Self-diagnosis of active head lice infestation by individuals from an impoverished community: high sensitivity and specificity

Introduction: Head lice infestations are common in sub-Saharan Africa, but knowledge, attitudes and practices have never been studied in this region.Methodology: This population-based study was conducted in a small rural community (population = 590) in Kwara State, Central Nigeria. Inhabitants of the community were interviewed regarding head lice infestations, using a pre-tested structured questionnaire, and examined regarding the presence of active pediculosis. Results: Of the 496 participants included, 367 (74.0%) had experienced head lice infestations, but only 26 (11.1%) of the individuals older than 15 years knew the correct mode of transmission. Of 142 individuals with active pediculosis, only 1 (0.7%) felt ashamed. Treatment was most commonly done by grooming (46.3%), followed by combing (27.2%). Only 4.6% used pediculicides, and 21.8% did not apply any treatment. Opinions about difficulties in controlling head lice were asked in three groups: biological, technical and social. In the first group, the most common difficulty noted was detecting head lice (52.1%), followed by possible resistance that would lengthen the time of infestation (38.9%). Technical constraints included concerns on the safety and effectiveness of products (48.7%) and difficulties in obtaining treatment (46.2%). Social contraints included difficulty in treating children (24.4%), lack of knowledge (23.5%), and the social behavior of children (22.2%). Conclusions: Head lice were not perceived as an important disease in a rural Nigerian community, and feelings about the infestation were mostly indifferent. Despite its common occurrence, knowledge on head lice was limited.

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“…Figures from resource-poor communities in Brazil, where head lice are highly endemic, were similar [21,22].…”

Section: Discussionmentioning

confidence: 88%

Knowledge, attitudes and practices regarding head lice infestations in rural Nigeria

Heukelbach

Ugbomoiko

2011

J Infect Dev Ctries

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“…A positive head lice examination was defined as one in which at least one viable head louse or nymph was detected by diagnostic wet combing -the most sensitive method for diagnosing head lice infestation. 11,12 We performed additional analyses on individual characteristics (sex, length and type of hair) and household characteristics (poverty level, crowding) to look for their potential association with the length of the infestation-free period.…”

Section: Discussionmentioning

confidence: 99%

“…The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11-45), as compared to 14 days (IQR: [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005).…”

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confidence: 99%

Household-wide ivermectin treatment for head lice in an impoverished community: randomized observer–blinded controlled trial

Pilger¹,

Heukelbach²,

Khakban³

et al. 2010

Bull World Health Org

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Objective To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis (head lice) in resource-poor communities. Methods We studied 132 children without head lice who lived in a slum in north-eastern Brazil. We randomized the households of the study participants into an intervention and a control group and prospectively calculated the incidence of infestation with head lice among the children in each group. In the intervention group, all of the children's family members who lived in the household were treated with ivermectin; in the control group, no family member was treated. We used the c² test with continuity correction or Fisher's exact test to compare proportions. We performed survival analysis using Kaplan-Meier estimates with log rank testing and the Mann-Whitney U test to analyse the length of lice-free periods among sentinel children, and we used Cox regression to analyse survival data on a multivariate level. We also carried out a subgroup analysis based on gender. Findings Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group. The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11-45), as compared to 14 days (IQR: 11-25) in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005). After treatment with ivermectin, the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys. Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period. Conclusion In an impoverished community, girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation. To decrease the number of head lice episodes per unit of time, control measures should include the treatment of all household contacts. Mass treatment with ivermectin may reduce the incidence of head lice infestation and associated morbidity in resource-poor communities.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

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“…Previous data from Brazil have shown that people in urban endemic communities diagnosed their head lice infestations with high positive predictive values (PPV) of 89% and 98%, respectively [5,6]. However, in Australia, a developed market economy, sensitivity of parental diagnosis of head lice in children was very low (16%), with a PPV of 67% [7].…”

Section: Introductionmentioning

confidence: 99%

“…In the Brazilian study, the authors concluded that treatment of head lice infestations could be based on selfdiagnosis, and that there is no need for resource-intensive and unnecessary diagnosis by clinical inspection [5,6]. On the contrary, in Australia the conclusion was that parental reporting was not a reliable indicator of pediculosis [7].…”

Section: Introductionmentioning

confidence: 99%

Self-Diagnosis of Head Lice Infestation in Rural Nigeria as a Reliable Rapid Assessment Tool for Pediculosis

Ugbomoiko¹,

Speare²,

Heukelbach³

2008

TODJ

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Pediculosis capitis is a common disease in industrialized countries, but there are also areas in sub-Saharan Africa where head lice infestations are highly endemic. However, there are no data available from the African continent on the accuracy of head lice diagnosis made by affected individuals.We performed a door-to-door survey in Skanko village (Kwara State, Central Nigeria). Individuals were asked to answer a question regarding their head lice status, and then wet combing with conditioner was performed to diagnose an active infestation.Active head lice infestation was observed in 144 (29.0%) of the 496 participants. Less than 1% of those without pediculosis stated being infested; and more than 90% of individuals with heavy infections did so. In contrast, only 47% of individuals with 5 lice were aware of their infestation. Overall sensitivity (73.6%), specificity (99.1%), positive predictive value (97.2%) and negative predictive value (90.2%) of self-diagnosis, as compared to wet combing were high.Our data show that interviewing individuals about their infestation status can be used as a simple rapid assessment method for diagnosing head lice in a typical rural setting in Nigeria.

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Self-diagnosis of active head lice infestation by individuals from an impoverished community: high sensitivity and specificity

Cited by 15 publications

References 7 publications

Knowledge, attitudes and practices regarding head lice infestations in rural Nigeria

Knowledge, attitudes and practices regarding head lice infestations in rural Nigeria

Household-wide ivermectin treatment for head lice in an impoverished community: randomized observer–blinded controlled trial

Self-Diagnosis of Head Lice Infestation in Rural Nigeria as a Reliable Rapid Assessment Tool for Pediculosis

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