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Year : 2018  |  Volume : 19  |  Issue : 4  |  Page : 331-334

Epidemiology of pediculosis capitis among schoolchildren in Damascus, Syria

Department of Microbiology and Biochemistry, Faculty of Pharmacy, Arab International University, Ghabaghib, Daraa Governorate, Syria

Date of Web Publication28-Sep-2018

Correspondence Address:
Prof. Mohammad Taher Ismail
Department of Microbiology and Biochemistry, Faculty of Pharmacy, Arab International University, Ghabaghib, Daraa Governorate
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpd.IJPD_123_17

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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 2021 Jun 24];19:331-4. Available from: https://www.ijpd.in/text.asp?2018/19/4/331/242410

  Introduction Top

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.[1],[2] They are connected to human hosts during all life stages, do not have wings, and cannot jump.[3],[4] 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.[3],[4] 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.[3],[5] Head lice are a common infection in school-age children worldwide, varied from 1.6% to 87%.[6],[7],[8] 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.[9],[10]

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 Top

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.[11] 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 Top

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].
Table 1: Prevalence of pediculosis capitis among primary schoolchildren

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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].
Table 3: Prevalence of pediculosis capitis by age and sex

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Our results also showed that the infestation rate among schools varied from 1.4% to 60.7% as shown in [Table 4].
Table 4: Prevalence of pediculosis capitis by school

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  Discussion Top

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.[10]

Lice infestation has also been reported as a global problem in many countries of the world.[8] 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%.[12],[13]

A similar rate was published in other countries such as Pakistan with infestation rate of 87%,[14] Nepal 59%,[15] Iraq 48.9%,[16] Malaysia 35%,[17] and Argentina 29.7%.[11] In contrast, lower infestation rates were reported in Korea 4.1%,[5] Poland 1.6%,[18] France 3.3%,[19] and the USA 1.6%.[20]

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.[14]

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,[21] in Turkey by Gulgun et al., 2013, and Karakuş et al.,[22],[23] in Thailand,[24] in Iran,[25] and in Jordan.[26]

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.[14] 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.[27],[28] 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.[14],[29]

This tendency has also been reported by many researchers in different countries such as India,[30] Pakistan,[31],[32] Malaysia,[17] Iran,[33],[34] Taiwan,[35] Venezuela,[36] Brazil,[37] Egypt,[27] Turkey,[38] Thailand,[12] and Greece.[39] 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 Top

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  [Table 1], [Table 2], [Table 3], [Table 4]

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