Survey assessment of parental perceptions regarding head lice

Estonian Parents' Awareness of Pediculosis and Its Occurrence in Their Children

Background and Objectives: Pediculosis, or head lice infestation, is a widespread health problem that can affect anyone, regardless of gender, age, or social background. The purpose of this study was to clarify the occurrence of pediculosis among Estonian preschool- and primary school-aged children according to their parents and the parent’s awareness of pediculosis and related behaviors. Materials and Methods: An online questionnaire was completed by the parents of the preschool children (n = 1141) in 2019 and the parents of the elementary school children (n = 362) in 2021. For the descriptive data, t-test, Mann−Whitney or χ2 test, linear regression, and logistic regression analyses were applied. Results: According to the parents, pediculosis had occurred in 34.7% of the children, and more than one-third of pediculosis patients had experienced it more than twice. Lice were mainly acquired from elementary school or preschool and less often from friends, relatives, or training environments. Parents’ knowledge of head lice was rather good; the average score of the correct answers was 14.0 ± 3.4 (max. 20). In the multivariate analysis, higher age (coefficient 0.07, p < 0.001), healthcare education (coefficient 1.19, p < 0.001), and a previous occurrence of pediculosis in a family (coefficient 1.95; p < 0.001) were factors influencing better knowledge. In order to treat the infestation, antilice shampoo and combing were the most often used methods. Conclusion: Despite parents’ awareness, pediculosis infestations continue to be common among our children.

Head Lice Infestation in Schoolchildren, in Poland-Is There a Chance for Change?

Pediculosis capitis is a current and neglected health issue worldwide. The lack of screening programs contributes to the marginalization of the problem and delays therapeutic measures. Our study aimed to analyze the occurrence of this parasitosis in primary schools in Poland and to determine factors contributing to the persistence of its foci. The research tools were two questionnaires: one for primary school children and the other for school managers. While children answered questions about the epidemiology of pediculosis capitis and expressed their opinion on the hygienic condition of infested persons, the school directors were asked about the occurrence of head lice in schools, preventive measures, and institutions supporting schools in combating the infestation. The survey covered the period 2014–2018. Pediculosis capitis was reported in 87.5% of the schools. The greatest number of cases was reported in the group of 6–9 year-olds (68%). Among 4970 children, 16.7% had no knowledge of head lice; however, 57.1% wanted to increase their awareness of the problem. Campaigns on lice were conducted mainly as a result of emerging pediculosis capitis cases, and most schools could not rely on institutional support. Screening programs and preventive educational campaigns should be part of pediculosis capitis control in Poland.

Prevalence of head lice (Pediculus humanus capitis) infestation among schools workers in the Eastern Region, Saudi Arabia

In a cross-sectional survey in February-May 2019, the prevalence of Pediculosis capitis with demographic data and the behavioral practices were investigated among 750 participants in the Eastern region of Saudi Arabia. Female participation was highly remarked with a percentage of 94.08% compared to that of male one about 5.91%. A deficiency of knowledge about lice infestation was noted especially among illiterate participants raised from their socio-economic levels (p-value = 0.001). Lice infestation reached higher rates in children aged less than 20 years with itching of the hair scalp. The obtained results revealed that 59.33% of the respondents believed that frequency of personal hygiene and washing of hair were the best methods for preventing the lice infestation. However, the treatment of lice infestation using anti-lice agents (p-value = 0.020) was preferred by 14.26% of participants. Although knowledge about the preventive tools for lice infestation (p-value 0.089) was not significantly associated with the experience of infestation but knowledge about the appropriate treatment to kill lice (p-value 0.020) and the wrong practices in the treatment of a head lice infestation were (p-value 0.005) significantly associated with the experience of infestation. Health programs and campaigns preventions are highly advised to increase the awareness of Pediculosis capitis with an effective strategic plan to control, manage, and prevent this disease.

Associations Between Bed Bugs and Mental Illness Among Emergency Department Patients

Background Bed bugs are common urban pests associated with stress, anxiety, depression, and some reports of suicidality. The emergency department (ED) treats patients with both acute mental illness and bed bug infestations. There have been few studies examining associations between bed bug infestations and mental illness. Methods A case-control study involving 332 adult ED patients infested with bed bugs and 4,952 uninfested control patients matched on sex, age (±1 year at the time of the ED visit), and the specific ED was completed. All clinic encounters occurred in northeast Ohio between February 1, 2011, and February 1, 2017, from a single health system. Univariable and multivariable regression analysis looked for associations between bed bug infestation and different psychiatric diagnoses and medications. Results Bed bug infested patients were more likely than uninfested patients to screen positive for an unsafe home and needing an abuse consult at ED triage (P≤.03 for both). ED psychiatric evaluations were not significantly more common among those with (2.4%) and without (1.3%) bed bugs (P=.14). Bed bug infested patients were significantly more likely to have an ED or inpatient diagnosis of alcohol abuse and psychosis (P≤.03 for both), but not for depression or suicidality. On univariable analysis, among ED patients not admitted to the hospital, bed bug infested patients were more likely to be diagnosed with psychosis or schizophrenia/schizoaffective disease (P≤.02) than uninfested patients. Among ED patients that received an ED or inpatient psychiatric evaluation and were admitted to the hospital, bed bug infested patients were significantly less likely to be diagnosed with depression and suicidality (P≤.03 for both). However, they were not significantly more likely to have insomnia or anxiety. Discussion Among ED patients, bed bug infestations were not associated with an ED or inpatient diagnosis of depression or suicidality. On univariable analysis, some mental health diagnoses such as anxiety and insomnia were more common among ED patients with bed bugs, but these associations were no longer significant on multivariable analysis. These associations likely reflect the complex relationships between socioeconomic factors, health disparities, mental illness, and having a bed bug infestation.

Head lice were also affected by COVID-19: a decrease on Pediculosis infestation during lockdown in Buenos Aires

Pediculosis is a worldwide disease affecting school-aged children produced by the presence of the head louse, Pediculus humanus capitis De Geer, an obligate ectoparasite on the human scalp feeding exclusively on blood. Transmission occurs primarily through direct physical head-to-head contact. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic. COVID-19 is caused by SARS-CoV-2, a variant of the coronavirus. Therefore, on March 18, 2020, the Argentinean government established mandatory isolation for an indefinite period. This obligatory isolation interrupted regular classes avoiding direct contact between children, thus affecting the dispersal route of individuals and the evolution of head louse populations. In this study, we evaluated through an online survey how confinement affected the prevalence of lice during lockdown compared to the situation prior to confinement. The survey allowed to discriminate the different control strategies, the number of treatments, and the amount of insects recorded by parents. Data of 1118 children obtained from 627 surveys were analyzed. As the main result, it was observed that prevalence of lice decreased significantly from before (69.6%) to during (43.9%) COVID-19 lockdown. Moreover, head lice infestation was more effectively controlled in households with up to 2 children in comparison to households with 3 or more children. This is the first study that analyzed the prevalence of head lice during COVID-19 pandemic. In addition, this work demonstrated the impact of social distance in the population dynamics of head lice and how it could affect the control strategies in the future.

Risk Factors Associated with Head Lice Infestation in Rural Pediatric Patients

Introduction:

Head louse infestation is a common parasitic disease in pediatric age group. It is common in collective centers such as schools, garrisons, campuses and old age homes. It is worldwide in distribution with no strict limitation with respect to age, gender and race.

Aims:

Present study was conducted to investigate the socio-economic and lifestyle risk factors for head louse infestation in pediatric patients.

Materials and Methods:

An observational descriptive study at a tertiary care hospital in rural Uttar Pradesh over a period of 1 year wherein measurement of disease/risk factors associated with head louse infestation was performed. It was carried out in all children between 5 and 15 years of age using a pre-validated questionnaire. The method of convenience sampling was used and multiple logistic regression was run to account for potential confounding variables using SPSS software.

Results:

A total of 165 (71.1%) females and 67 (28.8%) males were infested. Most common age group affected was between 5 and 7 years where 97 (41.8%) children were infected. Ninety-five (40.9%) children were in fourth to seventh standards. Parents of 137 (59%) children were not formally educated. Eighty-one (34.9%) children had six members in the family while per capita income was between 5000 and 2500 in families of 139 (59.9%) children. Eighty-seven (37.5%) children had hair length up to shoulders. One twenty-eight (55.1%) children had no family member affected. Seventy-six (32.7%) children took bath twice a week only.

Conclusion:

Social and economic factors as well as lifestyle and education level of patients play a significant role in epidemiology of head lice.

Prevalence of pediculosis and its related factors among primary school girls in the north of Iran

INTRODUCTION

Head lice infestation is one of the main public health problems worldwide and a sanitary, cultural and economic indicator for communities' health. This study aims to estimate the prevalence of head lice infestation among female primary school children in selected districts of Mazandaran Province, Iran.

METHODS

In this cross-sectional study, 3033 female school children were recruited using the consensus method. Head lice infestation was defined as visible adult lice, nymph or egg with the naked eye. Data were described by percent frequency and analyzed using the chi-squared test and multivariate logistic regression models. A p-value less than 0.05 was considered significant.

RESULTS

Prevalence of head lice infestation among female school children was estimated at 7.9%. The adjusted odds ratios (OR) [95% confidence intervals (CI)] for rural residents, low level educated mothers, family size more than five and not combing their hair were 1.96 (1.41-2.78), 2.46 (1.35-4.49), 2.04 (1.12-3.70) and 3.94 (1.73-8.96), respectively. In addition, considering first grade students as a reference group, the ORs (95% CI) for second and third grades were 1.89 (1.18-3.05) and 1.69 (1.05-2.74), respectively.

CONCLUSION

Our study showed that studying in urban schools, low educational level of mothers, grade, family size and no history of regular combing were predictors of head lice infestation.

Head lice infestations in rural Honduras: the need for an integrated approach to control neglected tropical diseases

BACKGROUND

Pediculosis capitis is a neglected tropical disease (NTD) that receives little attention in countries where it continues to be endemic. This study aimed to understand the impact of Pediculus humanus capitis infestations in the lives of Honduran children living in extreme poverty.

METHODS

A qualitative study on head lice infestation was conducted in June 2016 in a rural community in Honduras. Parents were invited to bring their children for head lice inspection using a dry-combing technique with a stainless steel-toothed comb with suction power. A semistructured questionnaire was administered to participants. Questions were broadly grouped into knowledge about transmission, control practices, barriers to treatment, and the overall impact of these infestations in children's wellbeing. Responses were coded, categorized, and organized through a theme-based approach.

RESULTS

In total, 52 children aged 2-14 years (42 girls) and their mothers were enrolled in the study. The overall proportion of children with an infestation was 83%. Response analysis revealed a lack of understanding regarding lice transmission and stigmatization of infested children and the widespread belief that head lice were acquired during bathing in the slow-flowing river running through the village. An agricultural plaguicide was commonly used to rid children of head lice.

CONCLUSIONS

The study underscores the dire situation of the rural poor, their physical and mental health affected by pediculosis capitis as well as other NTDs. These results highlight the need to reassess approaches and action towards combating NTDS under an integrated framework.

Mental health effects caused by red imported fire ant attacks (Solenopsis invicta)

Susceptible individuals who have suffered painful stings caused by red imported fire ants, Solenopsis invicta, usually experience physical health effects such as fever, dizziness, generalized urticaria, or other systemic reactions such as anaphylactic shock. Whether S. invicta stings also have negative effects on mental health is not clear. In the present study, the psychological impact of S. invicta stings was evaluated using a questionnaire that included a previously published posttraumatic stress disorder (PTSD) checklist, the Patient Health Questionnaire 9-item (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Beck Anxiety Inventory (BAI), and the Pittsburgh Sleep Quality Index, 5th scale (PSQI(5)). A total of 96 valid questionnaires were obtained; 37 participants were placed in the stung group, and 59 participants were placed in the unstung group. Our results showed that symptoms of anxiety, depression and sleep disturbances were not associated with S. invicta stings (for GAD-7 scale, Pearson Chi-Square test, χ² = 0.152, df = 1, P = 0.697; for the BAI, χ² = 2.252, df = 1, P = 0.133; for the PHQ-9, χ² = 0.098, df = 1, P = 0.754; for the PSQI(5), χ² = 0.536, df = 1, P = 0.453). In total, 2 of 83 individuals stung by S. invicta met the criteria (>50) for PTSD. However, there was no significant difference on PTSD between those stung by S. invicta in the 30-day group and the over 30-day group (χ² = 0.318, df = 1, P = 0.573). Overall, our data do not show an effect of S. invicta stings on mental health as measured using a range of indicators.

Prevalence of Head Lice Infestation and Its Associated Factors among Primary School Students in Iran: A Systematic Review and Meta-analysis

Objectives

Head lice infestation is one of the most important health problems, generally involving children aged 5–13 years. This study aims to estimate the prevalence of head lice infestation and its associated factors among primary school children using systematic review and meta-analysis methods.

Methods

Different national and international databases were searched for selecting the relevant studies using appropriate keywords, Medical Subject Heading terms, and references. Relevant studies with acceptable quality for meta-analysis were selected having excluded duplicate and irrelevant articles, quality assessment, and application of inclusion/exclusion criteria. With calculating standard errors according to binomial distribution and also considering the Cochrane's Q test as well as I-squared index for heterogeneity, pediculosis prevalence rate was estimated using Stata SE V.11 software.

Results

Forty studies met the inclusion criteria of this review and entered into the meta-analysis including 200,306 individuals. Using a random effect model, the prevalence (95% confidence interval) of head lice infestation among primary school children was estimated as 1.6% (1.2–2.05), 8.8% (7.6–9.9), and 7.4% (6.6–8.2) for boys, girls, and all the students, respectively. The infestation rate was found to be associated with low educational level of parents, long hair, family size, mother's job (housewife), father's job (worker/unemployed), using a common comb, lack of bathrooms in the house, and a low frequency of bathing.

Conclusion

This meta-analysis revealed that the prevalence of head lice infestation among Iranian primary school children is relatively high with more prevalence among girls. We also found that economic, social, cultural, behavioral, and hygienic factors are associated with this infestation.

Headlice eradication as everyday engagement with science: An analysis of online parenting discussions

This paper focuses on the way in which people deploy scientific knowledge alongside other resources in everyday interactions. In the UK headlice are common amongst schoolchildren, and treatment is viewed as a parental responsibility. Choice between treatment options lies with individual parents, with official guidance giving no clear steer. In the face of this combination of responsibility and uncertainty, users of an online parenting forum justify their actions using a variety of resources, including claims to scientific knowledge of both headlice and the action of various treatments, but also drawing on the authority of having direct experience, trust in brand-named products and generalised suspicion of "chemical" treatments. These discussions occasion expression of knowledge as part of portraying oneself as a responsible parent, and thus while they do not necessarily represent public knowledge about science more generally, they do offer a useful site to explore what people do with science.

Survey assessment on pediatricians' attitudes on head lice management

Background

Pediculosis capitis is a worldwide health problem. One of the most important factor in effective head lice eradication is to ensure that infestation is adequately recognized and treated. Our survey investigated the knowledge and practice among primary care Italian pediatricians regarding to the prevention and treatment of head lice.

Methods

The questionnaire was distributed to all the pediatricians registered at the Annual Congress of Practice in Pediatrics held in Florence, Italy, November 11–12, 2011. It includes 10 questions in a multiple choice format, and one answer for each question was provided. The questionnaire was conceived by pediatricians at the Infectious Disease Unit of the Department of Science for the Health of Woman and Child, University of Florence. Questions were designed according to the guidelines by the Italian Pediatric Society (SIP), and international guidelines, such as the Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics (AAP).

Results

Overall, 364/600 pediatricians (60.7% of physicians registered to the Congress) returned the questionnaire. The majority of them (232/364; 63,7%) believe that parents consult their primary care pediatrician only after the failure of other “remedies”. Mostly, they prescribe Malathion (116/364, 31,8%) as first line treatment. Two-hundred-fourty-three (66.7%) of participants consider creams, foams and gels the most effective formulations. Two-hundred-sixty-two of pediatricians interviewed (72.0%) suggest to repeat the treatment after one week, 37/364 (10.2%) after two weeks. The majority of the pediatricians interviewed reported that recurrences occur in less than 30% of cases (279/364; 76,6%). In their own opinion, most of recurrences are the consequence of a reinfestation in the community (259/264; 77%). Three-hundred-thirty-four (91.7%) of them have never prescribed oral therapy for the treatment of head lice. Finally, 289/364 (79.4%) pediatricians believe that no product is effective for prevention.

Conclusions

This is the first study that investigates the clinical practice of family pediatricians about the management and treatment of head lice globally, the Italian pediatricians surveyed proved to be quite informed on the head lice management. However, even in a country where pediatric assistance is free for everybody, a considerable proportion of parents do not seek advice to their own family pediatrician. Therefore, educations of parents, other than continuous updating of pediatricians, may contribute to a better management of head lice in the community.

Mental health effects from urban bed bug infestation (Cimex lectularius L.): a cross-sectional study

OBJECTIVE

To assess whether bed bug infestation was linked to sleep disturbances and symptoms of anxiety and depression.

DESIGN

Exploratory cross-sectional study.

SETTING

Convenience sample of tenants recruited in apartment complexes from Montreal, Canada.

PARTICIPANTS

39 bed bug-exposed tenants were compared with 52 unexposed tenants.

MAIN OUTCOME MEASURES

The effect of bed bug-exposed tenants on sleep disturbances, anxiety and depression symptoms measured using the Pittsburgh Sleep Quality Index, 5th subscale, Generalised Anxiety Disorder 7-item scale and Patient Health Questionnaire, 9-item, respectively.

RESULTS

In adjusted models, bed bug infestation was strongly associated with measured anxiety symptoms (OR (95% CI)=4.8 (1.5 to 14.7)) and sleep disturbance (OR (95% CI)=5.0 (1.3-18.8)). There was a trend to report more symptoms of depression in the bed bug-infested group, although this finding was not statistically significant ((OR (95% CI)=2.5(0.8 to 7.3)).

CONCLUSIONS

These results suggest that individuals exposed to bed bug infestations are at risk of experiencing sleep disturbance and of developing symptoms of anxiety and possibly depression. Greater clinical awareness of this problem is needed in order for patients to receive appropriate mental healthcare. These findings highlight the need for undertaking of deeper inquiry, as well as greater collaboration between medical professionals, public health and community stakeholders.

Parental attitudes towards head lice infestation in Greece

BACKGROUND

Pediculosis capitis constitutes a growing problem worldwide and is usually considered as an inconvenience. Parents often handle this infestation on their own initiative.

OBJECTIVE

We conducted a survey in order to depict the parental attitudes towards head lice infestation in Greece.

METHODS

Parents of children aged 3-14 years, attending a dermatology outpatient clinic at a children's hospital, were given a questionnaire regarding head lice. Demographic data, management, and prevention strategies were included in the questionnaire.

RESULTS

Three-hundred and seventy-two complete questionnaires were analyzed (response rate: 89%). Pediculosis capitis was more prevalent in the age groups 3-5 years and 6-8 years. The percentage of parents of infested children who sought advice on treatment from the pharmacist was 73%, and only 15% consulted their doctor. Chemical agents to treat head lice were used by 59% of them, products containing natural oils by 38%, and wet combing in parallel was employed by 79% of them. Preventive measures were employed by 66% of the respondents, and 54% applied botanical and synthetic products commercially available for this purpose.

CONCLUSION

There is a trend towards the use of natural oils for either prevention or treatment. More needs to be done to promote public education and rational use of either pediculicides or non-pharmacological agents for pediculosis capitis infestation.

Risk factors associated with head louse infestation in Korea

Head louse infestation (HLI) is one of the most frequently occurring parasitic diseases in children. This study was conducted to investigate the socioeconomic and personal factors influencing HLI in the Republic of Korea. A total of 2,210 questionnaires about various factors related to HLI were obtained from children in 17 primary schools throughout the country. The rate of HLI was significantly lower in children who lived together with mother or in a family where both parents worked. In addition, HLI was lower in children whose fathers or mothers were public officers or teachers. However, HLI was higher in children who had small families and washed their hair less often. Education levels of parents and the number of children in family were not significant. Improvement of socioeconomic factors and personal hygiene will be helpful for reducing HLI.

A pilot study of the use of oral ivermectin to treat head lice in primary school students in Australia

Head lice are a common, costly public health problem worldwide. We aimed to determine the feasibility of an ivermectin intervention program. Consenting students in two schools were screened for head lice. Infested students and siblings at one school were offered a head lice fact sheet and two doses of oral ivermectin, 7 days apart. Parents of infested students in the other school were given the same fact sheet and asked to treat the child and siblings using their preferred topical treatment. Seven hundred two of 754 (93.1%) students enrolled in the two schools were screened; 40 (5.3%; 95% CI 3.7-6.9) had head lice; 31 (9.4%; 95% CI 6.1-12.2) in the intervention school and nine (2.5%; 95% CI 1.1-3.8) in the control school. Subsequently 93.6% of children in the intervention school were treated with oral ivermectin. No adverse events were reported. At 6 months the reduction in the head lice infestation rates for the intervention and control schools were 87% and 56%, respectively. This pilot study suggests that school wide screening for head lice and the administration of oral ivermectin is feasible and acceptable. A randomized controlled trial at 20 schools is planned.

Head lice treatments and school policies in the US in an era of emerging resistance: a cost-effectiveness analysis

BACKGROUND

Head lice are a common infection in school-age children worldwide. Several authorities in the US have recommended different treatments and school policies in order to control this disease. Recent concerns of emerging lice resistance worldwide raise the necessity to reassess the current recommendations.

OBJECTIVES

To perform a cost-effectiveness analysis (from the US caregiver perspective) of three head lice treatments commonly used in the US, permethrin 1%, malathion 0.5% and the lice comb, in order to evaluate the cost effectiveness of different treatments in the current era, and to explore the effect of different factors in this analysis.

METHODS

We used a decision-tree model to represent the costs and effectiveness of the different treatment strategies. A patient/caregiver perspective was applied, with a time horizon of 2 weeks. Probabilities of treatment success or failure of the three treatments were based on the literature. Effectiveness was measured as the successful eradication of head lice, and costs - including the costs of the treatment, the physician co-pay and the costs of days out of school - were calculated. One-way and multi-way analyses were performed using decision analysis software (Treeage Pro Healthcare 2008).

RESULTS

Combing was dominated by permethrin 1%. The incremental cost-effectiveness ratio of malathion 0.5% versus permethrin 1% was $US161.75 per cure. For caregivers whose willingness to pay is <$US161.75 per cure, permethrin 1% is the most cost-effective option. For those with a willingness to pay of > or =$US161.75 per cure malathion 1% may offer the highest net monetary benefit. Twenty percent of the uncertainty in the model is due to variation in permethrin 1% resistance, and approximately 73% of the total variability of the model is attributed to the number of days the student has to be out of school because of the school's policy.

CONCLUSIONS

Our study suggests that permethrin 1% was the most cost-effective treatment for those with a willingness to pay of <$US162 per cure. Sensitivity of lice to permethrin and the specific school head lice policy had major effects on the model. Thus, informing communities in a given geographical area about the degree of head lice resistance and sensitivity is necessary in order for the public to make a rational decision regarding treatment. Schools' head lice policies have a major effect on the cost of head lice treatments.