To the Editors:
We embarked on a study to determine the prevalence of scabies and head lice among secondary school students attending boarding schools in Kuching, Sarawak, because we had noted that most of our clinic patients with infestations were boarding school students. The aim was to provide these data to the authorities to formulate a strategy to eliminate these infestations from boarding schools in Sarawak.
We randomly selected 2 of 9 boarding schools in Kuching, Sarawak, an Islamic school and a technical school. The protocol for this cross-sectional study was approved by the school authorities and the State Health and Education Department. The study was conducted between March and May 2009. All students who voluntarily consented were surveyed. The diagnoses were made clinically. Mass treatment of all the students was conducted after the survey. Data were subjected to descriptive analysis.
A total of 944 of 950 students consented to the survey. Of these, 488 (51.7%) were males and 456 (48.3%) were females. The median age was 16 years, ranging from 13 to 17. Malays constituted the majority with 708 (75.0%), followed by Bidayuhs 121 (12.8%) and Ibans 65 (6.9%).
We found that 233 (24.7%) students had head lice, and 76 (8.1%) students had scabies. All the students with head lice were females. This constituted 48.9% of the total female students surveyed. Scabies were seen in 61 males and 15 females. These constituted 12.5% of the male students and 3.3% of the female students studied. The point prevalences for head lice and scabies were 40% and 10.4% in the Islamic school and 7.1% and 5.7% in the technical school, respectively.
Our point prevalence for head lice of 24.7% was twice that for the prevalence of 12.9% among primary school children in Kuala Lumpur, Malaysia.1 The higher rate might have resulted from the fact that the survey was done in boarding schools where students were in close contacts with each others in the classes and in the dormitories.
We found that only female students were infested with head lice. Interestingly, we also found that the infestation by head lice was more common in the Islamic school than in the technical school. We suspect that the prevalence of head lice was higher in Muslim females because of the practice of wearing a head scarf, keeping long hair, infrequent hair washing, and the proximity among these students during mass prayers. Moreover, the dormitories in the Islamic schools were more overcrowded, housing 12 students per room compared with 8 in the technical school. In Nigeria, it was also found that the infestation rate was higher in the Islamic community with 4.1% compared with the Christian community rate of 3%.2 Females, longer hair, less frequent hair washing, sharing cleaning implements, and overcrowding were also identified as risk factors for head lice infestation.3,4
Scabies was found in 8.1% of the students in our study. In a survey among primary school children, the prevalence was 4% in urban Mali, 0.7% in Malawi, and 4.3% in rural Cambodia.5 The higher prevalence seen here might be due to the proximity and frequent handshaking among Muslim students in the boarding schools.
In conclusion, the prevalence of these infestations is high, warranting mass treatment by the education and health authorities to contain the transmission in all the boarding schools in Sarawak. Control of these infestations is important to allow a better quality of life and improve the educational and cocurricular performance of the boarding school students. We recommend that school authorities screen all new students for these infestations and refer them for appropriate treatment before starting school to prevent transmission of these diseases.
Felix Boon-Bin Yap, MD, MRCP
Estrellita M. T. Elena, MB BS
Muniandy Pubalan, MB BS, MRCP
Department of Dermatology Sarawak General Hospital Sarawak, Malaysia
1. Sinniah B, Sinniah D, Rajeswari B. Epidemiology and control of human head louse in Malaysia. Trop Geogr Med
2. Ebomoyi EW. Pediculosis capitis among urban school children in Ilorin, Nigeria. J Natl Med Assoc
3. Counahan M, Andrews R, Büttner P, et al. Head lice prevalence in primary schools in Victoria, Australia. J Paediatr Child Health
4. Ríos SM, Fernández JA, Rivas F, et al. [Pediculosis prevalence and associated risk factors in a nursery school, Bogota, Colombia] [Article in Spanish]. Biomedica
5. Landwehr D, Keita SM, Pönnighaus JM, et al. Epidemiologic aspects of scabies in Mali, Malawi, and Cambodia. Int J Dermatol