|Year : 2018 | Volume
| Issue : 4 | Page : 331-334
Epidemiology of pediculosis capitis among schoolchildren in Damascus, Syria
Mohammad Taher Ismail, Mohammad Maher Kabakibi, Abeer Al-Kafri
Department of Microbiology and Biochemistry, Faculty of Pharmacy, Arab International University, Ghabaghib, Daraa Governorate, Syria
|Date of Web Publication||28-Sep-2018|
Prof. Mohammad Taher Ismail
Department of Microbiology and Biochemistry, Faculty of Pharmacy, Arab International University, Ghabaghib, Daraa Governorate
Source of Support: None, Conflict of Interest: None
Background: Pediculosis is a common ectoparasitic infection in schoolchildren, causing a public health problem, which is neglected in Syria. Objective: This study aimed to determine the prevalence of infestation with head lice among primary schoolchildren in Damascus, Syria, and explore the predisposing factors of head lice infestation in public schools. Materials and Methods: The present study was to determine the head lice infestation (pediculosis) levels in primary schoolchildren, from March to July 2017. A total of 8689 (females: 4392, males 4297) schoolchildren aged 6–12 years from 18 selected primary school of Damascus city and countryside were examined for head lice. Pediculosis was defined as the presence of at least on living adult, nymph, or viable egg. Results: The overall head lice infestation rate was 14. 3% (1243/8689) and infestation rate was higher in girls (23.72%, 1042/4392) than in boys (4.67%, 201/4297). The infestation rate among schoolchildren varied from 1.4% to 60.7% and depended on the age group is 18.10% (6–8 years), 12.22% (9–10 years), and 13.30% (11–12 years). The infestation rate among girls varied from 22.2% (10–12-year-old group) to 42.8% (6–8-year-old group). Conclusions: Pediculosis is a common public health problem affecting primary schoolchildren in Damascus area, and the levels of infestation are of an endemic significance.
Keywords: Damascus, epidemiology, pediculosis capitis, schoolchildren, Syria
|How to cite this article:|
Ismail MT, Kabakibi MM, Al-Kafri A. Epidemiology of pediculosis capitis among schoolchildren in Damascus, Syria. Indian J Paediatr Dermatol 2018;19:331-4
|How to cite this URL:|
Ismail MT, Kabakibi MM, Al-Kafri A. Epidemiology of pediculosis capitis among schoolchildren in Damascus, Syria. Indian J Paediatr Dermatol [serial online] 2018 [cited 2020 Feb 29];19:331-4. Available from: http://www.ijpd.in/text.asp?2018/19/4/331/242410
| Introduction|| |
Pediculosis is a frequent public health problem in schoolchildren, especially primary level. The pattern and prevalence of pediculosis is dependent on many sociodemographic and economic factors. Pediculosis capitis is the infestation of human hair and scalp caused by head lice. Head lice are obligate human blood-feeding ectoparasites and feed only on human blood., They are connected to human hosts during all life stages, do not have wings, and cannot jump., However, the major route of head lice direct transmission is head-to-head contact with an infected person, and the indirect transmissions are by sharing clothing, hairbrushes, hats, towels, or other personal items of a person already infected. Head lice infestation is usually detected by three types of evidence; itching and inflammation of the scalp and neck, sighting of lice, and detection of eggs attached to hair shafts., The clinical symptoms of pediculosis capitis are pruritus, allergic reaction, and psychological stress because children believe that head lice infestation is a result of being dirty., Head lice are a common infection in school-age children worldwide, varied from 1.6% to 87%.,, However, this variation of infestation rate may be due to several factors including the eradication methods, closing contacts, diagnostic techniques, pesticide resistance, and knowledge regarding head lice.,
In Syria, no data were published on the prevalence of head lice infestation among primary schoolchildren until now and this study is the first one.
| Materials and Methods|| |
A total of 8689 primary schoolchildren (aged 6–12 years) including 4392 girls and 4297 boys from 18 primary schools in Damascus city and its countryside were examined for head lice during the period from March to July 2017. The study was done during the war in Syria, but the sample of the study was taken in calm areas, and these cases were frequent in our private clinics, part of this study is to educate school supervisors about treatment and prevention of this disease.
All the studied schools were Syrian government owned (public schools). All studied girls had long hair and the boys had short hair.
The examinations were conducted with the approval of the Ministry of Education. The entire head was examined carefully, while special attention was paid to the nape of the head and behind the ears, for a period of 5 min. Head lice infestation (pediculosis) was defined as the presence of at least one living adult, nymph, and viable nit (egg), which is white colored with an intact operculum. After the examination, the infested children were recorded for treatment using plastic fine-toothed comb to remove the head lice. We recommend using solution vinegar 5% for killing head lice (vinegar has been reputed to have strong antibacterial properties, it breaks down the glue which makes nits easy removal and it is a popular and cheap treatment, and it gave excellent results in addition to that there are no side effects).
The statistical analysis of results was performed using Chi-square test.
| Results|| |
Head lice infestation was observed in 8689 primary schoolchildren including 4297 boys and 4392 girls (boy:girl ratio: 1:1.02) in which 1243 of them showed at least one living adult, nymph, or viable nit. The overall infestation rate was 14.3% [Table 1].
Girls showed a significantly higher infestation rate than boys, with infestation rate of 23.72% and 4.67%, respectively, as shown in [Table 2].
|Table 2: Prevalence of pediculosis capitis among primary schoolchildren by sex|
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In this study, we found an increased prevalence of head lice with older schoolchildren, the highest was observed in 6–8 years, and pediculosis was more frequent in girls than boys as shown in [Table 3].
Our results also showed that the infestation rate among schools varied from 1.4% to 60.7% as shown in [Table 4].
| Discussion|| |
This study was performed in 18 primary schools and their age ranged between 6 and 12 years, from Damascus city, the capital of Syria. The infestation rate found that in this study, 14.3% shows the problem of head lice among schoolchildren, especially in schoolgirls.
Our results showed that the prevalence of pediculosis is a considered an endemic according to the national pediculosis association of the USA which classifies head lice infestation rate of more than 5% as an endemicity.
Lice infestation has also been reported as a global problem in many countries of the world. In Thailand, high levels of infestation rate have been reported among primary schoolchildren in both urban and rural areas which varied from 36.6% to 88.4%.,
A similar rate was published in other countries such as Pakistan with infestation rate of 87%, Nepal 59%, Iraq 48.9%, Malaysia 35%, and Argentina 29.7%. In contrast, lower infestation rates were reported in Korea 4.1%, Poland 1.6%, France 3.3%, and the USA 1.6%.
This variation of infestation rates may be due to several factors such as personal hygiene, overcrowded classes, rates of head-to-head contact, family income, and management methods.
Gender affects head lice infestation, and this study showed that girls were more infected (23.72%) than boys (4.670%) as shown in [Table 2]. This difference between boys and girls was statistically significant (P > 0.05) Similar findings are in agreement with the current study as reported in the studies conducted in Egypt, in Turkey by Gulgun et al., 2013, and Karakuş et al.,, in Thailand, in Iran, and in Jordan.
Many factors explain this variation in sex infection. Hair length was found to be correlated with head lice infestation. The frequency of children infested was significantly lower when they had short hair and infestation rate was significantly higher in children with long hair. All girls in this research have long hair.
Other factors have been attributed to gender-related behavioral differences; such as boys prefer playing outside only in brief contacts during sports or rough activities, while girls tend to play in small groups with closer contact (head-to-head contact) with each other., However, head-to-head contact is an important route of transmission as well as the passive transference such as sharing hair accessories, brushes, hats, or combs.
The infestation rate also changed through the age groups of primary schoolchildren. In this study, the schoolchildren females aged 6–8 years showed a higher infestation rate (42.8%) when compared with ones aged 10–12 years (22.2%) [Table 3]. In some reports, it has been indicated that there is a decrease in the infestation rate with age.,
This tendency has also been reported by many researchers in different countries such as India, Pakistan,, Malaysia, Iran,, Taiwan, Venezuela, Brazil, Egypt, Turkey, Thailand, and Greece. This finding may be attributed to the possible increase in closer contact between children aged 6–8-year-old group than older children group.
Finally, the infestation with head lice is a common public health problem affecting schoolchildren in Damascus, Syria, and is endemic. The suggestion for eradicating head lice is that the parents and teachers should urge the schoolchildren to regularly wash their hair with anti-head lice shampoo or herbal shampoo, 3–4 times per week, keep the students' hair short, not share a personal comb and towel, use an effective treatment on affected students, reduce the students' number in the class, because we found many classes with about 65 pupils in the same class, and four students sitting in the same desk, examine the students' hair daily by the mothers or weekly by teachers, and conduct educational course on pediculosis to avoid new infections.
The authors would like to thank the Ministry of Education for their encouragement and support. Great thanks are due to the headmasters (directors of the schools) for their assistance in this study.
Our thanks to the pharmacists, Boushra al-Haj Ali, Rahaf Al-Bashir, khawla Al-Zorkan, and Maram Bajbouj, for their help in examining the students.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nutanson I, Steen CJ, Schwartz RA, Janniger CK. Pediculus humanus capitis: An update. Acta Dermatovenerol Alp Pannonica Adriat 2008;17:147-54, 156-7, 159.
Frankowski BL, Bocchini JA Jr; Council on School Health and Committee on Infectious Diseases. Clinical report: Head lice. Pediatrics 2010;126:392-403.
Ismail MT, Al Kafri A. Parasitology and Medical Mycology. Syria: Damascus University Publication; 2008. p. 129-34.
Oh JM, Lee IY, Lee WJ, Seo M, Park SA, Lee SH, et al.
Prevalence of pediculosis capitis among Korean children. Parasitol Res 2010;107:1415-9.
Gur I, Schneeweiss R. Head lice treatments and school policies in the US in an era of emerging resistance: A cost-effectiveness analysis. Pharmacoeconomics 2009;27:725-34.
Bush SE, Rock AN, Jones SL, Malenke JR, Clayton DH. Efficacy of the LouseBuster, a new medical device for treating head lice (Anoplura: Pediculidae). J Med Entomol 2011;48:67-72.
Falagas ME, Matthaiou DK, Rafailidis PI, Panos G, Pappas G. Worldwide prevalence of head lice. Emerg Infect Dis 2008;14:1493-4.
Rukke BA, Birkemoe T, Soleng A, Lindstedt HH, Ottesen P. Head lice prevalence among households in Norway: Importance of spatial variables and individual and household characteristics. Parasitology 2011;138:1296-304.
Frankowski BL. American academy of pediatrics guidelines for the prevention and treatment of head lice infestation. Am J Manag Care 2004;10:S269-72.
Toloza A, Vassena C, Gallardo A, González-Audino P, Picollo MI. Epidemiology of pediculosis capitis in elementary schools of Buenos Aires, Argentina. Parasitol Res 2009;104:1295-8.
Thanyavanich N, Maneekan P, Yimsamram S, Maneeboonyang W, Puangsa-Art S, Wuthisen P, et al
. Epidemiology and risk factors of pediculosis capitis in primary school near the Thai-Myanmar border in Ratchaburi province, Thailand. J Trop Med Parasitol 2009;32:65-74.
Fan CK, Liao CW, Wu MS, Hu NY, Su KE. Prevalence of Pediculus capitis infestation among school children of Chinese refugees residing in mountanous areas of Northern Thailand. Kaohsiung J Med Sci 2004;20:183-7.
Saddozai S, Kakarsulemankhel KK. Infestation of head lice, Pediculus humanus
capitis in schoolchildren at Quetta city and its suburban areas, Pakistan. Pak J Zool 2008;40:45-52.
Shakya SR, Bhandary S, Pokharel PK. Nutritional status and morbidity pattern among governmental primary school children in the Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2004;2:307-14.
Al-Kubiassy W, Abdul Karim ET. Head lice in pupils of two primary schools in Baghdad. J Bahrain Med Soc 2003;15:34-8.
Bachok N, Nordin RB, Awang CW, Ibrahim NA, Naing L. Prevalence and associated factors of head lice infestation among primary schoolchildren in Kelantan, Malaysia. Southeast Asian J Trop Med Public Health 2006;37:536-43.
Buczek A, Markowska-Gosik D, Widomska D, Kawa IM. Pediculosis capitis among schoolchildren in urban and rural areas of Eastern Poland. Eur J Epidemiol 2004;19:491-5.
Durand R, Millard B, Bouges-Michel C, Bruel C, Bouvresse S, Izri A, et al.
Detection of pyrethroid resistance gene in head lice in schoolchildren from Bobigny, France. J Med Entomol 2007;44:796-8.
Williams LK, Reichert A, MacKenzie WR, Hightower AW, Blake PA. Lice, nits, and school policy. Pediatrics 2001;107:1011-5.
Abd El Raheem TA, El Sherbiny NA, Elgameel A, El-Sayed GA, Moustafa N, Shahen S, et al.
Epidemiological comparative study of pediculosis capitis among primary school children in Fayoum and Minofiya governorates, Egypt. J Community Health 2015;40:222-6.
Gulgun M, Balci E, Karaoğlu A, Babacan O, Türker T. Pediculosis capitis: Prevalence and its associated factors in primary school children living in rural and urban areas in Kayseri, Turkey. Cent Eur J Public Health 2013;21:104-8.
Karakuş M, Arıcı A, Töz SÖ, Özbel Y. Prevalence of head lice in two socio-economically different schools in the center of Izmir city, Turkey. Turkiye Parazitol Derg 2014;38:32-6.
Rassami W, Soonwera M. Epidemiology of pediculosis capitis among schoolchildren in the Eastern area of Bangkok, Thailand. Asian Pac J Trop Biomed 2012;2:901-4.
Moosazadeh M, Afshari M, Keianian H, Nezammahalleh A, Enayati AA. Prevalence of head lice infestation and its associated factors among primary school students in Iran: A systematic review and meta-analysis. Osong Public Health Res Perspect 2015;6:346-56.
AlBashtawy M, Hasna F. Pediculosis capitis among primary-school children in Mafraq Governorate, Jordan. East Mediterr Health J 2012;18:43-8.
Ahmed AM, Afifi AA, Malik EM, Adam I. Intestinal protozoa and intestinal helminthic infections among schoolchildren in central Sudan. Asian Pac J Trop Med 2010;3:292-3.
Kokturk A, Baz K, Bugdayci R, Sasmaz T, Tursen U, Kaya TI, et al.
The prevalence of pediculosis capitis in schoolchildren in Mersin, Turkey. Int J Dermatol 2003;42:694-8.
Akhter S, Mondal MM, Alim MA, Moinuddin MA. Prevalence of lice infestation in humans in different socio-economic status at Mymensingh in Bangladesh. Int J Bio Res 2010;1:13-7.
Mallik S, Chaudhuri RN, Biswas R, Biswas B. A study on morbidity pattern of child labourers engaged in different occupations in a slum area of Calcutta. J Indian Med Assoc 2004;102:198-200, 226.
Bibi F, Tasawar Z, Ali Z. The prevalence of human pediculosis in Kot Addu district, Muzzaffargarh (Punjab). Pak J Anim Plant Sci 2011;21:364-7.
Ali N, Ramzan F. Head lice infestation in school children at Dera Isamail Khan. Pak J Zool 2004;36:273-80.
Motovali-Emami M, Aflatoonian MR, Fekri A, Yazdi M. Epidemiological aspects of pediculosis capitis and treatment evaluation in primary-school children in Iran. Pak J Biol Sci 2008;11:260-4.
Shayeghi M, Paksa A, Salim Abadi Y, Sanei Dehkoordi A, Ahmadi A, Eshaghi M, et al.
Epidemiology of head lice infestation in primary school pupils, in Khajeh city, East Azerbaijan province, Iran. Iran J Arthropod Borne Dis 2010;4:42-6.
Fan PC, Chung WC, Chen ER. Parasitic infections among the aborigines in Taiwan with special emphasis on Taeniasis asiatica
. Kaohsiung J Med Sci 2001;17:1-5.
Cazorla D, Ruiz A, Acosta M. Clinical and epidemiological study of pediculosis capitis in schoolchildren from Coro, Venezuela. Invest Clin 2007;48:445-57.
Al-Mohammed HI, Amin TT, Aboulmagd E, Hablus HR, Zaza BO. Prevalence of intestinal parasitic infections and its relationship with socio-demographics and hygienic habits among male primary schoolchildren in Al-Ahsa, Saudi Arabia. Asian Pac J Trop Med 2010;3:906-12.
Shetty G, Avabratha KS, Gonsalves S, Dany A, Rai BR. Thrombocytopenia in children with malaria – A study from coastal Karnataka, India. Asian Pac J Trop Dis 2012;2:107-9.
Soultana V, Euthumia P, Antonios M, Angeliki RS. Prevalence of pediculosis capitis among schoolchildren in Greece and risk factors: A questionnaire survey. Pediatr Dermatol 2009;26:701-5.
[Table 1], [Table 2], [Table 3], [Table 4]