Journal of Clinical Medicine
Katarzyna Bartosik, Marzena Janczaruk, Zbigniew Zając, Aleksandra Sędzikowska, Joanna Kulisz, Aneta Woźniak, Anita Jasztal-Kniażuk, Ewa Kulbaka, Andrzej Tytuła
Why are head lice so common in Polish schools, and who's in the dark about it?
Head Lice Infestation in Schoolchildren, in Poland — Is There a Chance for Change? Open original study
Abstract
Pediculosis capitis, a global health concern, remains neglected due to the absence of screening programs, leading to delayed treatment. This study focuses on the prevalence of pediculosis capitis in Polish primary schools and identifies contributing factors. Data collection involved questionnaires for school children and managers. Students provided insights into the epidemiology of head lice and expressed opinions on hygiene among infested individuals. Meanwhile, school directors reported on head lice occurrences, preventive measures, and institutional support. The study spanned from 2014 to 2018 and revealed that 87.5% of schools reported cases of pediculosis capitis. The highest incidence occurred among 6-9 year-olds (68%). Surprisingly, 16.7% of 4,970 children surveyed had no knowledge of head lice, but 57.1% expressed a desire to increase their awareness of the issue. Lice awareness campaigns were mostly initiated in response to outbreaks, and institutional support was lacking for most schools. The findings underscore the importance of implementing screening programs and educational campaigns to control pediculosis capitis in Poland.
Methodology
The data for this study were collected through a survey conducted in eight regions in Poland: Podlaskie, Lubelskie, Podkarpackie, Świętokrzyskie, Łódzkie, Małopolskie, Mazowieckie, and Dolnośląskie Provinces, spanning the years 2014 to 2018. Two questionnaires were utilized: one aimed at primary school children, and the other was completed by school managers. Basic demographic information about the children, such as age and gender, was gathered. No sensitive data regarding the health status of the respondents or their family members was collected. The primary focus of the analysis was on children's awareness of pediculosis capitis and their willingness to expand their knowledge. Children were asked various questions about the sources and routes of head lice infection, as well as their opinions on the hygiene of infested individuals. They were also asked if they would inform anyone about their head lice infestation. The survey administered to school managers aimed to gather information on the prevalence of head lice in schools, preventive measures in place, and the responsible parties for addressing the issue. Additionally, the survey inquired about sources of support available to school staff for preventive actions and measures to reduce infestations among students. Participation in the study was voluntary, and anonymity was guaranteed to all respondents.
Confidence
To ensure the validity of the results, various statistical tests were employed. Pearson's chi-square test of independence was used to examine relationships between categorical variables. When expected values were insufficient, Yates's correction for chi-square tests was applied for 2 × 2 contingency tables, and the ML (maximum likelihood) chi-square test was used for larger contingency tables. Pearson's chi-square test was also used to assess the cardinality of responses. The significance of differences between structure indices was evaluated for multiple-response questions in two or more groups, using the Fp test when dealing with at least three groups. Non-parametric tests were used due to the non-normal distribution of data, including the Mann–Whitney U test to compare two groups and the Kruskal–Wallis test to compare at least three groups. The Kruskal–Wallis multiple comparison test was employed to identify significantly different pairs of groups. To assess the significance of differences between structure indices in two age groups, a test was used. A significance level of p < 0.05 was considered statistically significant for all analyses. The statistical calculations were performed using the STATISTICA 10 PL statistical package.
Results
The survey encompassed 168 schools in Poland, with varying rural, suburban, and urban distributions. Urban schools had more students on average, and schools affected by head lice had larger student populations. Head lice cases were reported in 87.5% of schools from 2014 to 2018, with urban and suburban schools having the highest incidence. The average number of children with head lice per school was 10.2, with the highest infestation rate among 6-9-year-olds, predominantly girls. Transmission among siblings was common in 69.4% of schools, and most parents consented to head inspections. Approximately 40% of schools found head lice elimination difficult, and educational campaigns were more prevalent in these schools. Most school directors recognized the need to monitor head lice. About 55.9% of schools received support, primarily from the Sanitary-Epidemiological Station. The survey included 4,970 children, with a majority of girls aged 6-12. Most children were aware of head lice, knew about transmission, but had misconceptions about transmission by domestic animals. Approximately 57% of students expressed a willingness to learn more about head lice, with differences related to gender and age.
Implications
Human lice, specifically Pediculus and Pthirus genera, have been persistent ectoparasites of Homo sapiens for a long time. Despite medical advancements and civilization progress, pediculosis capitis remains a significant global health concern, with varying prevalence rates. Certain conditions like orphanages, adult day care centers, military facilities, and prisons contribute to the persistence of this parasitosis. In many countries, including Poland, the frequency of P. humanus capitis infestation is underestimated, and there are no monitoring tools. Mandatory reporting of cases was discontinued in 2008, hindering the assessment of the situation. Only a few research articles on head lice in schoolchildren have been published in Poland since then. Our study revealed a high occurrence of pediculosis capitis in surveyed schools (87.5%). Girls tended to have a higher prevalence, and the early-school aged children (6–9 years) were most affected. Transmission between siblings was recorded in 68.5% of schools. Larger schools, regardless of location (rural, suburban, urban), had a higher frequency of infestation. Despite easier access to information, a significant number of children had limited knowledge of head lice (16.7%). Additionally, 5.8–43.3% provided incorrect information about head lice transmission. While most schools organized educational activities (95.2%), these were often reactive rather than preventive. To educate schoolchildren effectively, various forms of knowledge transfer may be necessary. Traditional educational campaigns can still be vital, particularly in regions with limited access to digital media. Parents and teachers play a crucial role in addressing pediculosis. Many parents lack basic epidemiological knowledge about head lice, and their awareness of prevention and treatment needs improvement. Adults often rely on unreliable sources of information, emphasizing the importance of campaigns based on credible sources. Parental education can lead to better compliance with hygiene standards and medical interventions when needed. Overall, there's a need for systemic changes, including legal regulations, to shift public perception of pediculosis capitis from a hygiene problem to a health issue. This includes regular education, screening programs, and timely interventions in schools to effectively reduce the prevalence of P. humanus capitis.