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

Abstract

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

Prevalence of pediculosis capitis in children from a rural school in Yucatan, Mexico

“…Dollars) per month was associated with PC (OR 9.943, 95% CI 2.15-45.79, p = 0.003) even though head lice was present among all socioeconomic groups. Poverty is known to play a role in the transmission dynamics of head lice 17 and the burden of epidermal parasitic skin diseases (including PC) at intolerably high levels has been suggested as an indicator of this inequality 7 . Our findings suggest that Mexican families with a low income may have limited access to health services or may not be able to afford treatment for their children (a regular pediculicide costs 70 Mexican pesos, approximately 5.5 U.S Dollars).…”

“…These figures, in conjunction with our findings, emphasize the need for health-care stakeholders and political decisionmakers in Latin America to incorporate the prevention of PC in current health promotion programs in primary schools. Such health promotion programs have to take an intersectoral approach as merely treating children infested with head lice does not lead to a sustained control of the infection 17 . Control programs should join together with community nurses, physicians, public health doctors, and teachers to promote selfdiagnosis and treatment in children and their families.…”

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

“…In resource-poor settings, head lice infestations, one of the major parasitic skin diseases, are of considerable public health importance and have been described to be associated with poverty [2,3]. Head lice infestations are common in several regions of sub-Saharan Africa [4][5][6][7], but knowledge, attitudes and practices (KAP) of affected populations in this region have never been studied systematically.…”

Ivermectin: panacea for resource-poor communities?

“…iii. The drug of choice to treat difficult-to-treat Pediculosis capitis (head lice infestation), the most common parasitic condition among children worldwide [37].…”