The sex distribution of the infectious skin diseases among the studied schoolchildren demonstrated that impetigo, warts, tinea capitis, and scabies were more common among boys than among girls, with a significant difference (P <0.05), whereas pediculosis capitis, chicken pox, herpes simplex, and molluscum contagiosum were more common among girls than among boys, with a significant difference (P<0.05; Table 3).
Skin disorders are among the most frequently diagnosed conditions in schoolchildren in both developing and industrialized countries 4. Studies from different countries have shown cross-sectional prevalence rates ranging from 22.8 to 96.8% 5–9. Skin diseases are considered to be the second most common cause of medical consultation for children in rural communities.
The school environment makes children vulnerable to cross-transmission of communicable skin diseases, which can be transmitted to family members 10. Therefore, it is of vital importance from the point of view of community health to not only assess the prevalence of skin disease but also identify possible associated socioeconomic factors.
Results of the present study revealed that the prevalence rate of skin infections was ∼29.6% among the total studied Egyptian schoolchildren in urban (Cairo governorate) and rural areas (Gharbia governorate). The prevalence rate of skin infections was found to be 35.7% in urban areas and 24.6% in rural areas.
Bacterial skin diseases are observed in 10% of the total number of infected pupils in urban areas and 0.7% of the total number in rural areas. Impetigo contagiosum represented the majority of cases in urban areas (8%) and 0.7% in rural areas. This is in accordance with the results obtained by Ali et al. 11, who reported that bacterial skin infections were found among 10.3% of schoolchildren in Cairo governorate. The current results pointed out that the prevalence of impetigo in rural areas was lower than that reported by Baraka et al.12, who found that the prevalence of impetigo reached 1.5% among Qalyobia schoolchildren, and by Abdel Rahman et al.13, who found the prevalence among schoolchildren of Dakahlia governorate to be 3.4%.
Parasitic skin infestations were the second common prevalent skin infection (9.7%) among the total studied pupils in urban areas. Pediculosis capitis (7.7%) was the most prevalent parasitic skin infestation. This was to some extent comparable to the results of the study in the Bab El-Shareia region 11, where prevalence was 8.5% among studied schoolchildren. Parasitic skin infestations had the highest prevalence rate (17.9%) in the total rural area sample, of which pediculosis capitis (17.2%) constituted the main portion. This was comparable to the result of the study in Dakahlia governorate, where prevalence was 17.8% 11. However, the prevalence rate of pediculosis capitis was relatively low among Qaluobia schoolchildren (14.7%) 12. Studies in other countries showed a variable prevalence rate for pediculosis capitis; in Iran, the prevalence among schoolchildren was 3.8% in a sample of 1200 children 14; in Saudi Arabia, it was 5.2% among female schoolchildren in a sample of 1337 children 15. The highest prevalence rate for pediculosis capitis was found among children in India (22.6% in a sample of 2455 children) 16.
The prevalence of scabies was 2% in urban areas and 0.7% in rural areas. It was similar to the rates reported in other studies – 2.6% in Bab El-Shareia 11 and 1.7% in Qaluobia governorate 12. Similar rates for scabies were recorded among schoolchildren in Turkey (2.2%) in a sample of 785 children 10. In Poland, the prevalence was 10.4% in a sample of 10 000 children 17, whereas in Nigeria it was 4.7% in a sample of 1066 children 1. The difference between the current results and those of other studies may be due to the warm climate during the implementation of the present survey, which could have contributed to the low prevalence of scabies in rural areas.
Viral skin infections affected 8% of all the studied schoolchildren in urban areas and 3.5% in rural areas. Warts were the most prevalent and were seen in 5.9% of schoolchildren in urban areas and 2.6% in rural areas. These rates were comparable to those of the study conducted in Bab El-Shareia, where the prevalence of viral skin infections was 9.9% and that of warts was 7.3% 11. Previous reports in rural areas showed variable rates (0.3–2.8%) 12,13. Studies in other countries showed variable prevalence rates for warts among schoolchildren: 2.4% in Taiwan in a sample of 3273 children 18 and 3.8% in Turkey in a sample of 785 children 10. In India, the prevalence rate for warts among children was 2.6% in a sample of 2455 children 16. In China, the prevalence of warts was 6% in a sample of 331 children 19. In Kuwait, the prevalence was 13.1% in a sample of 10 000 children 20. The prevalence of cutaneous superficial fungal infections was 8% of the total number of pupils in urban areas and 1.3% in rural areas. These results were compatible to some extent with those reported in the study conducted in Bab El-Shareia (9.4%) 11 but were incompatible with a previous report from Assiut, a rural area, where the prevalence rate was 16.2% 21. The present study revealed that tinea capitis was the most common fungal infection among the current studied children with a prevalence rate of 5.9% in urban areas and 0.7% in rural areas. This variation in rates in different surveys could be due to different environmental factors, different survey methods, and different sample sizes.
The high prevalence of scabies, impetigo, warts, and tinea capitis among boys could be because boys engage in outdoor activities more often than girls. In addition, boys are more susceptible to cross-infection – for example, through infected towels at the barber’s and through other cross-infection activities.
In this survey the prevalence rates of infectious skin diseases among pupils of schools A, B, and C were 18.8, 52.7, and 24.4%, respectively, and the difference was statistically significant. This difference may be due to variation in the level of sanitation and hygiene, level of parents’ education, overcrowding of schools, and socioeconomic status of the pupil’s family, as school A is a government language school, whereas others are general government schools.
The most prevalent infectious skin disease among schoolchildren in urban areas was bacterial infection, whereas parasitic infestation was the most prevalent in rural areas. Improvement in socioeconomic status, together with programs directed at educating parents, may be needed to decrease the prevalence of some of these skin infections. Routine school surveys should be carried out monthly for the early diagnosis and treatment of infectious skin diseases; in addition, health education, good personal hygiene, and health awareness will definitely help improve the health status of schoolchildren and prevent many communicable skin diseases.
Conflicts of interest
There are no conflicts of interest.
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Keywords:© 2013 Egyptian Women's Dermatologic Society
epidemiology; infectious skin disease; schoolchildren