Head lice prevalence in primary schools in Victoria, Australia

Head lice-induced anemia in a child and implications for oral health: Case report

Pediculosis capitis, colloquially referred to as head lice, engenders adverse social and economic consequences among children. While generally not considered a health hazard, chronic and severe head lice infestations have been linked to secondary iron-deficiency anemia. This case report documents a 7-year-old girl who presented for dental treatment with a history of social isolation and poor school attendance. Upon examination, the patient was found to have head lice and scabies infestations, resulting in secondary iron-deficiency anemia. The patient could return to full-time education after successful treatment for the head lice infestation administered by the dental team. This case underscores the need for treatment guidelines to manage children with diagnosed or suspected cases of head lice from a dental perspective. In instances of severe infestation, referral to a medical professional may be necessary for further management. This report highlights the importance of a multidisciplinary approach in managing head lice infestations and its implications on dental management.

Pediculosis capitis risk factors in schoolchildren: hair thickness and hair length

The human head lice is a cosmopolitan ectoparasite that causes pediculosis. The main way of spreading lice is through direct head-to-head contact. It is popular knowledge that some individuals are more susceptible to contracting head lice than others. Reports of individuals who have never been affected by the disease are common, even living in the same environment and under the same conditions as people who regularly have lice infestations. Previous research has been carried out on the risk of this infection associated with different human factors like gender or age. However, studies on the influence of the individual hair characteristics are scarce. The objective of the study was to analyze the pediculosis risk using geographical location, gender, age and individual hair characteristics as variables. Pediculosis was diagnosed through the detection of living lice in the hair. This cross-sectional school-based epidemiological study was conducted in 310 schoolchildren aged 1 to 13 years of schools in 4 municipalities situated in the State of Paraná, Brazil. The prevalence of head louse infection in primary school students was 49.35 %. The Odds Ratio of presence of pediculosis (OR) was estimated using multivariate logistic regression analysis. The results obtained indicate that hair length and thickness increase the risk of infection. Furthermore, the inclusion of hair color, hair shape, kind of hair-scale as covariates increases the risk of pediculosis, indicating that these variables partly explain this susceptibility and that pediculosis is independent of gender. A smaller hair diameter may favor insect fixation to the hair in the nymphal phases. These results may explain why girls are a greater risk as they let their hair grow for cultural reasons, i.e., being of female gender is an agglutinating variable. The conclusions drawn may explain the discrepancies obtained in previous analyses.

Pediculosis humanus capitis in 6-7 years old schoolchildren in Valencia, Spain

OBJECTIVES

Pediculosis humanus capitis is a worldwide public health concern that affects mostly school-aged children. The aim of this study is to determine the rate of pediculosis and to determine possible risk factors in a group of primary school children in Valencia, Spain; 227 children, 6-7 years old, were selected from 7 schools.

METHODS

A self-reported questionnaire completed by the parents/guardians about the presence of pediculosis in their children and their knowledge about pediculosis. The results recorded in the questionnaire were analysed by SPSS® software.

RESULTS

30.4% of the children had pediculosis. The results showed significant variation (p < 0.05) in prevalence depending on the following factors: sex, hair length, level of parental education, family size, presence of affected family member in the home, and frequency of hair washing. Less than half of parents/guardians showed an appropriate level of knowledge on pediculosis. Pediculosis remains a health problem in Valencian schoolchildren. The family size and existence of another member with pediculosis were shown to be the main potentiating factors.

CONCLUSIONS

Parents are not sufficiently informed about pediculosis and adopt inappropriate practices. There is a need to promote studies with the objective of determining risk factors for pediculosis as well as the need for actions to increase the knowledge of parents and healthcare professionals on this parasitosis to prevent outbreaks in the community, assure correct treatment and maintain effective epidemiological surveillance.

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.

Assessment of the prevalence of pediculosis capitis and related effective features among primary schoolchildren in Ahvaz County, Southwest of Iran

The present research was carried out to investigate the prevalence of head lice and related effective features among students in primary schools of Ahvaz County; Iran; to suitable training programs via improve the health promotion of the students in this county during winter 2016 and spring 2017. The sample size was 5930 students that was determined by using a single population proportion formula. In this analytical-descriptive study, samples were selected by a multistep, classification random sampling strategy. The data was collected in two parts, a carefully visual examination of the hair and scalp with head lice comb, and an interview to complete a questionnaire about epidemiologic factors. The collected data was evaluated using SPSS software, version 22. These data were compared using a Chi-square analysis, and a p value of less than 0.05 was considered to be significant. The overall head lice infestation rate in the studied population was 26.3%. The prevalence rate was 15.2% in the boys and 37.9% in the girls, while the rate of infestation was 25.1% in the urban areas and 36.9% in the villages. Also, a statistical significant relationship was observed between Pediculosis capitis and gender, geographical area, type of home, access to tap water, hygiene bath at home, bath times per week, the number of family individuals, sleeping in the common bedroom, use common bedding, daily comb, use common comb, use common towel, use common scarf, history of infestation, presence health educator in school, access to primary health services, knowledge about head lice, infestation in the family, performing personal hygiene, itching on the head and hair style, length, density, and color. The high prevalence of head lice among students in the majority of primary schools in Ahvaz County is attributable to inadequate access to health educators, sanitation facilities, inattention to personal health, and other related factors. The controlling program must be done more efficiently to prevent the prevalence of head lice infestation. It is suggested that the people's knowledge and attitude about biology, clinical presentation, prevention, and treatment strategies of pediculosis capitis should be improved.

Pediculosis capitis among school-age students worldwide as an emerging public health concern: a systematic review and meta-analysis of past five decades

Pediculosis by Pediculus humanus capitis is still an important health issue in school-age students worldwide. Although pediculicidal agents effectively kill head lice, the re-infestation rate is still high. This study was conducted to provide a summary of evidence about the prevalence of pediculosis capitis among school-age students worldwide. Different databases including MEDLINE/PubMed, Scopus, and Web of Science were searched for publications related to pediculosis capitis in school-age students from 1977 to 2020. All peer-reviewed original research articles describing pediculosis capitis among school-age students were included. Statistical heterogeneity of the different years among studies was assessed using the standard chi squared and I² tests. Due to the significant heterogeneity, a random effect model was adopted to estimate the pooled, continent, and gender-specific prevalence of pediculosis. Two hundred and one papers met the inclusion criteria of this review and entered into the meta-analysis including 1,218,351 individuals. Through a random effect model, the prevalence of pediculosis capitis among school students was estimated as 19% (CI 95% = 0.18-0.20%, I² = 99.89%). The prevalence of pediculosis capitis among boys was 7% (CI 95% = 0.05-0.10) compared to 19% (CI 95% = 0.15-0.24) in girls. The highest prevalence was in Central and South America (33%, CI 95% = 0.22-0.44, I² = 99.81%) and the lowest was in Europe (5%, CI 95% = 4-6, I² = 99.28%). Relatively high pediculosis capitis prevalence among school-age students observed in this study emphasizes the need for implementing screening and prophylaxis tailored to the local context.

Perinatal risk factors associated with skin infection hospitalisation in Western Australian Aboriginal and Non-Aboriginal children

BACKGROUND

Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA.

OBJECTIVE

We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalisation in WA children, focussing on Aboriginal children aged <17 years.

METHODS

We conducted a retrospective population-based cohort study with linked perinatal and hospitalisation data on WA-born children (1996-2012), of whom 31 348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to first hospitalisation with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year.

RESULTS

Overall, 5439 (17.4%) Aboriginal and 6750 (1.5%) non-Aboriginal children were hospitalised at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalisation rate (63.2 per 1000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth, and multi-parity (≥3 previous pregnancies) accounting for 24%, 23%, and 15% of skin infection hospitalisations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy, and low birthweight.

CONCLUSIONS

We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalisations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalisations. Our evidence not only supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families.

[Randomised clinical trial to evaluate the efficacy and safety of a new pediculicide made with saponified olive oil in the eradication of Pediculus humanus capitis]

INTRODUCTION

The aim of the study was to evaluate the efficacy and safety of a new pediculicide in the eradication of Pediculus humanus capitis infestation.

MATERIAL AND METHODS

A randomised clinical trial was designed, in which children aged between 5 and 15 years diagnosed with pediculosis were selected. Treatment was administered on days 1 and 7 after selection, and they were evaluated in 4 visits (day 2, 7, 9, and 14). The product under evaluation with saponified olive oil was Inex Pediculicide Soap^®, which was compared with Paranix^®, with a similar mechanism of action. The primary efficacy endpoint was the eradication of the parasite by day 14 (louse-free rate), using an intention to treat analysis.

RESULTS

Six paediatricians from 5 Primary Health Care centres in the Community of Madrid (Spain) and one private clinic participated in the study. A total of 45 children were included, of which 75.6% were girls (n=34). The mean age was 7.1 years (95% CI 6.3-7.9). The large majority (80%) were middle class, and 82.2% had a history of previous pediculosis. The efficacy at 14 days was 76.2% (95% CI 52.8-91.8) in the group treated with Inex Pediculicide Soap^® group, and 79.2% (95% CI 57.9-92.9) in Paranix^® group (NNT=33.3). No adverse effects were observed with treatment.

CONCLUSIONS

The 2 products were effective and safe in the eradication therapy Pediculus humanus capitis, with no statistical differences.

Head lice predictors and infestation dynamics among primary school children in Norway

BACKGROUND

Health providers need to know which measures to take and children to prioritize in order to decrease costs associated with head lice infestations.

OBJECTIVE

Our aim was to determine the most important predictors for head lice and identify the major drivers of an infestation outbreak in a low-prevalence area.

METHODS

The study was based on three datasets of head lice prevalence (retrospective, point prevalence and prospective approach) from primary school children (ages 6-12) at 12 schools in Oslo, Norway. The tested predictors were siblings with lice, individual and household characteristics as well as class and school affiliation. Self-reported monthly incidences (prospective approach) of head lice were used to evaluate infestation dynamics.

RESULTS

Infested siblings strongly increased the odds of head lice infestation of school children (odds ratio 36, 26 and 7 in the three datasets) whereas having short hair halved the odds. Household characteristics were of minor importance, and class affiliation proved more important than school affiliation. Having head lice in one school term increased the odds of an infestation in the next, but this effect diminished over time. About 97% of all self-reported infestations were noted in two consecutive months or less.

CONCLUSIONS

With the exception of hair length, we have found that individual and household characteristics are of minor importance to predict head lice infestations in a low-prevalence country and that unnoticed transmissions in school classes and families are likely to be the major driver upon outbreaks.

Impact of family ownerships, individual hygiene, and residential environments on the prevalence of pediculosis capitis among schoolchildren in urban and rural areas of northwest of Iran

In the appraisal of head lice outbreak, in addition to socioeconomic factors and availability of health care services, environmental conditions of the households must be taken into account. However, interviewing with children or mailing questionnaires to families may not reflect the actualities. Therefore, in this study, all the inclusive factors which may be associated with head lice outbreak were thoroughly and closely investigated. The data were collected by examining students at schools and surveying patients' households. A questionnaire concerning children's personal hygienic practices, family features, and environmental conditions of the households was filled out during the close assessment of the residential area. The overall prevalence of head lice was obtained as 5.9%, and the difference was not significant within the urban (5.1%) and rural (6.1%) communities. Overall, the number of infested students was more frequent in girls (6.6%) than boys (2.8%), but the difference was not significant. The highest infestation rate was obtained in the examined students whose fathers were unemployed, farmer, and herdsman. Family income showed greater correlation with the prevalence of pediculosis capitis. A high frequency of pediculosis capitis was identified among the students who were sharing individual items with siblings. Assessment of households showed that room flooring material and keeping animals at home were highly correlated with head lice prevalence. Households should be informed that infestations happen, irrespective of socioeconomic status. However, the physical and environmental conditions of living areas and households play an important role in head lice prevention.

Ex vivo effectiveness of French over-the-counter products against head lice (Pediculus humanus capitis De Geer, 1778)

Head lice infestation is still a public health problem worldwide, with an intracountry and intercountry prevalence variation of 0.7 to 59%. There is a large variety of over-the-counter anti-louse products, but their efficacy is not always well assessed. Our objective was to test the pediculicidal and ovicidal efficacy of 21 over-the-counter head louse products, available in France during the period of 2008 to 2012. We tested children living in Tours City in central France and visiting preschools, primary schools, kindergarten, camps, and child care facilities, as well as children in their family houses, and were examined for the presence of lice. The products were collected from randomly selected pharmacies by covert investigators and then tested in the laboratory on an ex vivo sample of head lice and their eggs, collected from the hair of infested children. Living lice and unharmed eggs were collected from the scalps of 3-12 years old. The laboratory conditions for ex vivo testing mimicked the manufacturers' instructions for exposure time and application method. In 21 runs, 3919 living lice and 4321 undamaged living eggs were collected from the scalp of over 400 children. The 21 products were classified in three groups: 6 products in a group of potentially 100% pediculicidal activity and potentially 100% ovicidal activity, 8 products in a group of potentially 100% pediculicidal activity but insufficient ovicidal activity (including 2 products with claims of single application treatment), and 7 products in a group of insufficient pediculicidal activity and ovicidal activity. The pharmaceutical market for head lice products in France is swamped with poorly tested and ineffective products. Rigorous efficacy testing preregistration and periodic screening and testing of effectiveness in the post-registration period should be endorsed by the health authorities.

A retrospective study of ectoparasitosis in patients referred to Imam Reza Hospital of Mashhad, Iran

This cross-sectional study was performed on all patients suspected to be suffering from ectoparasites who were referred to the parasitology laboratory of Imam Reza Hospital of Mashhad during 15 years (April 1995 to April 2010). All patients' data were collected from the questionnaires and then analyzed statistically. From 1814 suspected patients to be suffering from ectoparasites, 375 patients had scabies and, 99 suffer from pediculosis. The mean age of patients was 26/18 ± 17/68. The most common age of scabies was 10–19 (27/7%) and pediculosis 0–9(9/6%) (P value = 0.00). The highest incidence of pediculosis was in women (3.6%) and scabies in men (13.7%) (P value = 0.00). Pediculosis is more common in children (9/9%) and scabies in workers (32%)(P value = 0.00). Scabies and pediculosis were more prevalent in patients from Razavi Khorasan Province with 18.7% and 5%, respectively (P value = 0.08).

Pediculosis capitis: prevalence and its associated factors in primary school children living in rural and urban areas in Kayseri, Turkey

OBJECTIVE

The aim of this study was to investigate the prevalence and risk factors of pediculosis capitis in schoolchildren living in rural and urban areas in Kayseri, a city located in central Anatolia in Turkey.

METHODS

This cross-sectional school-based study was performed in 24 randomly selected public schools. A total of 8,122 schoolchildren aged 5-16 years, from kindergarten to eighth grade, were examined for the presence of pediculosis capitis. A child was defined as being infested by the presence of live or dead lice or eggs/nits. The results were analyzed using the chi-squared test and logistic regression analysis.

RESULTS

The overall prevalence of head lice infestation was 13.1%. Pediculosis was more frequent in girls (25.2%) than in boys (0.86%) (p < 0.001). The prevalence was lower in children aged 5-8 years than in those aged 9-11 or 12-16 years (p < 0.001). In multiple regression analyses, the variables demonstrating statistically significant association with pediculosis were: being a girl (OR = 40.93; 95% Cl = 29.06-57.66), being 9-11 years old (OR = 1.54; 95% Cl = 1.25-1.89), residing with > or = 3 siblings (OR = 1.98; 95% Cl = 1.57-2.50), having a mother with no education (OR = 1.73; 95% CI = 1.29-2.33), having a father with no education (OR = 1.45; 95% Cl = 1.08-1.94), living in a rural area (OR = 2.34; 95% Cl = 2.02-2.71) and living in a one-room house (OR = 2.39; 95% CI = 1.41-4.08).

CONCLUSIONS

Pediculosis capitis remains a health problem in schoolchildren in Kayseri, Turkey. In addition to improvement in socioeconomic status, collaborative and participation efforts among physicians, nurses, teachers, and parents are necessary to maintain effective epidemiological surveillance and provide treatment.

Knowledge, attitudes, and practices of parents/guardians regarding pediculosis in the Umm el-Jimal district of Jordan

The aim of this study is to assess the prevalence of pediculosis capitis in one district in Jordan, and to determine the knowledge, attitudes and practices of parents/guardians regarding head lice. The study was performed in Jordan’s Umm el-Jimal district from February 2010 to May 2010, and involved the surveying of 105 randomly selected households containing a total of 213 children. The households’ parents were interviewed for their knowledge, attitudes and practices regarding pediculosis, and afterward their children’s hair was checked for head lice via a 5-min visual scalp examination. Chi-square testing was used to analyse the data, with statistical significance assumed at p < 0.05. The prevalence rate of pediculosis among the 213 children was found to be 14.6%. Parental knowledge of head lice was found to be very limited; only 35.2% of the parents/guardians correctly answered 10 of the 20 questions (50%), and only 17.1% correctly answered 14 questions (70%). More than 94% of the parents reported feeling shame upon learning that their children were infested with pediculosis, and nearly 90% felt too ashamed to ask for help from a healthcare provider. Many parents used traditional/local techniques that they believed to be effective in managing pediculosis; 61% of the parents applied kerosene to the scalps of infested individuals, 39.9% used medical shampoo and 37.6% used special combs. There is a clear deficiency in Jordanian parents’ knowledge of, and practices concerning, pediculosis capitis. It is recommended that the Jordanian Ministry of Health and local health departments work together to ensure the dissemination of accurate and consistent head lice information to families.

Head lice in Norwegian households: actions taken, costs and knowledge

INTRODUCTION

Head lice infestations cause distress in many families. A well-founded strategy to reduce head lice prevalence must shorten the infectious period of individual hosts. To develop such a strategy, information about the actions taken (inspection, treatment and informing others about own infestations), level of knowledge and costs is needed. The present study is the first to consider all these elements combined.

MATERIALS AND METHODS

A questionnaire was answered by 6203 households from five geographically separated municipalities in Norway.

RESULTS

94% of the households treated members with pediculicides when head lice were discovered. Nearly half of the households checked biannually or not at all. Previous occurrence of head lice and multiple children in a household improved both checking frequency and method. More than 90% of the households informed close contacts about their own pediculosis. Direct costs of pediculosis were low (less than €6.25 yearly) for 70% of the households, but the ability to pay for pediculicides decreased with the number of head lice infestations experienced. One in three households kept children from school because of pediculosis. Other widespread misconceptions, such as that excessive cleaning is necessary to fight head lice, may also add unnecessary burden to households. School affiliation had a significant effect on checking frequency and method, knowledge and willingness to inform others about own pediculosis.

CONCLUSIONS

Increased checking frequencies appear to be the most important element to reduce head lice prevalence in Norway and should be a primary focus of future strategies. National campaigns directed through schools to individual households, might be an important tool to achieve this goal. In addition to improving actions taken, such campaigns should also provide accurate information to reduce costs and enhance the level of knowledge about head lice in households.

Head lice infestation in schoolchildren and related factors in Mafraq governorate, Jordan

BACKGROUND

Little is known about the effect of socioeconomic status on the infestation by head lice in schoolchildren in Jordan.

MATERIALS AND METHODS

A cross-sectional school-based study was conducted from December 2009 to February 2010. A list of all primary schools in Mafraq governorate was obtained (394 primary schools). Eight primary schools were randomly selected (four male schools and four female schools). Data were collected by five well-trained nurses. Hair was examined for head lice as well as for eggs/nits. Analysis of data was conducted by using SPSS software version 16. The chi-square test was used to assess statistical significance of subgroup differences in the prevalence of infestation, and multivariate logistic regression was used to control for potential confounding.

RESULTS

Out of 1550 primary schoolchildren screened, 412 (26.6%) were infected with lice, 163 (19.6%) boys and 249 (34.7%) girls. The results showed significant variations in head lice infestation by factors such as gender, age, and socioeconomic variables (family income, father's education, mother's education, number of rooms, number of siblings younger than 15 years, frequency of hair washing per week, and bathing per week). There was no significant variation in lice infestation with parents' occupation (P > 0.05).

CONCLUSIONS

Socioeconomic status is a major factor influencing the occurrence of pediculosis capitis among schoolchildren in both sexes. Improving standards of living and personal hygiene might significantly reduce pediculosis capitis in schoolchildren in Jordan.

Head lice prevalence among households in Norway: importance of spatial variables and individual and household characteristics

Head lice prevalence varies greatly between and within countries, and more knowledge is needed to approach causes of this variation. In the present study, we investigated head lice prevalence among elementary school students and their households in relation to individual and household characteristics as well as spatial variables. The investigation included households from 5 geographically separated municipalities. Present infestations among household members as well as previous infestations in the household were reported in a questionnaire. In elementary school students prevalence was low (1·63%), but more than one-third of the households (36·43%) had previously experienced pediculosis. Prevalence was higher in elementary school students than in other household members, and highest in third-grade children. Prevalence was also influenced by the school attended, which suggested that interactions between children in the same school are important for head lice transmission. Previous occurrence of head lice in homes also increased the risk of present infestation. Prevalence of previous infestations was higher in households with more children and in more densely populated municipalities, indicating that the density of hosts or groups of hosts influences transmission rates. These results demonstrate that information of hosts' spatial distribution as well as household and individual characteristics is needed to better understand head lice population dynamics.

Measuring social networks in British primary schools through scientific engagement

Primary schools constitute a key risk group for the transmission of infectious diseases, concentrating great numbers of immunologically naive individuals at high densities. Despite this, very little is known about the social patterns of mixing within a school, which are likely to contribute to disease transmission. In this study, we present a novel approach where scientific engagement was used as a tool to access school populations and measure social networks between young (4-11 years) children. By embedding our research project within enrichment activities to older secondary school (13-15) children, we could exploit the existing links between schools to achieve a high response rate for our study population (around 90% in most schools). Social contacts of primary school children were measured through self-reporting based on a questionnaire design, and analysed using the techniques of social network analysis. We find evidence of marked social structure and gender assortativity within and between classrooms in the same school. These patterns have been previously reported in smaller studies, but to our knowledge no study has attempted to exhaustively sample entire school populations. Our innovative approach facilitates access to a vitally important (but difficult to sample) epidemiological sub-group. It provides a model whereby scientific communication can be used to enhance, rather than merely complement, the outcomes of research.

A nationwide survey of prevalence of pediculosis in children and adolescents in iran

BACKGROUND

Since 2005, pediculosis is one of the obligatory reportable diseases from community to the Center of Disease Control. This study is the first nationwide survey on the prevalence of pediculosis and some associated risk factors in Iranian children and adolescents.

METHODS

National data of the Ministry of Health and Medical Education were gathered in 2005 through school screening programs and obligatory reports from the country health centers.

RESULTS

12,359,448 Iranian children and adolescents were screened in 2005. Overall, 213,450 students, consisting of 198,947 girls and 14,320 boys were reported to have pediculosis. The prevalence of pediculosis was 581 per 100,000 population that varied from 1/100 000 to 8,303/100,000. In general, the highest prevalence of pediculosis was documented in south-eastern cities. The prevalence of pediculosis was significantly higher in girls than in boys (93% vs.7%, respectively, p<0.0001). In both genders, the highest prevalence of pediculosis was documented in the 6-10- year age group. Of those infected, 62% lived in rural areas, and 32% of those infected with pediculosis had a previous history of this infection. Most (99.37%) infected individuals had head lice, the rest had body and pubic pediculosis.

CONCLUSION

The prevalence of pediculosis is low in Iranian children and adolescents, but this infestation is still a health problem in some south-eastern cities with warm climate and low to middle socioeconomic status.

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.

Skin infections in developing countries

PURPOSE OF REVIEW

In developing countries, where the majority of people have a low income and live in resource-poor settings, skin infections are prevalent. Data from recent studies provide insight into the most common skin infections and their management.

RECENT FINDINGS

Several studies confirm that skin infections account for the majority of pediatric mortality and morbidity in developing countries. They are prevalent in resource-poor settings and rural areas in certain parts of the world. Also, hot, humid climates and overcrowding predispose to skin infections. Most of the skin infections are curable with effective medication.

SUMMARY

Skin infections are of particular importance in developing countries. This review focuses on the most common skin infections and summarizes the most recent knowledge on the epidemiology, morbidity, and treatment in resource-poor settings.

Head lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2002 clinical report on head lice was published by the American Academy of Pediatrics, patterns of resistance to products available over-the-counter and by prescription have changed, and additional mechanical means of removing head lice have been explored. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting.

Prevalence of pediculosis capitis among schoolchildren in Greece and risk factors: a questionnaire survey

Pediculosis capitis is a common problem worldwide. The aim of this study was to estimate the prevalence of pediculosis capitis in children of preschool or school age in Greece, as well as to investigate the potential risk factors. The study included children of preschool and school age from all over Greece, including urban, semi-urban, and rural areas of Greece. A questionnaire with both closed and open-type questions, which was constructed by the researcher and filled in by the children's parents, was used. A total of 5,084 questionnaires were distributed, of which 2,792 were adequately filled and subsequently evaluated. Descriptive statistics and logistic regression models were used. The median age of the children was 8 years (range: 3-13 yrs) and 54% of them were girls. Pediculosis was found to be prevalent in 12% of the tested population. The prevalence of the disease seems to be increased after the age of 10 years and the risk is higher in girls. The number of family members was correlated positively with the risk of being infected with pediculosis at least once. The children's gender, their age, and family size were correlated with the risk of infection.

Epidemiological aspects of Pediculosis capitis and treatment evaluation in primary-school children in Iran

This study was undertaken to assess the prevalence of and epidemiological factors associated with, head lice infections in Iranian primary schools in 2006 and evaluate data on the therapeutic efficacy of lindane shampoo. A total of 40586 children (19774 boys (48.72%) and 20812 girls (51.28%)] from 198 Governmentprimary schools in Kerman, were screened for head lice between March and June 2006. The diagnosis of head lice infestation was confirmed by clinical inspection of scalp and hair for the presence of adult lice nymphal stage, or eggs (nit) by line-toothed head lice comb. All children infested with lice were treated with lindane shampoo (1% gamma benzene hexachloride). The overall prevalence of head lice infestation was 1.8%. The prevalence of infestation was significantly higher in girls (2.9%) than in boys (0.6%) (p = 0.000). The infestation rate was greater among pupils who were living in rural areas (4.6%) than in urban areas (1.5%). Of the 721 children with a positive examination result, 424 pupils (58.8%) were reported as having been infested with head lice in the previous 6 months. Mother's education level was a significant risk factor in this model (p < 0.05). At 2 weeks after the primary treatment, the success rates of treatment were 49%. Comprehensive survey in our work showed the better future of the disease and related factors. Education campaigns by health care officials, physicians and teachers are expected to be helpful for head lice control. It is essential that governments should be supported form cooperation between the school authorities and public health centers to successful control head lice infestation in primary school. Also there is an urgent need to identify safe, novel insecticides for proved efficacy.

A highly efficacious pediculicide based on dimeticone: randomized observer blinded comparative trial

Background

Infestation with the human head louse (Pediculus humanus capitis) occurs worldwide. Existing treatment options are limited, and reports of resistance to commonly used pediculicides have been increasing. In this trial we assessed the efficacy of a product containing a high (92%) concentration of the silicone oil dimeticone (identical in composition to NYDA^®), as compared to a 1% permethrin lotion.

Methods

Randomized, controlled, observer blinded clinical trial. Participants were recruited from a poor urban neighbourhood in Brazil where pediculosis capitis was highly prevalent. To minimize reinfestation during the trial, participants (145 children aged 5–15 years with head lice infestations) were transferred to a holiday resort outside the endemic area for a period of 9 days. Two applications of dimeticone or 1% permethrin were done, seven days apart. Outcome measures were defined as cure (absence of vital head lice) after first application and before and after second applications, degree of itching, cosmetic acceptability, and clinical pathology.

Results

Overall cure rates were: day 2 – dimeticone 94.5% (95% CI: 86.6% – 98.5%) and permethrin 66.7% (95% CI: 54.6% – 77.3%; p < 0.0001); day 7 – dimeticone 64.4% (95% CI: 53.3% – 75.3%) and permethrin 59.7% (95% CI: 47.5% – 71.1%; p = 0.5); day 9 – dimeticone 97.2% (95% CI: 90.3% – 99.7%) and permethrin 67.6% (95% CI: 55.4%-78.2%); p < 0.0001). Itching was reduced similarly in both groups. Cosmetic acceptability was significantly better in the dimeticone group as compared to the permethrin group (p = 0.01). Two mild product-related incidents occurred in the dimeticone group.

Conclusion

The dimeticone product is a safe and highly efficacious pediculicide. Due to its physical mode of action (interruption of the lice's oxygen supply of the central nervous system), development of resistance is unlikely.

Trial registration

Current Controlled Trials ISRCTN15117709.

Metalloproteases and egg-hatching in Pediculus humanus, the body (clothes) louse of humans (Phthiraptera: Insecta)

To investigate the biochemical components of egg-hatch in the body louse, Pediculus humanus, egg-shell-washings (ESW) were collected during the first 2 h post-hatching and analysed by gelatin SDS-PAGE. These ESW contained proteases with molecular mass in the range of 25–100 kDa; the most abundant proteases were ~25 kDa. The 3 main regions of protease activity in the one-dimensional gelatin SDS-PAGE gels resolved to at least 23 distinct regions of protease activity when analysed by two-dimensional gelatin SDS-PAGE, with iso-electric points spread over the entire 3 to 10 pH range. Mechanistic characterization indicated that the ESW contained proteases of the metallo-class, inhibited by both 1,10-phenanthroline and EDTA. Several protease inhibitors were tested for their ability to inhibit louse egg-hatch in vitro. The metalloprotease inhibitor 1,10-phenanthroline and the aminopeptidase inhibitor bestatin significantly inhibited (P<0·05) louse egg-hatch (100% and 58%, respectively). The presence of metalloproteases at the time of egg-hatch and the inhibition of egg-hatch in P. humanus by metalloprotease inhibitors suggests a crucial role for these proteases in the hatching of this medically important parasite.

Hairdressing is associated with scalp disease in African schoolchildren

BACKGROUND

Anecdotal reports suggest that certain disorders are common in African hair and may be associated with hairstyles.

OBJECTIVES

A cross-sectional study of 1042 schoolchildren was performed to test this hypothesis.

METHODS

A questionnaire was administered and scalp examinations performed, after ethics approval.

RESULTS

Participants included 45% boys and 55% girls. The majority of boys, 72.8%, kept natural hair with frequent haircuts (within 4 weeks). The prevalence of acne (folliculitis) keloidalis nuchae (AKN) was 0.67% in the whole group and highest (4.7%) in boys in the final year of high school, all of whom had frequent haircuts. The majority of girls (78.4%) had chemically relaxed hair, which was usually combed back or tied in ponytails, vs. 8.6% of boys. Traction alopecia (TA) was significantly more common with relaxed than natural hair, with an overall prevalence of 9.4% (98 of 1042) and of 17.1% in girls, in whom it increased with age from 8.6% in the first year of school to 21.7% in the last year of high school. The proportion with TA in participants with a history of braids on natural hair was lower (22.9%), but not significantly, than among those with a history of braids on relaxed hair (32.1%). No cases of central centrifugal cicatricial alopecia were identified.

CONCLUSIONS

We found associations between hairstyle and disease in our population of schoolchildren. AKN appears to be associated with frequently cut natural hair and TA with relaxed hair. These associations need further study for purposes of disease prevention.

Pediculosis capitis

Pediculosis capitis is a worldwide public health concern. Infestation occurs most commonly in children, with a peak incidence between 5 to 11 years of age. The condition is more common in girls and less common in Black children. Direct head-to-head contact is the most common mode of transmission. Pruritus is the most common symptom of infestation. The gold standard for diagnosing pediculosis capitis is finding a live louse or nymph in the scalp or viable egg in the scalp hair. Pediculicides are the most effective treatment. All household members and close contacts should be examined and treated concurrently if infested. The child should be allowed to return to school or to a child care facility after proper treatment. The child should be discouraged from close, direct head contact with others or from sharing items that have come in contact with the hair.

Ectoparasitic infestations

Ectoparasitic infestations are highly prevalent in resource-poor populations throughout the world and are associated with considerable morbidity. Reliable data on the epidemiology, immunology, and therapy of ectoparasitic infestations and on the biology of the parasites remain scarce. The control of parasitic skin diseases, such as scabies, pediculosis, tungiasis, myiasis, and cutaneous larva migrans in endemic areas remains a challenge. Using appropriate study designs, it is imperative to increase further the knowledge on the various aspects of the parasites and the infestations they cause.