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ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 1  |  Page : 15-20

Prevalence of dermatoses among the tribal children studying in residential schools of South Chhattisgarh, India


1 Department of Dermatology, Government Medical College, Rajnandgaon, India
2 Additional Superintendent of Police, Dantewada, n Police Service, Chhattisgarh, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Yasha Upendra
Department of Dermatology, Government Medical College, Rajnandgaon - 491 441, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_128_16

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  Abstract 

Introduction: Dermatoses are common among schoolgoing children and lead to significant morbidity. Objective: The present study was conducted to find the prevalence of various dermatoses in children studying in residential schools of remote tribal areas. Materials and Methods: A cross-sectional study was conducted on 1943 children studying in eight residential government schools over a period of 2 months (August and September 2016). Diagnosis of various dermatoses was made on the basis of detailed clinical examination and necessary investigations. Data analysis done by SPSS version 21.0 and Chi-square test was used to analyze categorical variables. Results: The prevalence of dermatoses was 72.1%. Majority had single skin lesion. Among infections and infestations, scabies (13.6%), pediculosis capitis (9.2%), and pyoderma (7.5%) were most prevalent. Among the noninfective conditions, xerosis (32.63%), pityriasis alba (18.9%), acne (8.6%), and atopic dermatitis were most prevalent. The prevalence of pyoderma, tinea corporis, pityriasis versicolor, scabies, and xerosis was higher in boys while pediculosis capitis and pityriasis alba were more prevalent in girls. The prevalence of xerosis, pityriasis alba, and phrynoderma was higher in primary school students while tinea corporis, scabies, acne, and pediculosis capitis were more prevalent in high school students. Conclusions: The burden of dermatoses in residential school children is very high. Health education of children, teachers, and caregivers regarding signs and symptoms of dermatoses is warranted for early detection and timely intervention. There is urgent need to address dermatoses under school health program.

Keywords: Dermatoses, prevalence, residential school, tribal area


How to cite this article:
Upendra Y, Sendur S, Keswani N, Pallava A. Prevalence of dermatoses among the tribal children studying in residential schools of South Chhattisgarh, India. Indian J Paediatr Dermatol 2018;19:15-20

How to cite this URL:
Upendra Y, Sendur S, Keswani N, Pallava A. Prevalence of dermatoses among the tribal children studying in residential schools of South Chhattisgarh, India. Indian J Paediatr Dermatol [serial online] 2018 [cited 2018 Jan 20];19:15-20. Available from: http://www.ijpd.in/text.asp?2018/19/1/15/206061


  Introduction Top


Dermatoses constitute an important health problem in pediatric age group and lead to significant morbidity.[1] Many studies have been conducted to find prevalence and pattern of pediatric dermatoses in the community, hospitals, and school children. The prevalence of pediatric dermatoses has varied from 8.7% to 69% in various school-based surveys with higher prevalence in rural and tribal school children.[2],[3] All the school-based studies have been conducted in day schools; no study has been conducted yet to find prevalence and pattern in the residential schools. Thus, the present study is aimed to find the prevalence of pediatric dermatoses in children studying in remote residential schools located in the tribal areas.


  Materials and Methods Top


A cross-sectional study was conducted over a period of 2 months (August and September 2016) in eight government residential schools of Dantewada district, Chhattisgarh. Out of eight residential schools covered, four were exclusively for boys while four were for girls (two primary schools [children aged 6–10 years] and two high schools [children aged 10–16 years]). These eight schools were located in different subdivisions of the district. Since all children of the village were studying in residential school, so it gave a complete representation of all children in the village. After getting requisite approval from the institutional ethical committee, a regular weekly camp was organized on Sunday by a team of 3–4 doctors including a skin specialist. An interior remote residential school was chosen for the study in consultation with police agencies regarding security condition due to naxalite problem. An informed consent was taken from the school superintendent and warden. All school children present in the school were examined for the presence of dermatoses. A total of 1943 children were enrolled in the study. The diagnosis was made after detailed history taking and clinical examination and wherever required, relevant investigation (such as wood's lamp examination, Gram's stain, KOH test, tzanck smear, and skin biopsy) was done for confirmation of the diagnosis. The findings were recorded in a pro forma prepared exclusively for the study.

Analysis of categorical variables was done by Chi-square test using SPSS version 21.0 SPSS version 21.0 (IBM, New York, USA). Criteria of significance used in the study were P < 0.05 (two-tailed).


  Results Top


Total 1943 children studying in eight residential schools were examined, out of which 1004 (51.6%) were boys and 939 (48.4%) were girls. 1054 (54.3%) children were from primary schools (age: 6–10) while 889 (45.7%) children were from high schools (age: 10–16). There were 533 boys compared to 521 girls in primary school, while there were 471 boys compared to 418 girls in high schools [Table 1].
Table 1: Age and sex distribution of the study population

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The prevalence of dermatoses among school children was 72.1% as 1401 children suffered from at least one of the dermatoses. Majority had single skin condition (n = 741, 38.1%) while 584 (30.1%) had two skin condition and only 76 (3.9%) were suffering from more than two skin conditions [Table 2].
Table 2: Number of dermatoses in each affected child

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Pyoderma (n = 146, 7.5%) was the most common among infections while both the infestations, scabies, and pediculosis capitis were common with the prevalence of 13.6% and 9.2%, respectively. Among noninfective conditions, xerosis (n = 634, 32.63%), pityriasis alba (n = 368, 18.9%), acne (n = 167, 8.6%), and atopic dermatitis (n = 90, 4.6%) had higher prevalence. The prevalence of other dermatoses found in the study was juvenile plantar dermatoses (n = 51, 2.6%), tinea corporis (n = 43, 2.2%), molluscum contagiosum (n = 35, 1.8%), pityriasis versicolor (n = 34, 1.7%), seborrheic dermatitis (n = 32, 1.6%), phrynoderma (n = 26,1.3%), folliculitis (n = 15, 0.8%), wart (n = 14, 0.7%), vitiligo (n = 13, 0.7%), nevus (n = 11, 0.6%), angular cheilitis (n = 7, 0.4%), pityriasis rosea (n = 5, 0.3%), and tinea capitis (n = 5, 0.3%) in the descending order [Table 3].
Table 3: Prevalence of various dermatoses

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The total prevalence of dermatoses was similar across both sexes (boys [73.9%] and girls [70.2%]) and difference was statistically nonsignificant. The prevalence was significantly higher in boys compared to girls in pyoderma (n = 99 [9.9%] vs. n = 47 [5.0%], P = 0.001), tinea corporis (n = 34 [3.4%] vs. n = 9 [1.0%], P < 0.001), pityriasis versicolor (n = 27 [2.7%] vs. n = 7 [0.7%], P = 0.001), scabies (203 [20.2%] vs. 60 [6.4%], P < 0.001), and xerosis (354 [17.7%] vs. 280 [14.9%], P < 0.001) while the prevalence was statistically significant in girls compared to boys in pediculosis capitis (163 [17.4%] vs. 15 [1.5%], P < 0.001) and pityriasis alba (199 [21.2%] vs. 169 [16.8%], P = 0.02) [Table 4].
Table 4: Gender wise prevalence of various dermatoses

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Among boys, the prevalence was significantly higher in primary school students (age: 6–10) compared to high school students (age: 10–16) in xerosis (n = 204 [38.4%] vs. n = 150 [31.8%], P < 0.001) and pityriasis alba (n = 124 [23.3%] vs. n = 45 [9.6%], P < 0.001) while the prevalence was significantly higher in high school students (age: 10–16) compared to primary school students (age: 6–10) in tinea corporis (n = 28 [5.9%] vs. n = 6 [1.1%], P < 0.001), scabies (n = 124 [26.3%] vs. n = 79 [14.8%], P < 0.001), and acne (n = 76 [16.1%] vs. n = 1 [0.2%], P < 0.001) [Table 5].
Table 5: Age differences in prevalence of various dermatoses across gender

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Among girls, the prevalence was higher in primary school students (age: 6–10) compared to high school students (age: 10–16) in xerosis (n = 167 [32.1%] vs. n = 113 (27 ,1%), P = 0.002), pityriasis alba (n = 167 [32.1%] vs. n = 32 [7.7%], P < 0.001), and phrynoderma (n = 11 [2.1%] vs. n = 2 [0.5%], P = 0.04) while the prevalence was significantly higher in high school students (age: 10–16) compared to primary school students (age: 6–10) in pediculosis capitis (n = 116 [27 .8%] vs. n = 47 [9.0%], P < 0.001) and acne (n = 87 [20.8%] vs. n = 3 [0.6%], P < 0.001) [Table 5].

There was no statistical difference in total prevalence of dermatoses between primary school children (age: 6–10) and high school children (age: 10–16) [Table 6]. The prevalence was significantly higher in primary school students (age: 6–10) compared to high school students (age: 10–16) in xerosis (n = 371 [35.2%] vs. n = 263 [29.6%], P < 0.001), pityriasis alba (n = 291 (27.6%) vs. n = 77 [8.7%], P < 0.001), and phrynoderma (n = 20 [1.9%] vs. n = 6 [0.7%], P = 0.03) while the prevalence was significantly higher in high school students (age: 10–16) compared to primary school students (age: 6–10) in tinea corporis (n = 32 [3.6%] vs. n = 11 [1.0%], P < 0.001), scabies (n = 157 [17.7%] vs. n = 106 [10.0%], P < 0.001), pediculosis capitis (n = 126 [14.2%] vs. n = 52 [4.9%], P < 0.001), and acne (n = 163 [18.3%] vs. n = 4 [0.4%], P < 0.001).
Table 6: Age-wise distribution of various dermatoses

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Among primary school students (age: 6–10 years), the prevalence was significantly higher in boys compared to girls in scabies (n = 204 [38.4%] vs. n = 167 [32.1%], P < 0.001) and xerosis (n = 204 [38.4%] vs. n = 167 [32.1%], P < 0.001) while the prevalence was statistically significant in girls compared to boys in pediculosis capitis (n = 47 [9.0%] vs. n = 5 [0.9%], P < 0.001) and pityriasis alba (n = 167 [32.1%] vs. n = 124 [23.3%], P < 0.001) [Table 7].
Table 7: Sex differences in prevalence of various dermatoses across age groups

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Among high school students (age: 10–16 years), the point prevalence was higher in boys compared to girls in pyoderma (n = 53 [11.3%] vs. n = 18 [4.3%], P = 0.002), tinea corporis (n = 28 [5.9%] vs. n = 4 [1.0%], P < 0.001), pityriasis versicolor (n = 16 [3.4%] vs. n = 3 [0.7%], P = 0.001), scabies (n = 124 [26.3%] vs. n = 33 [7.9%], P < 0.001), and xerosis (n = 150 [31.8%] vs. n = 113 (27.1%), P = 0.005) while the prevalence was significant in girls compared to boys in pediculosis capitis (n = 116 (27.8%) vs. n = 10 [2.1%], P < 0.001) and molluscum contagiosum (n = 14 [3.3%] vs. n = 3 [0.6%], P = 0.005) [Table 7].


  Discussion Top


The present study has revealed the prevalence of dermatoses to be 72.1% among the 1943 tribal residential school children which is in consonance with earlier studies on rural or tribal school children.[1],[3],[4],[5] The high prevalence could be due to sharing of fomites, low awareness level among the school staffs regarding basic dermatological signs and symptoms, remote location, and poor healthcare delivery system due to widespread health workforce deficiency owing to extreme naxalite problem.

Pyoderma was the most common infection in our study affecting 146 (7.5%) of the school children. It was significantly more common in boys compared to girls with no significant difference between primary and high school children. Previous studies conducted on rural children have shown similar findings.[5],[6],[7] 13.6% of the children had scabies with boys significantly more affected than girls and among boys, it was significantly higher in high school children compared to primary school children.

The epidemic of scabies in two of the boy's high school and nondetection of illness were the primary reasons for high prevalence among high school boys. In our study, the prevalence of pediculosis capitis was found to be lower (9.2%) compared to earlier studies.[2],[4],[8] This might have been due to easy detection of this condition by the school staffs and widespread use of shampoos by the children in residential school. The prevalence of pediculosis capitis is significantly higher in girls compared to boys similar to other studies [2],[4] and may be due to long hair in girls.

The prevalence of fungal infections such as tinea corporis, tinea capitis, and pityriasis versicolor is about 4% which is similar to previous studies on rural children.[9],[10] Tinea corporis was significantly more common in boys compared to girls which could be due to lesser concern with personal hygiene and grooming.

Among noninfective dermatoses, xerosis had the highest prevalence of 32.6%. Similar result was seen earlier.[3] It was more common in primary school children compared to high school children and boys compared to girls. Higher prevalence in boys could be due more sun exposure and outdoor sports. Pityriasis alba too had a high prevalence of 18.9% which was similar to previous studies [5],[11] and was significantly more common in girls. This could be related to higher prevalence of atopic dermatitis found in the girls in this study. The prevalence of acne was about 9% and was similar in both the sexes with higher occurrence in high school children compared to primary school children. Earlier studies have also shown higher prevalence of acne in adolescents compared to children <10 years.[12],[13]

The prevalence of other noninfective dermatoses such as atopic dermatitis, seborrheic dermatitis, vitiligo, nevus, pityriasis rosea, and juvenile plantar dermatoses was low (0.3%–4.6%) similar to other studies.[1],[3],[4],[12]

The prevalence of nutritional disorders in our studies (1.7%) is lesser compared to earlier studies,[14],[15] which may be due to free nutritious meals served to children three times a day along with regular deworming and iron and folic acid supplementation as per government scheme.


  Conclusions Top


The burden of dermatoses in residential school children is very high. Health education of children, teachers, and caregivers regarding signs and symptoms of dermatoses is warranted for early detection and timely intervention. There is urgent need to address dermatoses under school health program. Health camps by skin specialists at the time of disease outbreak can prevent epidemics in residential schools.

Acknowledgment

We received full support and cooperation from Dantewada police and district administration to provide logistic support and requisite security in view of naxalite problem.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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