Journal of Research in Health Sciences

• Home
• About
• Log In
• Register
• Search
• Current
• Archives
• AuthorGuidelines

JRHS 2009; 9(1): 48-51

Copyright © Journal of Research in Health Sciences

The Prevalence of Pediculosis capitis in Primary School Students in Bahar, Hamadan Province, Iran

Moradi AR( MSc)a, Zahirnia AH( PhD)b, Alipour AM(  B.Sc)c, Eskandari Z(  BSc)d

aHealth center of Bahar, Hamadan University of Medical Science& Health Services, Iran

bDepartment of Parasitology, School of Medicine, Hamadan University of Medical Sciences& Health Services, Iran

cHealth center of Kabootrahang, Hamadan University of Medical Science& Health Services, Iran

dHealth center of Hamadan, Hamadan University of Medical Science& Health Services, Iran

*Corresponding author: Zahirnia AH, , E-mail: zahirnia@umsha.ac.ir

Received: 7 November 2008; Accepted: 25 May 2009

Abstract

Background: Head lice infestation caused by Pediculus humanus var capitis (Pediculus capitis) is a worldwide pub­lic health concern that affects mostly school aged children. This descriptive, analytical study was carried out in 2008 to determine the prevalence of pediculosis capitis and some risk factors among primary-school pupils in Bahar, Hamadan Province, Iran.

Methods: We selected 900 pupils (50% girls and 50% boys) from 18 primary schools by multistage, systematic ran­dom sampling. Their hair was examined for head louse infestation. The results and demographic information re­corded in the questionnaire and then were analyzed by SPSS software.

Results: Twelve students (1.3%) were infected with lice, 10 (2.2%) girls and 2 (0.44%) boys. The rate of infection was 0.66% in urban and 1.66% in rural areas. The results showed significant variations in head lice infestation, and factors such as sex, level of parent education and habitat (P<0.05), while there was no significant variation between school grade, members of family and the frequency of hair washing (P> 0.05).

Conclusions: The prevalence of pediculosis was less than average percentages observed in other stu­dents inside and outside Iran. 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.

Keywords:  Pediculosis, Students, Pediculus capitis, Iran

Introduction

Head lice infestation caused by Pediculus capi­tis (Anoplura: Pediculidae) is a world wide pub­lic health concern. Head lice gener­ally affect primary school girls, aged 3-12 yr, in both the developed and the devel­oping countries (1).

The head louse is transmitted mainly through physical contact. Symptoms associ­ated to the infestation are constant itching and scalp ir­ritation. This ectoparaisite feed by sucking blood and cause pruritus and subsequent skin excoriation may lead to sec­ondary infection. In addition, chronic irrita­tion and secondary infection may disrupt behavior, school perform­ance and cause psychological distress (2, 3).

In the United States 6-12 million persons are infested every year with an estimated $100 million being spent annually on treatment (4).

In certain epidemiologic school surveys con­ducted in different countries the preva­lence of head lice has been found to be 6.8% in Turkey (5), 8.9% in Belgium(6), 13% in Aus­tralia (7), 35% in Brazil (8), 5.8% in Ko­rea (9) and 52% in Ukraine (10).

Previous studies in different parts of Iran showed infestation rates of 5.1, 4.5, 2.2, 28.5 and 12%, mostly in the primary school chil­dren, in Rasht, Tabriz, Babol, Ardabil and   Boushehr, respectively (11-15). In two other studies that were carried out in Hamadan Prov­inces, the overall infestation rates were 7.5 and 6.85%, respectively (16, 17).

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. Over­crowded living conditions and the arising of resis­tance to insecticides have contributed to the in­crease of head lice in the last few years (17).

The present study was conducted to assess the head lice infestation rate and some risk factors in schoolchildren in Bahar, Province of Hamadan, Iran.

Methods

This descriptive, analytical study was con­ducted between February and June 2008 in Bahar, Province of Hamadan, Iran. A total of 900 children including 450 boys (50%) and 450 girls (50%) from 18 government pri­mary schools were selected by multistage, system­atic random sampling, then were ex­amined for the presence of P. capitis.

The sample populations were 600 children of 12 schools in rural areas and 300 children from 6 schools in urban areas. Children were ranging in school grades from first to fifth that were diagnosed by health care employ­ers.

A team of health care workers skilled in the detection of head lice conducted the screen­ing under the supervision of the co-investi­gator medical entomologist.

The diagnosis of head lice infestation was confirmed by clinical inspection of scalp and hair under the light of a reading lamp and by using a manual magnifier for the presence of adult lice, nymphal stage or eggs (nits).

Before examining the students, a detailed questionnaire including sex, school grade, family size, parent's education, parent's job, hair washing (per week)and social factors were recorded for each child.

Data were analyzed using SPSS software ver­sion 11.0. To compare qualitative vari­ables, the chi-square test was used. P< 0.05 were considered significant.

Results

Of 900 children examined, the mean age of the children was 8.5±1.9 yr (range, 6-11 yr).

The overall prevalence of head lice infesta­tion was 1.3% and this study showed that the prevalence of infestation was signifi­cantly higher in girls (2.2%) than in boys (0.44%)   (P< 0.05) and the infestation rate was greater among pupils who were living in rural areas (1.66%) than those in urban areas (0.66%) (P< 0.05).

The prevalence of head lice infestation by school grade was 1.6, 1.1, 1.1, 2.2 and 0.55% for first, second, third, fourth and fifth grades, re­spectively. No statistical dif­ference was found between the five values (P> 0.05) (Table 1).

Table 1: Prevalence of head louse infestation in pri­mary School students by sex and social factors in Bahar, Iran

When head lice infestation rate was com­pared according to parents' literacy, an in­crease in the prevalence rates was observed in children with uneducated parents (P< 0.05) (Table 2).

Table 2: Prevalence of head louse infestation in primary School students according to parents' literacy in Bahar, Iran

The analysis of other variables, such as fam­ily size and the frequency of hair washing in relation to infestation showed no significant differences between infested and nonifested subjects (Table 1).

Discussion

P. humanus capitis is an obligate ectopara­site that lives only on human hair and feeds on the blood from the skin.

Infestation rates among school children in some Middle Eastern and other regional countries have shown a range of infestation of 4.2 -78% (18-22).

The overall infestation rate in the present study was 1.3% that is one of the lowest rates among the reported results from the Middle Eastern and other regional countries. Results reported, mostly in primary school children, from different parts of Iran showed a rate between 2.2 to 28.5% (11-17,23) and the prevalence in the present study (1.3%) was lower than previous reported in Hama­dan Province (7.5%,6.85%,5%),(16,17 ,24).

In comparison with some of the results that have been reported from different parts of Iran, the over-all infestation rate of 1.3% in the present study and the results reported from Babol and Kerman(1,13) are the lowest lice infestation rate that have been reported from Iran. There may be a number of likely explanations for this difference including: a bias due to the detection method or the sam­pling strategy used, deficient population groups, variation in the study design and consequently increase of government atten­tion to health of schools.

In the present study and almost all previous studies in Iran and other parts of the world, the prevalence of head lice infestation in school boys was lower than the prevalence of the infestation in school girls. Difference in behavior patterns between boys and girls might have affected transmission rates and susceptibility to head lice infestation. Trans­mission of head lice most commonly occurs through close physical contact, espe­cially head- to-head contact. Girls generally have longer hair as compared to boys and longer hair require better grooming and combing. More­over girls in Iran use kerchief in the class­room situation and outside during daily ac­tivities. They occasionally replace their ker­chief with each other that would in theory be an ideal situation for transmissions of head lice.

In the present study, urban areas had lower prevalence of head lice infestation than rural areas, which is attributed to better hygiene, because more often urban school have health teacher or supervisor. Some researchers have claimed that head louse is found in all socio-economic classes (1, 5, 7, 8), whereas oth­ers have reported that head louse is more fre­quent in poor peoples (9, 25). It has been proposed that in areas of high social disad­vantage, larger families may pay less atten­tion to hair care due to lake of support and financial limitations.

This study and studies conducted in Turkey (5), Babol (13) and Kerman (25) showed in­festation rates among children with educated parents were lower than that among children with uneducated parents, which suggested that literacy was an important factor in the prevalence of infection. Teaching the com­munity about personal hygiene and the availability of anti-pediculosis drugs could lead to the reduction in the prevalence of pediculosis capitis among children (17).

We found that there was not a relationship between the rate of infestation and factors such as school grade, members of family and the frequency of hair washing. This is in agreement with results of a number of previ­ous studies (17, 20, 25).

Educational campaigns by community health care workers, nurses, public health doctors and teachers are expected to be help­ful for head lice control. It is essential that school authorities and care centers cooperate to successfully control head louse Infestation in primary schools. In addition, care centers teams should be responsible for treatment and prevention of louse infestation besides carry­ing out other care centers service func­tions.

Acknowledgements

This research was supported by a grant from Deputy of   Research of Hamadan University of Medical Sciences, Iran.

The authors gratefully acknowledge the staff of Health Centre of Bahar District, Hamadan University of Medical Sciences. The authors declare that there is no conflict of interests.

References

1. Motovali-Emami M, Aflatoonian MR, Fekri A, Yazdi M. Epidemiological as¬pects of Pediculosis capitis and treat¬ment evaluation in primary-school chil¬dren in Iran. Pak J Biol Sci. 2008; 11(2): 260-4.
2. Bailey AM, Prociv P. Persistent head lice following multiple treatments: Evi¬dence for insecticide resistance in Pedi¬culus humanus capitis. Aust J Der¬matol. 2000; 41: 250-254.
3. Dodd C. Treatment of head lice. Br Med J. 2001; 10:323, 1084.
4. Burgess IF. Human lice and their man¬agement. Adv Parasitol. 1995; 36: 271-342.
5. Kokturk A, Baz K, Bugdayci R, Sas¬maz T, Tursen U. The prevalence of Pedi¬culosis capitis in school children in Mersin, Turkey. Int J Dermatol. 2003; 42(9): 694-8.
6. Willems S, Lapeere H, Headens N, Pastels I. The importance of socio-eco¬nomic status and individual charac¬ter¬is¬tics on the prevalence of head lice in schoolchildren. Eur J Der¬matol. 2005; 15:387-392.
7. Counahan M, Andrews R, Buttner P, Byrnes G, Speare R .Head lice preva¬lence in primary school in Victoria. Aust J Paediator. 2004; 40: 616-619.  
8. Burges R, Mendes J. Epidemiological aspects of head lice in children attend¬ing day care centers, urban and rural schools in Uberlandia, Central Brazil. Mem Inst Oswaldo Cruz, Rio de Janiro. 2002; 97(2): 189-92.
9. Sim S, Lee LY, Lee KJ, Seo JH. A sur¬vey on head lice infestation in Korea and the therapeutic efficacy of oral trime¬thoprim/sulfamethoxazole adding to lin¬dane shampoo. Korean J Parasi-tol. 2003, 41: 57-61.
10. Kurhanova L. Lice infestation and lice control remedies in the Ukrain. Ann N Y Acad Sci. 2006; 1078: 357-360.
11. Golchai J, Ahmadi Ghajar M. Study of the prevalence of Pediculus capitis among children aged 3-7 years in nurs¬ery school of Rasht (in Persian). J Gi¬lan Univ Med Sci. 2002; 41: 21-24.
12. Hodjati MH, Mousavi N, Mousavi M. Head lice infestation in school children of a low socioeconomy area of Tabriz city, Iran. African Journal of Bio¬tech¬nol¬ogy. 2008; 13: 2292-2294.
13. Zabihi A, Jafarian Amiri S, Rezvani SM, Yasrebi A. Study of infestation rate of Pediculus capitis in primary school stu¬dents in Babol city (in Persian). J Babol Univ Med Sci. 2005; 4: 88-93.
14. Edalatkhah H, Arshi S, Sadeghi H, Sepehram V. Prevalence of Pediculus capitis in school children in Ardebil province (in Persian). J Ardebil Univ Med Sci. 2005; 6: 36-45.
15. Arjomanzadeh S, Tahmasebi R, Jokar M. Prevalence of pediculosis and scabies in primary school in Boushehr city. (in Persian). J South Med. 2001; 1: 41-46.
16. Zahirnia AH, Taherkhani H, Bathaii JA. comparative study on the effectiveness of three shampoos in treatment of head lice (pediculus capitis) in primary school-children in Hamadan province, Iran 2000-20001 (in Persian). J Mazan¬darn Univ Med Sci. 2005; 15(49):16-24.
17. Nazari M, Fakoorziba MR, Shobeiri F. Pediculus capitis infestation according to sex and social factors in Hamedan, Iran. South East Asian J Trop Med Pub Health. 2006; 37(3): 95-98.
18. Chunge RN. A study of head lice among primary schoolchildren in Kenya. Trans Roy Soc Trop Med Hyg. 1986; 80: 42-54.
19. Bahamdan K, Mahfour AA, Tallab T. Skin diseases among adolescent boys in Abha, Saudi Arabia. Int J Dermatol. 1996;  35: 405-407.
20. Mumcuoglu KY, Miller J, Gofin R. Epidemiological studies on head lice in¬fes¬tation in Israel. I. Parasitological ex¬amination of children. Int J Dermatol. 1990;  29: 502-506.
21. Ilhan F, Budak S, Guruz AY .The preva¬lence of Pediculus humanus capitis among the student of a secondary and three elementary schools in Kariyaka Izmir, Turkey. J Egypt Soc Parasitol. 1997; 27: 157-161.
22. Al-Shawa RM .Head louse infestations in Gaza governorates. Med Entomol. 2006; 43(3): 505-507.
23. Pourbaba R, Moshkbide Haghighi M, Habibpour R, Mirzanezhade M. A survey of prevalence of pediculosis among pri¬mary school students of Gilan province. (In Persian). J Gilan Univ Med Sci. 2004; 13(52):15-23.
24. Farshchian M, Mani Kashani Kh, Khademalreza N, Fariba H .The study of prevalence of pediculos capitis and determing some effective factors on it among pupils in primery and secondary schools in Hamadan city between 1998-99. (inPersian). Hakim J. 2001; 4(1): 39-44.
25. Kamiabi F, Nakhaei FH .Prevalence of Pediculosis capitis and determination of risk factors in primary-school children in Kerman. East Mediterr Health J. 2005; 11(5-6): 988-992.