Additionally, the prevalence rate was high significantly increased in poor family (28.6%) (p<0.001). Furthermore, the association between education level of the father and mother was observed, decreased rate of infestation among students, who had parents with high level of education (8.6 and 4.4%) for father and mother, respectively. Moreover, it was significant associations between level of mother education more than father. On the other hand, occupation of mother was not significantly associated with head lice infestation. Moreover, the size of family and number of people sharing a rooms were not significant with prevalence of head lice.


Head lice (pediculosis capitis) infestation is public health problem even in well developed countries (Karakus et al., 2014). A total of 590 students were examined for present of head lice and overall infestation rate in the present study was 12.2% (72/590), which is similar that reported in Jazan Province (13.3%) by Bosely and El-Alfy (2011), but it is higher than that recorded in Eastern of Saudi Arabia (5.2%) by Al-Saeed et al. (2006). That may due to the survey were conducted around 10 year before this study. There are many studies have stressed differences in the prevalence of head lice infestation between children with different socio-economic level and personal factors. This study also was conducted to detect head lice infestation rate among students girls in primary school in Riyadh and associated with different socio-economic level and personal factors. The prevalence of head lice was higher among non Saudi students (14.6%) most of them form Egypt, Jordan and Syria some of these countries which have a high rate of infestation (16.7%) in Egypt (Abd El Raheem et al., 2014) and (26.6%) in Jordan (AlBashtawy and Hasna, 2012). Admittedly, the infestation rate was significantly higher in rural (19.2%) (p<0.001) that was in agreement, which found in Turkey by Gulgun et al. (2013) (9.7 and 20%), in Jordan with highly significant by AlBashtawy and Hasna (2012) (23.5 and 31.2%), in Iran by Moradi et al. (2009) (0.66 and 1.66%) in urban and rural, respectively and in Yemen by Al-Maktari (2008), who recorded the highest infestation rate in rural area (20.6%). Moreover, the high rates infestation in rural were recorded in different province in Saudi Arabia, in Al Hassa by Amin et al. (2011) (4.9%) and in Jazan by Bosely and El-Alfy (2011) (20.5%). The highest rates of infestation between students were in the first, second and third grade (17.6, 17.9 and 14.1%, respectively) (p<0.01). In spite of this disagreement with Vahabi et al. (2012), who reported children aged 10-11 years were the most frequently affected, it is in agreement with AlBashtawy and Hasna (2012) who found children aged between 6 years and 8 year was the highest rates of infestation significantly and Degerli et al. (2013), who recorded that the first grade students were more infested. This can be explained by behavioral factors whereby children at this age have more direct physical contact with each other.

Moreover, the incidence of close contact with members of family and friends at this age may effect infestation rate, which might decrease as children get older (AlBashtawy and Hasna, 2012). Regarding to hair length, a high significant difference was found between long haired (30.2%) and short haired students (8.2%) (p<0.001), because it is hard to keep it clean, comparison with short hair. This result was come to an agreement with AlBashtawy and Hasna (2012), Tappeh et al. (2012) and Degerli et al. (2013). Additionally, Students, who had previous history of infestation with Pediculosis capitis were receptivity to infested (21.8%) more than those, who had not been infested before, (10.7%) (p<0.05), which in matching with Degerli et al. (2013) and AlBashtawy and Hasna (2012).

In spite of there were directly proportional to the invasion of head lice with frequency of hair washing, it was not significant that is in agreement with Moradi et al. (2009), Tappeh et al. (2012) and Degerli et al. (2013). However, It is contradict some studies which found strong associated between infestation and number of hair washing per week (Sim et al., 2011; AlBashtawy and Hasna, 2012). Also, cleansing material for hair washing were not significant difference between infested and non-infested students (p>0.05), which means kind of washing materials is not effect on infestation head lice that was in reach a decision with Gulgun et al. (2013).

On the other hand, Degerli et al. (2013) suggested that there was no significant association between head lice infestation and sharing articles, while according to Vahabi et al. (2012), Toloza et al. (2009) and AlBashtawy and Hasna (2012), the head lice infestation rate was more prevalent significantly in children sharing common instruments such as combs, hats, scarves, pillows, beds, towels and sweaters etc. This is because head lice infestation may be transmitted by sharing infested tools, which is more in agreement with result of this study. Studies from Turkey and Jordan proposed that a significant association between family income and prevalence rate of head lice (AlBashtawy and Hasna, 2012; Gulgun et al., 2013). Our finding is an agreement with them. Demographical results showed that there was a significant increase of prevalence of head lice with increasing father’s education. Regarding to mother’s education, there was a high significant difference in students infestation and mother’s education. This is because mothers, who have a high level of education will have more knowledge about head lice due to their social communication (Toloza et al., 2009; Moradi et al., 2009). The infect of socioeconomic status upon the prevalence rate found in this study support with other studies (Toloza et al., 2009; Moradi et al., 2009; AlBashtawy and Hasna, 2012; Vahabi et al., 2012; Gulgun et al., 2013). In spite of that, it is disagreement with Sim et al. (2011) and Tappeh et al. (2012), who found no significant relationship between parent’s education and infestation. On the other hand, Sim et al. (2011) found the children, whose mothers are house wives are easily infested by head lice with significant association. Despite, in this study, the researcher did not detect any significant associations among infestation rates and occupation of mother, which come in agreement with that recorded in other studies (AlBashtawy and Hasna, 2012; Tappeh et al., 2012; Gulgun et al., 2013). AlBashtawy and Hasna (2012) suggested that there was a significant association between head lice infestation and size of family, while according to Sim et al. (2011) who found a low correlation between the infestation and the size of family or the number of people sharing room. Our finding showed that, in spite of the high rates of prevalence of head lice was in families, which have 4 children or more and when four or more people sharing room, there were no significant difference. Consequently, our finding are more in agreement with Sim et al. (2011).


Head lice (Pediculus humanus, capitis) infestations remain a pesky communicable problem, particularly in school-age children in Kingdom of Saudia Arabia, misdiagnosis of head lice infestations is common. The diagnosis requires detection of live head lice. Detection of nits alone does not indicate active infestation. We recommend that the parents and teachers should receive training about the danger of infection and its distribution in family and school in order to prevent it.


We would like to thank the nurses, who helped the researcher in the process of examination and data collection, specially Associate professor in Pediatric Nursing Dr. Nehal Allam. Also we thank all school principals and the parents and students of the schools that participated in this study for their cooperation and kind help.


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