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

Prevalence and associated factors of head lice infestation among primary school children in low- and middle-income countries: systematic review and meta-analysis

INTRODUCTION

Head lice infestation remains a persistent public health concern among primary school children in resource-limited settings, affecting their well-being and academic performance. Despite previous studies, there is no consistent evidence on the prevalence and factors associated with head lice infestation. This study aimed to determine the prevalence and factors related to head lice infestation among primary school children in low and middle-income countries.

METHODS

This review was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Relevant electronic databases, including PubMed, Cochrane Library, Web of Science, Science Direct, AJOL, and Google Scholar, were used to retrieve articles. The study included only published articles written in English languages between December 01, 2014 to January 31, 2024 for studies reporting the prevalence of head lice infestation or associated factors among primary school children in low- and middle-income countries. This review has been registered on PROSPERO with Prospero registration number CRD42024506959. The heterogeneity of the data was evaluated using the I2 statistic. A meta-analysis was conducted using STATA 17 software, with a 95% confidence interval. Publication bias was evaluated using funnel plots and statistical tests, such as Egger's and Beggs's tests, to identify publication biases in the included studies. Meta-regression was also carried out to assess the source of publication of publication bias.

RESULTS

The review included 39 studies involving 105,383 primary school children. The pooled prevalence of head lice infestation among primary school children in low- and middle-income countries was 19.96% (95% CI; 13.97, 25.95). This review also found out that being a girl was 3.71 times (AOR = 3.71; 95% CI: 1.22-11.26) more likely to have head lice infestation as compared to boys, while children with a previous history of infestation were 4.51 times (AOR = 4.51; 95% CI: 2.31-8.83) more likely to have head lice infestation as compared to their counterparts.

CONCLUSION

The overall prevalence of head lice infestation among primary school children in low- and middle-income countries was found to be high. Female gender, children who had a previous history of infestation, and family size were significant predictors of head lice infestation. As a result, policymakers and program administrators should focus on the identified determinants.

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.

Molecular Monitoring of Knockdown Resistance in Head Louse (Phthiraptera: Pediculidae) Populations in Iran

Knockdown resistance (kdr) is a common mechanism of insecticide resistance in head lice to the conventionally used pyrethroid pediculosis and can be the result of various amino acid substitutions within the voltage-sensitive sodium channel (VSSC). In this study, 54 sequences from varied specimens were investigated to monitor well-known resistance mutations and probable new mutations. The Pediculus humanus capitis de Geer specimens were collected from 13 provinces in Iran. The specimens were stored in 70% ethanol until DNA extraction and PCR amplification of ~900-bp fragment of VSSC. The sequences were analyzed using different bioinformatics software for the detection of well-known kdr substitutions and additional mutations potentially associated with kdr resistance in head lice. There were six new and an old (haplotype I) kdr haplotypes within the Iranian head louse population. K794E, F815I, and N818D amino acid substitutions were reported for the first time. The P813H mutation was the most prevalent amino acid substitution in eight provinces. Among 53 sequences, 26 (49%) were homozygous susceptible, and 27 (51%) were heterozygotes. Thus, 51% of the head lice collected in Iran harbored only the P813H allele. The exact test for the Hardy-Weinberg (H-W) equilibrium showed that genotype frequencies differed significantly from the expectation in East-Azerbaijan and Tehran provinces. Moreover, these populations had an inbreeding coefficient (Fis) <0, indicating the excess of heterozygotes. This observation suggests that the populations of head lice from Iran are currently under active selective pressure. For the rest of the populations, H-W equilibrium and the expectations were significantly in harmony. The results of the current study highlight molecular techniques in the accurate detection of resistance genotypes before their establishment within the head louse population. Accurate detection of resistant genotypes seems to be helpful in decision-making on lice control programs and resistance monitoring and management.

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.

Knowledge, Attitude, and Practice of Pediculus Capitis Prevention and Control and Their Predictors among Schoolchildren in Woreta Town, Northwest Ethiopia, 2018: A School-Based Cross-Sectional Study

Background

Pediculus capitis is a human head lice infestation, a major public health issue that is most prevalent in resource-limited countries globally. The current study aimed to assess the knowledge, attitude, and practice of pediculus capitis prevention and control and their predictors among schoolchildren in North West Ethiopia.

Methods

About 402 randomly selected schoolchildren from three schools in Woreta town participated in the study from April to June 2018. The outcomes of this study were knowledge, attitude, and self-reported practice of schoolchildren about pediculus capitis prevention and control. We used EPI Info 7.1 and SPSS 21 software for data entry and analysis, respectively. Binary logistic regression was employed to test the association of covariates with the outcome/response variables. Variables with a p value <0.2 during the bivariable binary logistic regression analysis were included in the multivariable binary logistic regression analysis. Variables with p value <0.05 were declared as significantly associated with outcomes.

Results

The mean age of the study participants was 10.19 (±1.62) years. About 58.8%, 45.8%, and 78.6% of the schoolchildren had better self-reported pediculus capitis prevention knowledge, attitude, and practice, respectively. Age of children [9 to 11 years (AOR = 2.24, 95% C.I (1.10, 4.55)) and>12 years (AOR = 3.84, 95% C.I (1.56, 9.46))], better practice (AOR = 2.93, 95% C.I (1.39, 6.18)), and those who were not infested (AOR = 2.25, 95% C.I (1.14, 4.44)) were predictors of knowledge regarding pediculus capitis prevention. Better practice (AOR = 4.33, 95% C.I (1.69, 11.09)) and absence of infestation (AOR = 2.97, 95% C.I (1.64, 5.36)) were predictors of attitude of schoolchildren about pediculus capitis prevention. Number of students in a class [51 to 56 students per classroom, AOR = 4.61, 95% C.I (1.83, 11.67); 57 to 58 students per classroom, AOR = 8.18, 95% C.I (2.73, 24.46)], less than five family size (AOR = 2.37, 95% C.I (1.24, 4.54)), better knowledge (AOR = 2.93, 95% C.I (1.32, 6.50)), desirable attitude (AOR = 4.24, 95% C.I (1.60, 11.23)), and absence of infestation (AOR = 3.52, 95% C.I (1.22, 10.15)) were predictors of self-reported pediculus capitis prevention practice.

Conclusion

The knowledge, attitude, and practice of schoolchildren regarding pediculus capitis prevention and control were not satisfactory. To bring change, intensive efforts on factors associated with the knowledge, attitude, and practice should be encouraged.

Risk Factors Associated with Head Lice Infestation in Rural Pediatric Patients

Introduction:

Head louse infestation is a common parasitic disease in pediatric age group. It is common in collective centers such as schools, garrisons, campuses and old age homes. It is worldwide in distribution with no strict limitation with respect to age, gender and race.

Aims:

Present study was conducted to investigate the socio-economic and lifestyle risk factors for head louse infestation in pediatric patients.

Materials and Methods:

An observational descriptive study at a tertiary care hospital in rural Uttar Pradesh over a period of 1 year wherein measurement of disease/risk factors associated with head louse infestation was performed. It was carried out in all children between 5 and 15 years of age using a pre-validated questionnaire. The method of convenience sampling was used and multiple logistic regression was run to account for potential confounding variables using SPSS software.

Results:

A total of 165 (71.1%) females and 67 (28.8%) males were infested. Most common age group affected was between 5 and 7 years where 97 (41.8%) children were infected. Ninety-five (40.9%) children were in fourth to seventh standards. Parents of 137 (59%) children were not formally educated. Eighty-one (34.9%) children had six members in the family while per capita income was between 5000 and 2500 in families of 139 (59.9%) children. Eighty-seven (37.5%) children had hair length up to shoulders. One twenty-eight (55.1%) children had no family member affected. Seventy-six (32.7%) children took bath twice a week only.

Conclusion:

Social and economic factors as well as lifestyle and education level of patients play a significant role in epidemiology of head lice.

Identification of Novel Voltage-Gated Sodium Channel Mutations in Human Head and Body Lice (Phthiraptera: Pediculidae)

In recent years, the increase of head louse infestation in Iran (7.4%) and especially in West-Azerbaijan Province (248%) has raised the hypothesis of insecticide resistance development. There are different mechanisms of resistance to various groups of insecticides, and knockdown resistance (kdr) is a prominent mechanism of resistance to pyrethroids, an insecticide group which is used conventionally for pediculosis control. For detection of kdr-type well-known amino acid substitutions (M815I-T917I-L920F) and additional sodium channel mutations potentially associated with kdr resistance in head and body lice, louse populations were collected from West-Azerbaijan and Zanjan Provinces of Iran. Six novel mutations were found to be located in the IIS1-2 extracellular loop (H813P) and IIS5 (I927F, L928A, R929V, L930M, and L932M) of the α-subunit. Genotyping results showed that all specimens (100%) have at least one of these or the well-known mutations. Therefore, the presence of kdr-related and novel mutations in the sodium channel is likely to be the reason for the frequent use of pyrethroid insecticides due to treatment failure against lice. Further studies are now required to evaluate the prevalence of the kdr-like mutant allele for monitoring of insecticide resistance and the management of head and body lice in other provinces of the country.

Socioeconomical Factors Associated With Pediculosis (Phthiraptera: Pediculidae) in Athens, Greece

Pediculosis in humans and especially in children is a very common dermatological disorder caused by the ectoparasite Pediculus humanus capitis De Geer. We investigated the socioeconomic factors affecting the prevalence of pediculosis in the Greek urban area of Athens during 2004-2006. The target population consisted of children from kindergartens. In total, 434 children from single- or two-parent families were investigated with respect to socioeconomic factors such as education, income and family composition, and the prevalence of pediculosis. The overall pediculosis rate was 5.30%. Head louse infestations were significantly higher in female children and in two-parent families. Lice infestations peaked in low- and medium-income families. Head louse infestation rates were influenced by income, parents' education, and nationality.

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.

Epidemiology of pediculosis capitis among schoolchildren in the eastern area of Bangkok, Thailand

OBJECTIVE

To determine the prevalence of infestation with head lice in primary schoolchildren in the eastern area of Bangkok, Thailand.

METHODS

The present study was to determine the head lice infestation (Pediculosis) levels in primary schoolchildren, during May, 2011 to July, 2011, A total of 3 747 schoolchildren aged 5-12 years old from 12 selected primary school of Ladkrabang district, the eastern area of Bangkok were examined for head lice. Pediculosis was defined as the presence of at least on living adult, nymph and viable egg.

RESULTS

The overall head lice infestation rate was 23.32% and infestation rate was higher in girls (47.12%) than in boys (0%). The infestation rate among schoolchildren varied from 12.62% to 29.76%. The infestation rate among girls varied from 26.07% (12 years old group) to 55.89% (8 years old group).

CONCLUSIONS

Pediculosis is a common public health problem affecting primary schoolchildren in eastern area of Bangkok and those levels are epidemic importance.

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.

Prevalence of Pediculus humanus capitis infestation among kindergarten children in Bahía Blanca city, Argentina

The human head louse, Pediculus humanus capitis De Geer (Anoplura: Pediculidae), is a worldwide public health concern. This human obligate ectoparasite usually infests school age children. The aim of this work was to investigate the prevalence of head lice in kindergarten children from Bahia Blanca. In addition, the influence of risk factors for pediculosis infestation, such as gender, hair characteristics, and socioeconomic class, was studied in relation to the prevalence of this ectoparasite. From a total of 220 pupils examined (125 girls and 95 boys), 94 showed pediculosis. The overall prevalence of head lice infestation was 42.7 %. Pediculosis was more frequent in girls (53.6 %) than in boys (28.4 %) and in medium, long, and very long hairs. No differences were found between socioeconomic classes. This indicated that head lice are relatively common in kindergarten children from Bahía Blanca.

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 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.

Risk factors associated with head louse infestation in Korea

Head louse infestation (HLI) is one of the most frequently occurring parasitic diseases in children. This study was conducted to investigate the socioeconomic and personal factors influencing HLI in the Republic of Korea. A total of 2,210 questionnaires about various factors related to HLI were obtained from children in 17 primary schools throughout the country. The rate of HLI was significantly lower in children who lived together with mother or in a family where both parents worked. In addition, HLI was lower in children whose fathers or mothers were public officers or teachers. However, HLI was higher in children who had small families and washed their hair less often. Education levels of parents and the number of children in family were not significant. Improvement of socioeconomic factors and personal hygiene will be helpful for reducing HLI.