|Year : 2013 | Volume
| Issue : 1 | Page : 58-62
Skin infections in male pupils of primary schools in Al Ahsa
Montassar Amri, Tarek Amin, Waseem Sulaiman
Department of Dermatology, College of Medicine Al-Ahsa, King Faisal University, Saudi Arabia
|Date of Web Publication||7-Mar-2013|
Department of Dermatology, College of Medicine at Al-Ahsa, PB 55038, King Faisal University, Al-Ahsa, Zip Code: 31982
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: To determine the prevalence, the nature, and the possible socio-demographic risk factors involved in the development of common transmissible skin disorders (TSD) among the studied population. Materials and Methods: A cross-sectional consecutive survey was carried out from November 15, 2008 to May 14, 2009 in Al-Ahsa governorate. This study included 1337 male primary school children. Data were collected using the following tools: Socio-demographics and hygienic habits according to pre-established forms and a thorough dermatological examination of all the included children. Results: The prevalence of TSD was 27.15% with a statistically significant difference according to rural/urban locations (33.74% vs. 22.27%). Fungal infections were the leading diseases (9.1%) followed by bacterial infections (8.9%), parasitic infestations (4.3%), and viral infections (4.1%). TSD were significantly more frequent in students whose fathers have a primary or preparatory educational status and in the students having the habit to play barefooted. Conclusion: Our study found that TSD was relatively frequent among male primary school students in Al-Ahsa. Our study has several limitations. One major limitation is that female primary school students were excluded from the study. Despite this major limitation, we hope the findings may be useful in planning health care programs for Saudi children with the hope of reducing the prevalence of TSD in the future.
Keywords: Childhood, skin infections, skin parasitic infestations
|How to cite this article:|
Amri M, Amin T, Sulaiman W. Skin infections in male pupils of primary schools in Al Ahsa. J Fam Community Med 2013;20:58-62
| Introduction|| |
Transmissible skin disorders (TSD) represent a substantial part of dermatology. It is known that some TSD are more frequent in childhood and are related to several socio-demographic and environmental factors. Our aim was to determine the prevalence and the nature of common TSD among male primary school children in Al-Ahsa governorate, and to identify the possible socio-demographic risk factors involved in their development.
| Materials and Methods|| |
A cross-sectional consecutive survey from November 15, 2008 to May 14, 2009.
The study was carried out in Al-Ahsa governorate located at the eastern province of Saudi Arabia; an updated list of all public primary schools was used. Schools were stratified proportionately according to urban/rural distribution. Sixteen schools were randomly selected; 6 rural and 10 urban schools. From each school, one class from each grade was randomly chosen. All the students in that chosen class were included in the sample.
Data were collected using the following tools:
- Socio-demographics: A form including age, nationality, residence, educational and occupational status of the parents, family income, family size, birth order of the child and type of current residence, pets in the house, number of rooms, and skin lesions among family members and their nature, if any. These forms were sent to children parents/guardians at home, to be completed a few days before the screening for skin disorders. A cover letter and consent form were also attached which included the objectives, methods and possible referral for treatment of cases.
- Hygienic habits of the included children: Another form for data collection on the same day of examination gathering data regarding personal habits through personal interview.
- Clinical examination: Thorough dermatological examination was carried out on all school children upon receiving parental approval. Examination was done in a private room within the school, using natural light with students in their underwear.
Data entry and data processing was carried out using SPSS version 13 software (SPSS Inc. Chicago, Illinois, USA). Both descriptive and inferential data analyses were applied using the appropriate statistical tests of significance (Chi-square, Z-test for proportions and t-test). Categorical variables were expressed in percentage with using 95% confidence intervals. Multivariate binary logistic regression model was generated by inclusion of significant variables at the univariate analysis, relating various socio-demographics and personal hygienic habits against the most commonly encountered conditions as dependent variables. Sampling variations were reported using 95% confidence interval and significance level was set at 5%.
Permissions were obtained from the local school health and education directorates. Prior orientation of the teaching and administrative school staff was carried out. Before commencing the procedures of interviewing and examination, a brief orientation of the students was carried out. Data confidentiality and subject's privacy were maintained throughout the study.
| Results|| |
This study included 1337 male primary school children (768 from urban locations and 569 are rural). Lesions of TSD were found in 363 students (27.15%). The prevalence of TSD in rural students was 33.74% (192/569), and 22.27% (171/768) in those from an urban location. Thus, the difference was statistically significant (χ2 = 21.77; P < 0.0001). [Table 1] shows the socio-demographic characteristics of the included population in relation to their school location. Data related to personal hygienic habits and domestic conditions of the included children are summarized in [Table 2]. The prevalence of different diagnosed TSD is displayed in [Table 3]. However, we note particularly that fungal infections were at the top of list (122 students; 9.1%) followed by bacterial infections (119 students; 8.9%), parasitic infestations (57 students; 4.3%), and viral infections (55 students; 4.1%). If we proceed by single diagnosis classification, the top five are the following: Folliculitis (78; 5.8%), tinea pedis (71; 5.3%), pediculosis capitis (47; 3.5%), warts (44; 3.3%), and impetigo (36; 2.7%).
|Table 1: Socio-demographics of the study population, male primary school children|
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|Table 2: Stated personal hygienic habits and pet ownership among male primary school children|
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|Table 3: Distribution of transmissible skin disorders in relation to urban-rural location of primary school children|
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| Discussion|| |
Regarding epidemiologic data, and socio-demographic characteristics, the prevalence of TSD in our population is close to those reported by previous surveys. Indeed, Wisuthsarewong and Viravan  have reported a prevalence of 21.9% of skin infections in their studied pediatric population. This prevalence was estimated to 35.3% by Kharfi et al.  We noted that the prevalence was significantly higher among rural students. The particular high prevalence of TSD in poor communities living in conditions of overcrowding was reported by previous authors. , Our study found significant differences between average income of the family, and type of residential accommodation according to urban/rural location.
The correlation between the prevalence of TSD and parent's educational level was mentioned by other authors. , Actually, this finding was noted in our survey.
As for personal hygienic habits and domestic conditions, statistically significant differences between the urban/rural subgroups were noted only in 2 items: Presence of animals in the domestic environment, and the habit of playing barefooted. This could be an additional proof supporting the high levels of TSD in the group of rural students since some TSD are zoonotic in origin or are transmitted through contact with soil.
Analysis of relative prevalence of diagnosed TSD in our survey has showed that the group of fungal infections ranked first while viral infections ranked last. These findings are different from those of previous surveys conducted in other countries. Indeed, viral infections were at the top of list followed by fungal infections, bacterial infections, and parasitic infestations, according to a Tunisian survey.  Similarly, viral infections ranked first followed by bacterial infections, fungal infections, and parasitic infestations in a study conducted in Netherlands.  The difference of relative viral infection prevalence in the above mentioned surveys and in ours could be attributed to variations of environmental factors in the different countries in which surveys were conducted.
As far as single diagnosis is concerned, the top five diagnosed TSD list in our survey were the following (in a descending order): Folliculitis, tinea pedis, pediculosis capitis, warts, and impetigo. Odueko et al.  have reported that tinea, scabies, and impetigo were the most commonly observed childhood TSD in their survey. For Mohammedamin et al.  warts, dermatophytosis, and impetigo were the most frequent TSD in their studied population. Thus, our commonly diagnosed TSD are characterized by a particular relatively high prevalence of folliculitis, and pediculosis capitis. We draw attention to the fact that a significant difference between the prevalence of pediculosis capitis according to rural/urban location was statistically significant, while no significant difference was noted regarding folliculitis. On the other hand, the relative high prevalence of tinea pedis among the group of fungal infections in our survey deserves a particular mention since previous surveys conducted in Saudi Arabia did not report similar findings. Indeed, al-Sogair et al.  have reported that tinea versicolor was the predominant fungal infection in their survey, onychomycosis and paronychia ranked second, tinea capitis ranked third, and tinea pedis and tinea manuum ranked fourth. In the study of Venugopal and Venugopal  tinea pedis ranked fifth after tinea capitis, tinea versicolor, tinea corporis, and onychomycosis. The interpretation of these variations is difficult and needs further analysis.
| Conclusion|| |
Our dermatological study builds upon two previous studies conducted in Saudi Arabia. Our study found that TSD was relatively frequent among male primary school students in Al-Ahsa.
Significant correlations between the prevalence of TSD, socio-demographics, and hygiene habits were ascertained. Regarding urban/rural differences, we found that significant difference according to rural/urban location regarding the habit of playing barefooted noted in our survey was not associated with significant difference regarding the prevalence of tinea pedis in the 2 rural/urban subgroups. Our study has several limitations. One major limitation is that female primary school students were excluded from the study. Investigations were not systematically performed and the diagnosis was done clinically in the majority of cases. Despite these limitations, we hope the findings would be useful in planning health care programs aimed at reducing the prevalence of TSD among Saudi children.
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[Table 1], [Table 2], [Table 3]