Academic journal article Bulletin of the World Health Organization

Household-Wide Ivermectin Treatment for Head Lice in an Impoverished Community: Randomized Observer-Blinded Controlled trial/Traitement Par L'ivermectine Contre Les Poux De Tete De Rensemble Des Membres Des Foyers Dans Une Communaute Appauvrie : Essai Controle Randomise En Simple Aveugle

Academic journal article Bulletin of the World Health Organization

Household-Wide Ivermectin Treatment for Head Lice in an Impoverished Community: Randomized Observer-Blinded Controlled trial/Traitement Par L'ivermectine Contre Les Poux De Tete De Rensemble Des Membres Des Foyers Dans Une Communaute Appauvrie : Essai Controle Randomise En Simple Aveugle

Article excerpt

Introduction

Pediculosis capitis (head lice infestation) is probably the most common parasitic condition among children worldwide. It is particularly common in resource-poor communities in the developing world, where it affects individuals of all age groups, and prevalence in the general population can be as high as 40%. (1) Children aged < 12 years show the highest prevalence and bear the highest burden of disease. (2-4)

Despite the public health relevance of the condition, strategies to effectively control it are not evidence-based, and recurrent head lice infestations are a common problem. (5,6) This is of particular concern in resource-poor communities, where this parasitic skin disease prevails and is associated with considerable morbidity. (1,4,7)

We assessed household-wide treatment with ivermectin as a means of controlling the transmission of head lice in a resource-poor setting based on the premise that in such settings, as opposed to more affluent ones, (6,8) within-household transmission of head lice plays a crucial role in transmission dynamics. The lessons learned on head lice transmission and the usefulness of this approach for the control of this parasitic skin infestation are presented in this paper.

Methods

Study area and participants

The study was conducted during February and March 2007 in a typical favela (slum) in Fortaleza, the capital of Ceara state in north-eastern Brazil. Of the favela's population, 60% has a monthly family income of less than two minimum wages (1 minimum wage = 200 United States dollars, USS). The unemployment rate is high, violence and drug abuse are common and adult illiteracy is about 30%. (4) Health care is provided by the national primary health care system (Programa de Saude da Familia) through a primary health-care centre in the area.

Children and teenagers from 5 to 15 years of age who were free from head lice were eligible for the study. All children were participants of a clinical trial comparing two head lice treatments that had taken place immediately before this field study was initiated. (9) For the clinical trial, children with head lice living in an urban slum were recruited and sent to a holiday resort where the trial took place. While still in the holiday resort but immediately before this study, children received oral ivermectin to assure that they were free of head lice by the time the field study started. In addition, baseline head lice status was assessed by vigorous wet combing, the most sensitive method for detecting head lice. (10) Children were not admitted into the field study if they were (i) unwilling to participate in the trial, (ii) presumed absent from the study area for more than a week, or (iii) found to have active head lice infestation during the baseline wet combing. Patients and their parents or legal guardians gave informed written consent. In total, 132 children free from head lice (sentinel children) from 78 families were included. All participants were recruited in a single day.

Study design

We randomized the households of participating children into two groups. In the intervention group, we gave all household members 200 [micro]g/kg of ivermectin orally. Ten days later, the same dose was given to all household members except for the sentinel children who were free of head lice. Household members of the control group remained untreated. One day after the householdwide treatment with ivermectin, sentinel children returned home from the holiday resort. They were subsequently examined for the presence of head lice by wet combing every 3 to 4 days during a period of 60 days.

Using structured questionnaires, we collected socioeconomic information on participating households. Because most people living in slums are not regularly employed and have no steady income, to measure poverty we used an index that was independent of household income but that assessed the physical characteristics of the dwelling and household consumption. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.