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  
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  
Objective: To determine the rela-  
tionship between head lice infes-  
tation and hair grooming practices  
in Primary school children in Port  
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 <  
Okoh BAN  
Alikor EAD, Akani NA  
Department of Paediatrics,  
University of Port Harcourt Teaching  
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  
Key words: Head lice, Hair  
grooming, School children.  
socioeconomic backgrounds. An estimated 6 to 12  
million head lice infestations occur each year in,11the  
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  
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  
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  
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-  
wide prevalence of Pediculosis capitis ranges from zero  
night. Head lice infestation also causes13stigmatization  
59% in various regions. It is endemic both in develop-  
and negatively affects school attendance.  
ing and developed countries and affects persons of all  
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  
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.  
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  
The study was a cross-sectional population-based study  
nits less than 0.6cm from the scalp on inspection or  
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  
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  
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  
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.  
05 pupils aged 6- 12 years were recruited. Fifteen to  
twenty pupils were selected randomly from each class  
using the class register.  
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  
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  
No. (%)  
No head lice  
No. (%)  
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  
0 (0.0)  
1 (0.2)  
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)  
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  
1340 (99.3)  
χ for trend = 20.67, df = 4, p < 0.001  
significant (χ = 15.21, df = 1, Fisher exact < 0.001).  
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  
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 =  
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.  
Similarly, Chunge, Suleman and Fatima, Bachok et  
, 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  
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  
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  
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  
No. (%)  
No head lice infesta-  
No. (%)  
Frequency of  
hair wash  
3 (0.3)  
5 (2.6)  
1 (1.0)  
1 (1.5)  
986 (99.7)  
186 (97.4)  
102 (99.0)  
66 (98.5)  
10 (0.7)  
1340 (99.3)  
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 with 6hair straightened by chemicals is  
(0%) in respondents from social class I to 3 (9.1%) in  
respondents from social class V. This observed trend  
similar to the study in primary school children in Pla-  
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).  
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-  
which may coincidentally suffocate head lice. Hair  
grooming that includes oiling the hair might also3 help to  
cioeconomic class from class I to V. This finding is  
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  
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. One 3promoted treatment for head louse is  
actually hot air. The LouseBuster™ head lice treat-  
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,  
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.  
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  
observed by Bac4hok et al in Malaysia. Similarly, in a  
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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