ORIGINAL

Niger J Paed 2014; 41 (3):158 –162

Okoh BAN

Alikor EAD

Akani NA

Relationship between head lice

infestation and hair grooming

practices in primary school children

in Port Harcourt

DOI:http://dx.doi.org/10.4314/njp.v41i3,2

Accepted: 11th February 2014

Abstract Background: Hair

grooming practices and hair char-

acteristics are some of the host

related risk factors for head lice

infestation. Certain hair grooming

practices and characteristics have

been reported to affect head lice

infestation.

Objective: To determine the rela-

tionship between head lice infes-

tation and hair grooming practices

in Primary school children in Port

Harcourt.

Methods: A cross-sectional study

was conducted, using a stratified

multi-staged sampling technique.

A total of 1350 pupils from thir-

teen primary schools located in

three School Districts were re-

cruited. Data was collected using

a proforma completed by parents /

guardians. The heads of the pupils

were inspected for head lice and

nits with the aid of a battery oper-

ated Robi lice comb, magnifying

glass and a torch as light source.

Results: Ten (0.7%) of the 1350

pupils had head lice infestation,

all of whom were females. Seven

(2.5%) of the 276 pupils with long

hair (hair length greater than 5cm)

had a significantly higher preva-

lence of head lice infestation, com-

pared to 3 (0.3%) of the 1074 pu-

pils with short hair (p < 0.001).

Head lice infestation significantly

increased with a reducing fre-

quency of hair wash from 3 (0.3%)

in those that washed daily to 1

(1.5%) in those that washed

monthly (p = 0.034) but was not

significantly associated with the

use of chemicals to straighten hair.

Head lice infestation significantly

increased with reducing social

class from 0 (0%) in social class I

to 3 (9.1%) in social class V (p <

0.001).

(

)

Okoh BAN

Alikor EAD, Akani NA

Department of Paediatrics,

University of Port Harcourt Teaching

Hospital,

P.M.B. 6173, Port Harcourt,

Rivers State, Nigeria

Email: bomadatown@yahoo.com.

Conclusion: A higher prevalence

of head lice infestation is signifi-

cantly associated with longer hair

and reduced frequency of hair

wash.

Key words: Head lice, Hair

grooming, School children.

1

0

Introduction

socioeconomic backgrounds. An estimated 6 to 12

million head lice infestations occur each year in_,₁₁the

1

The head louse, Pediculus capitis is transmitted mainly

through p_,h₂ysical contact and affects mainly school-aged

United States among children 3 to 11 years of age. It

can affect people of₁ all ages but school – aged children

1

children. Besides race, age group, sex and socio-

are mostly affected.

economical conditions, hair characteristics (such as

length and textu_-r₅e) is a host related risk factor for head

Pruritus i₁s₂ the most common symptom of head lice in-

festation. Excoriations and secondary pyoderma may

follow trauma resulting from scratching of the scalp.

This occurs commonly in tropical en₁v₂ironments where

there is poor sanitation and hygiene. Since head lice

feed on human blood, chronic heavy infestation among

school children may lead to anemia, which is manifested

as fatigue, sleepiness in the classroom, and poor learning

performance and cognitive function. Infested children

may also experience disturbance of sleep at night due to

intense scratching since the head lice are most active at

3

lice infestation. Good hygienic practices like avoiding

sand on hair, social education; good grooming and hy-

giene have been re_,₇ported to significantly reduce the

6

prevalence of lice. Hair hygiene promotes growth of

hair, and prevents loss of hair, itching, infection, accu-

mulation of dirt,₈dandruff, oil, and tangles and helps to

destroy pediculi.

Pediculus humanus capitis, the causative organism of

head lice infestation, is distributed worldwide. World-

2

wide prevalence of Pediculosis capitis ranges from zero

night. Head lice infestation also causes₁₃stigmatization

9

–

59% in various regions. It is endemic both in develop-

and negatively affects school attendance.

ing and developed countries and affects persons of all

1

59

This study was conducted to examine the relationship

between head lice infestation in primary school children

and hair grooming practices including length of hair,

hair treatment with oils or straightening chemicals and

heat.

paper which was also inspected, using a magnifying

glass, for the presence of lice and nits. A total of four

lice combs were used. They were cleaned after use on

every child by removing the combing unit and cleaning

same with methylated spirit to help maintain asepsis. A

new comb was used whilst one was being cleaned up.

The lice comb was then re-assembled after the combing

unit had dried completely.

Methods

When nits were found on strands of child’s hair during

inspection, their distance from the scalp was measured

using the wooden ruler and classified as either less than

or equal to 0.6cm, or greater than 0.6cm from the scalp.

Each child’s hair was examined for a period of five min-

utes, timed with a stop-clock, by an assistant. Hair

length was measured with a 30cm wooden ruler using

the maximum stretch length, and classified as short (less

than or equal to 5cm) and long (greater than 5cm). Hair

type was classified as untreated or straightened with

chemicals / hot comb. In this study, a child was said to

have head lice infestation if there was visualization₄ of

The study was carried out in Port Harcourt city (PHC),

capital of Rivers State of Nigeria. Rivers State is located

in the South-South geo-political zone of Nigeria. Port

Harcourt is a cosmopolitan city with diverse Nigerian

ethnic groups and foreigners living in the city. Port Har-

court is the nerve centre of the oil industry. The urban

nature of the area and oil exploration and production

activities has caused a great influx of people from all

over Rivers State, neighbouring states and indeed, the

country.

1

The study was a cross-sectional population-based study

nits less than 0.6cm from the scalp on inspection or

st

carried out between 1 February and 31 May 2011. A

stratified multi-staged sampling technique was used to

recruit pupils between 6-12 years of age, from thirteen

primary schools located in the three school districts in

Port Harcourt. A minimum sample size of 1344 was

visualization of at least on₁₁e_,₁₅head louse on inspection

and/or following combing.

This is because a viable

nit, signifying a current infestation is more likely to be

1

4

found close to the scalp (less than 0.6 cm) on the hair.

Data was collated and analyzed using the Epi-info 3.5.1

statistical software. The association between presence of

pediculosis and hair length, (grouped into two discrete

variables of “long” and “short”) was determined using

2

calculated using the formula, n = z (pq) / e where: n =

minimum sample size, z = 2.243 (constant at a confi-

dence level of 97.5%), p= prevalence, q = 100 – p and e

2

=

sampling error of 2.5. Data was collected using a pre-

Chi Square (χ ); so also was the association between

tested questionnaire completed by parents / guardians

that had duly signed consent letters that were sent to

them via their children / wards. A total of 1350

questionnaires were retrieved.

presence of pediculosis and use of chemicals / social

status of parents. A p value of less than 0.05 was

regarded as significant.

Ethical Consideration

The schools were first stratified into three school dis-

tricts. They were also stratified according to school pro-

prietorship into private and public. The thirteen schools

were then selected by simple random method from the

three school districts according to the ratio of schools in

these districts. Six (three public and three private)

schools were selected from Diobu, five (three public and

two private) from Township and two (one public and

one private) from Trans-Amadi school districts. In

schools with more than one arm of a class, one arm was

selected randomly to represent the others, while in

schools with only one arm of a class, that arm was cho-

sen. Arms were selected from all six classes in all the

selected schools. In each selected school an average of

Ethical clearance was obtained from the Ethics Commit-

tee of the University of Port Harcourt Teaching Hospi-

tal. Permission was obtained from the Rivers State Min-

istry of Education, the Head teachers of the index

schools and the parents / guardians of the pupils. Parents

of children that were found to have head lice infestation

were invited to the respective schools where they were

counseled and given a prescription for a pediculicide

shampoo. Treated children had their hair re – inspected a

week after for head lice to ensure cure and confirm there

was no re – infestation.

1

05 pupils aged 6- 12 years were recruited. Fifteen to

twenty pupils were selected randomly from each class

using the class register.

Results

A total of 1350 pupils were examined. There were 743

(55.0%) females and 607 (45.0%) males, giving a fe-

male to male ratio of 1.2:1. The age of the pupils ranged

from 6 to 12 years with a mean age of 8.8 ± 1.9 years

and mode of 9 years. Seven hundred and forty four

(55.1%) of the respondents were from public schools

while 606 (44.9%) were from private schools. None of

the 1350 pupils examined had live lice, while 15 (1.1%)

had nits in their hair. Of the 15 pupils that had nits, 10

The children’s heads were inspected and hair thoroughly

combed from base to tip using a battery operated Robi

lice comb, model number ME 400-01, made in China.

The lice comb emits a light buzzing sound when

switched on and the buzzing stops once lice or nits are

detected. The comb effectively kills lice and destroys

nits. The comb was afterward, inspected for lice and nits

which were cleaned off the comb unto a white sheet of

1

60

(

0.7%) had nits found less than or equal to 0.6cm from

Table 2: Distribution of head lice infestation in relation

the scalp (signifying a current infestation). All of the

pupils that had evidence of head lice infestation were

females (10 out of 743) while none of the male pupils

to socioeconomic class

Head lice

infestation

No. (%)

No head lice

infestation

No. (%)

Socioeconomic

class

2

Total

were infested (χ = 8.23, df = 1, Fisher exact = 0.002).

Ten (1.3%) of the 744 pupils from public schools were

infested compared to none (0%) of the 606 pupils from

I

II

III

IV

V

0 (0.0)

1 (0.2)

5 (2.3)

3 (9.1)

10 (0.7)

208 (100.0)

468 (99.8)

424 (99.8)

210 (97.7)

30 (90.9)

208

469

425

215

33

2

private schools (χ = 8.21, df = 1, Fisher exact = 0.004).

Of the 1350 pupils in the study, 276 (20.4%) had long

hair (hair length greater than 5cm), while 1074 (79.6%)

had short hair (hair length less than or equal to 5cm). All

the pupils that had long hair were females. Seven (2.5%)

of the pupils that had long hair were infested with head

lice. In contrast, 3 (0.3%) of those that had short hair

were infested. This observed difference was statistically

Total

1340 (99.3)

1350

2

χ for trend = 20.67, df = 4, p < 0.001

2

significant (χ = 15.21, df = 1, Fisher exact < 0.001).

Discussion

2

,4,16-,20

the present study

One hundred and fifty one (11.2%) of the studied pupils

had their hair treated (straightened with chemicals or hot

combs), while 1199 (88.8%) had untreated hair. All the

pupils that had their hair treated were females. Ten

Similar to previous studies,

shows a higher prevalence of head lice infestation in

children with long (2.5%) than those with short (0.3%)

hair which was statistically significant. Melann et al

1

6

(

while none (0%) of the pupils with hair straightened by

chemicals or hot combs were infested. This observation,

however, was not statistically significant (χ = 1.27, df =

1

0.8%) of the pupils with untreated hair were infested,

found that children with long hair had a higher percent-

age of head lice infestation than their counterparts with

short hair in primary schools in Plateau S₂ta₀te, Nigeria.

2

4

Similarly, Chunge, Suleman and Fatima, Bachok et

2

19

, Fisher exact = 0.304).

al and Kamiabi and Nakhaei observed statistically

significant higher prevalence of infestation among chil-

dren with long than short hair in Kenya, Pakistan, Ma-

laysia and Iran respectively. This is probably due to the

fact that children with long hair wash their hair less fre-

quently, which is related to an increased prevalence of

head lice infestation. Also, head lice infestation can go

unnoticed for a longer period of time in longer hair,

compared to short hair that is combed and washed more

frequently.

Table 1 shows the distribution of head lice infestation in

relation to frequency of hair wash. A steady increase

(

with a reduced frequency of hair wash was observed,

except the peak of 2.6% observed in pupils that washed

their hair weekly. This observed trend was statistically

0.3% to 1.5%) in the prevalence of head lice infestation

2

significant (χ for trend = 4.48, df = 3, p = 0.034).

Table 1: Distribution of head lice infestation in relation

to frequency of hair wash

2

1

On the contrary, Salemi et al in South – Eastern Iran,

found that the difference in head lice infestation between

children with short, medium and long hair was not sta-

tistically significant. Unlike the other studies that

grouped subjects into those with short or₂₁long hair based

on a particular hair length, Salemi et al grouped chil-

dren into short, medium and long hair based on if the

hair did not touch the ears, touched the ears or shoulders

respectively. This method may not capture the actual

stretch-length of the child’s hair, especially in children

with curled and frizzy hair; hence the apparently near

similar prevalence rates in pupils with short, medium

and long hair.

Head lice

infestation

No. (%)

No head lice infesta-

tion

No. (%)

Frequency of

hair wash

Total

Daily

3 (0.3)

5 (2.6)

1 (1.0)

1 (1.5)

986 (99.7)

186 (97.4)

102 (99.0)

66 (98.5)

989

191

103

67

Weekly

Biweekly

Monthly

Total

10 (0.7)

1340 (99.3)

1350

2

χ for trend = 4.48, df = 3, p = 0.034

Table 2 shows the distribution of head lice infestation in

relation to socioeconomic class. The prevalence of head

lice infestation increased with reducing social class from

The finding in the present study of a higher prevalence

of head lice infestation in children with untreated hair,

than in those with₆hair straightened by chemicals is

0

(0%) in respondents from social class I to 3 (9.1%) in

1

respondents from social class V. This observed trend

similar to the study in primary school children in Pla-

2

was statistically significant. (χ for trend = 20.67, df = 4,

teau State, Nigeria. Chemicals used to straighten hair

may have pediculicidal properties, hence the finding of a

low prevalence of head lice infestation in children with

hair straightened by chemicals. The use of hair oils, hair

straightening chemicals and hot hair dryers have also

been shown to affect head lice infestation. The low inci-

dence of head lice infestation in the black children has

p < 0.001).

1

61

been attributed to the use of hair-oils to straighten hair,

In the present study, the prevalence of head lice signifi-

cantly increased fro₅m 0% to 9.1% with decreasing so-

2

which may coincidentally suffocate head lice. Hair

grooming that includes oiling the hair might also₃ help to

2

cioeconomic class from class I to V. This finding is

2

2,19,26-28

26

Olaitan

prevent nits from being stuck to the hair shafts. Litera-

supported by some previous studies.

ture suggest that women who relax their hair with caus-

found the prevalence of head lice in school children in

Ibadan to be higher in children of non-working m₂₈others

than those of working mothers. In a similar study in Ile

-Ife, children of artisans had a higher prevalence of head

lice infestation than children of professionals. Just like

the present study, the findings in both studies were sta-

tistically s₉ignificant. On the foreign sc₂₇ene, Kamiabi and

tic creams have an advantage as₃this might help to kill

2

the lice and control infestations. When a woman goes

under the hot air blast of the hair dryer for 30 minutes or

more, any louse or egg on the hair may be

destroyed. One₃promoted treatment for head louse is

2

actually hot air. The LouseBuster™ head lice treat-

1

ment is a revolutionary new way to kill head lice and

their eggs that use small blasts of hot air directed at the

hair especially near the scalp. The marketers explain

that “The LouseBuster™ device is highly effective be-

cause the small size and shape of head lice and their

eggs make it difficult for them to conserve water. As

such, when they are exposed to the right amount of

heated air at the right temperature and for the right

length of time, they dry out and die.” The device was

developed and tested at the University of Utah and has

been approved by the Food and Drug Administration of

the United States of

Nakhaei, and Nazari and Saidijam in two separate

studies in Iran found the prevalence of head lice in chil-

dren to significantly increase with decreasing level of

mother’s education and father’s job, and decreasing

level of both parent’s education respectively. Similarly,

2

Bachok et al found a significant increase in infestation

with decrease in father’s income in school children in

Malaysia. This is expected because a low education and

income will provide poor housing with possible over-

crowding and increased physical contact, which will

promote spread of head lice and therefore, an increased

prevalence of infestation.

America.

This study has shown that head lice infestation is signifi-

cantly higher in pupils with long hair, those that washed

their hair less frequently and those from a lower social

class. Head lice infestation is also less prevalent in pu-

pils that have their hair treated with straightening chemi-

cals or hot combs. It is therefore recommended that pri-

mary school pupils wear their hair short, to allow for

better hair care (such as daily wash) and prevention of

head lice infestation. Hair that must be worn long should

be treated at regular intervals with hair-straightening

chemicals or hot combs. Screening for head lice infesta-

tion should remain a part of the School Health Pro-

gramme at pre-school entrance and periodic medical

examination for children, in order to detect and appro-

priately treat those infested before it spreads to close

contacts in school and at home.

The statistically significant decreasing prevalence of

head lice infestation with increasing frequency of hair-

wash noted in the present study is in keeping with trends

2

observed by Bac₄hok et al in Malaysia. Similarly, in a

2

study in Lagos, the absence of head lice infestation

noted in LASU staff school pupils compared to pupils in

other schools, was attributed to better general sanitation

and hygienic conditions reported by students of LASU

staff school as opposed to other schools surveyed. Stu-

dents at LASU regularly washed their hair with medi-

cated soap hence improving their personal hygiene stan-

dards unlike in the other schools. Social amenities in-

cluding properly treated water supply, well spaced sit-

ting conditions was better in LASU as compared to the

other schools. The hygienic conditions of the other

schools visited were low compared to LASU Staff

School. All particles, including head lice and nits (if

present) are usually removed by frequent hair washing

and this will therefore, help in prevention and a reduc-

tion in prevalence of head lice infestation.

Conflict of Interest : None

Funding : None

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