Tropical Biomedicine 29(2): 207–211 (2012)
Prevalence and risk factors of Pediculus (humanus)
capitis (Anoplura: Pediculidae), in primary schools in
Sanandaj City, Kurdistan Province, Iran
Vahabi, A.1, Shemshad, K.2, Sayyadi, M.3, Biglarian, A.4, Vahabi, B.5, Sayyad, S.6, Shemshad, M.7 and
1Environmental Health Research Centre and Department of Public Health, School of Health,
Kurdistan University of Medical Sciences, Sanandaj, Iran
1Department of Nursing and Midwifery, Islamic Azad University, Sanandaj Branch, Sanandaj, Iran
2Department of Entomology, Science and Research Branch, Islamic Azad University, Tehran, Iran
3Kermanshah University of Medical Sciences, Ghods Hospital, Paveh, Iran
4Department of Biostatistics, University of Social Welfare and Rehabilitation (USWR), Tehran, Iran
5Islamic Azad University, Sanandaj Branch, Sanandaj, Iran
6Kermanshah University of Medical Sciences, School of Medicine, Kermanshah, Iran
7Department of Agricultural Extension and Education, Science and Research Branch, Islamic Azad University,
8*Evaluation Management and Development Center, Deputy of Research Ministry of Health and Medical
Education, Tehran, Iran
8*Department of Medical Entomology, School of Public Health, Tehran University of Medical Sciences,
*Correspondence author email: firstname.lastname@example.org
Received 21 November 2011; received in revised form 10 January 2012; accepted 14 January 2012
Abstract. Human head lice, Pediculus (humanus) capitis, infest people worldwide and are
most prevalent in children. The aim of this study was to determine the prevalence of head
lice, in relation to socioeconomic status of the family and hygienic practices in the home. The
prevalence rate was determined in 27 primary schools that had 810 students in Sanandaj city
who were selected by multistage, systematic random sampling. A total of 38 students from all
grades were infested with different rates of infestations. In addition, standard questionnaire
recorded information about demographic features of each student were fulfilled. Children
aged 10-11 years were the most frequently affected, there was a significant relationship
between head louse infestation, family income and parents education level (α=5%). Pediculosis
is a public health problem in many parts of the world. Pediculosis was found to be more
prevalent among children of fathers with lower level of education and socioeconomic status,
it is necessary to give health education to families in order to prevent pediculosis in this area.
The human head louse, Pediculus humanus
var. capitis De Geer, 1778, are wingless,
obligate ectoparasites of humans, which
affect millions of children worldwide,
especially teenagers in both developed and
developing countries generally, rates are
heavier among girls (Burgess, 2004).
Although head lice are not known to be
vectors of human disease, pediculosis causes
scalp pruritis which occurs due to
sensitization to both louse saliva and fecal
antigens and may be so intense that lead to
excoriations, secondary bacterial infection
(Malcolm & Bergman, 2007), sleep loss,
disturbances and scratching (Suleman &
Jabeen, 1989; Downs et al., 1999; Burgess,
2004). Acute glomerulonephritis caused by
nephritogenic strains of streptococci is a
famous complication, especially in the
tropical countries (Svartman et al., 1973).
Severely affected patients may even develop
anaemia (Linardi, 2002). Pediculosis may
detrimentally influence schoolchildren’s
learning performance by negatively affecting
concentration, or through stigmatization by
peers following detection. Pediculosis is
contagious and transmission occurs mainly
by head to head contact. It affects
schoolchildren of all socio-economic status
and not just the poor, uneducated or those
living in unhygienic conditions (Speare &
Buettner, 1999). The role of head lice in
transmitting human disease is not well
understood but it has received increased
concern due to bioterrorism threats
(Robinson et al., 2003). There are many
factors related to the host that can be
associated to head lice prevalence: race, age
group, sex, social-economical conditions and
hair characteristics (Sinniah et al., 1981;
Arene & Ukaulor, 1985; Chunge, 1986).
Overcrowded living conditions and
development of resistance to insecticides
have contributed to the increase of head lice
in the last few years (Linardi et al., 1988;
Pollack et al., 1999; Lee et al., 2000). Head
louse infestations are common in different
parts of Iran but its epidemiology in Sanandaj
is unknown. The main objective of this study
was to determine whether factors such as age
group, socioeconomic condition, hair
characteristics as well as children’s health
facility including using private comb and
frequency of hair washing in a week influence
the distribution of head lice in the children.
MATERIALS AND METHODS
The survey was conducted in Sanandaj
City, Kurdistan province, Iran. The study
was carried out in 27 schools with 810
primary girls students. In each school 2
classes with the sample size of 15 students
were investigated for head lice using cluster
random selection. For the diagnosis of head
lice, the entire head was examined carefully
after parting the hair; special attention was
paid to the nape of the neck and behind the
ears. A child was considered infested if living
lice, eggs either live or dead or nits were
detected. After carefully examining, these
lice were collected by hand and if necessary,
with a small hair brush dipped in 70% alcohol.
A questionnaire was given that included
questions relating to the following: school
grade, socio-economic status, age, parent’s
job, level of parents’ education and family
income. Public health questionnaire focusing
on demographic information and head lice
manifestation were completed during the
interview. Data were analyzed by computer
using Statistical Package for Social Science
During this study, a total of 810 students were
examined and 38 (4.7%) were found to be
infested with a single species of louse (Tables
1-3). In the study, the social status and living
standard of human being significantly (α=5%)
affected the prevalence of pediculosis.
Analysis of social-economical profile
indicated that children with lower
socioeconomic status had the most
infestation rate (89.4%). Parents’ professions
of the students were diverse including
working for government, small business
owners and hard labour workers (Table 2).
Age of the individuals had an effect on the
prevalence of pediculosis. The prevalence
of pediculosis was significantly (p<0.01)
higher in population of 10-11 years old (50%)
group. Age had a significant effect on the
incidence of infestation, students above the
age of 12 years had the least (5.4%) chance
of being infested compared to younger ones.
Special factors such as sharing of bed and
combs (α=5%) and taking bath in a common
place, helps in the dissemination of lice
infestation. There was a negative correlation
between the frequency of hair washing and
head lice infestation, pupils who wash their
hair once or twice a week had more chances
of infestation and risks of infestation when
compared to those who wash their hair three
times weekly (α=5%) (Table 3).
The prevalence of head lice in children found
in this study was 4.7%. Children aged 10-11
years were most frequently infested with head
lice, which could be explained because of
their age and their head to head contact
(Downs et al., 1999; AL-Shawa, 2008). The
total prevalence of head pediculosis among
primary school children in Fars Province,
southern Iran was 0.49%, 0.37% and 0.20%
in autumn, winter and spring, respectively.
The above-mentioned figures are lower than
in Hamadan, western Iran, where 847
schoolchildren aged 6-12 yr showed a
prevalence of 6.85%. In a study in Kerman,
central Iran, 3.8% of 1200 primary school
students were infected with P. capitis
(Kamiabi & Nakhaei, 2005; Nazari et al., 2006;
Moradi et al., 2009). Demographical results
showed that there was a significant decrease
in children’s infestation with increasing
father’s education. As regards mother’s
education, significant difference was found
in prevalence and mother’s education. This
is because educated mothers have more
information about head lice due to their social
communication (Toloza et al., 2009; Moradi
et al., 2009; Bibi et al., 2011). The impact of
socioeconomic status upon the infestation
rate detected in our study agreed with other
Table 2. Prevalence of head lice infestation in relation
to sociodemographic status of parents and age of
Children’s grade school
Table 3. Prevalence of head lice infestations in
relation to personal hygiene
Variables Number of
Number of hair washing
Once a week
Twice a week
Three times a week or more
Length of hair
Having hygiene teacher
Sharing common comb
* The length of the hair
Table 1. Correlation between head lice infestation
with different variables
Level of education
Frequency of hair washing
Length of hair
Having hygiene teacher
Using common comb
studies, and low socioeconomic status
significantly increased the rate of infestation
(Kamiabi & Nakhaei, 2005; Nazari et al.,
2006; AL-Shawa, 2008; Toloza et al., 2009;
Bibi et al., 2011). In spite of this, frequent
shampooing, brushing of the hair and
examination the hair for lice were found to
be important factors in the prevention of lice
infestation. A strong correlation was found
between infested children and shampooing
the hair besides using louse comb in
examination the hair (α=5%). The head lice
infestation rate was more prevalent in
children sharing common comb because
head lice infestation may be transmitted by
sharing infested instruments including hats,
scarves, sweaters, sharing common pillows,
etc. Such results have been reported by other
researchers (Toloza et al., 2009; Bibi et al.,
2011). A lower prevalence were seen by
increasing awareness of hygienic, health
promotion, early detection and effective
management strategies by medical and
health center staffs (Heukelbach et al., 2005).
Physical contacts, especially head-to-head
contact are the most important factors in
transmission of head lice infestation (Toloza
et al., 2009). Head lice infestations are
more prevalent in poor socioeconomic
status, and length of hair, family size, age,
level of education and personal hygiene are
important factors affecting its epidemiology
(Sinniah et al., 1981; Suleman & Jabeen,
1989; Muhammad Zayyid et al., 2010;
Kamiabi & Nakhaei, 2005; Nazari et al.,
2006; AL-Shawa, 2008). Results show that
screening and treatment for head lice among
children need to be done continuously in order
to decrease the infestation rates (Muhammad
Zayyid et al., 2010).
Acknowledgments. This study was
financially supported by Kurdistan University
of Medical Sciences. We thank the students,
teachers, health center staffs, who so
willingly agreed to participate in this survey.
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