Despite global improvements in the hygiene and sanitation of societies, pediculosis is reported from both developed and developing countries. This is considered as a growing neglected infestation in many regions of the world, especially developing countries. Pediculosis can be occurred in schools and other residual centers of rural and urban areas (5).The high prevalence (8.4%) of pediculosis in recent study is in line with the previous studies in Iran, which demonstrated prevalence from 1.6–67% in different provinces 17, 19, 31. No statistically significant difference between pediculosis and age, weight, height, and BMI of pupils. There were also no relationship between the variables in previous studies in Iran and other countries 22, 32. However, this study showed that all pupils in schools are at risk of head lice infestation. On the other hands, it was shown that the number of individuals in the families is an effective factor on more infestation. This finding agree with the previous study in Iran with an association between mentioned variable 31. In the line with other studies in Iran, despite more infestation in long hair pupils (62%), no statistical difference was indicated in the current study 31, 32. Heavy and light pediculosis was demonstrated in all infested pupils in every age group. Although, the occupation and education level of parents have been showed no effect on the frequency of pediculosis 20. According to the study results, it seems any increasing in the education level of the family members, can lead to serious changes in the attitude, viewpoint and behavior of all family members about pediculosis. However, its reasons has been not explained exactly, and needs additional clarification on the specific reasons in various studies. High prevalence of pediculosis in Mashhad elementary schools could be a reflection of the family’s lifestyle changes in recent years. This problem might be related to increasing use of music player devices and using tools such as earphones and headphones, which are usually shared between family’s members. Moreover, other urban civilization phenomenon such as the subway, which has been more popular, can be effective as a crowded and closed place in the formation of uncontrolled outbreaks. Furthermore, the use of schools to welcome local rural pilgrims in recent years on various occasions has let to temporarily accommodate large human populations in the metropolis of Mashhad. This event could be considered as a potential in creating an epidemic at the schools, particularly in winter that must be considered.
Interventions in the infested pupils and programming for the training of parents and pupils as well as teachers have critical role in the control of pediculosis in each society 33, 34. Improvement of parent's awareness, knowledge, and perception about head lice, timely preventive health actions, and interruption of the parasite lifecycle could lead to decrease of this infestation in the present study. For example, before intervention in our study, more than 86% of parents have no knowledge about transmission routes of pediculosis. While, after the intervention, the ratio has changed significantly. Our findings are in line with studies of 28 and 35 that previously measured the level of parental learning in health education programs for pediculosis. Despite this significant decrease in the prevalence rate, the eradication was not achieved, which seems to be due to the short duration of intervention and control. Therefore, it is suggested to approve and implement some long-term 5-year plans for future projects. For example, Frankowski et al. could achieve a considerable success in this field, during a 6-year plan 11. Furthermore, from confounding factors in this study can be pointed to fungal diseases in such children age group that mimic as pediculosis. Therefore, it should be distinguished specifically from superficial fungal diseases such as trichomycosis, tinea capitis, white piedra, black piedra and dandruff caused by Malassezia29. Interestingly in the current study we faced with several misdiagnosed cases how later rule out for pediculosis. Choosing the right treatment requires a prior accurate diagnosis (clinical and laboratory), because of the possibility of drug interactions and side effects. However, some physicians do empirical treatment regardless of patient referral to the laboratory for definitive diagnosis. In some cases, these infections may also be simultaneously 30. Hence, in such cases it requires the collaboration of an entomologist/parasitologist with other specialists such as a mycologist and dermatologist.
And finally, some of the important results that we achieved in this study include: first, creating a sense of responsibility in pupils to convey and share useful about prevention of infestation among their families, relatives and classmates. Second, the parent-teacher association (PTA) and its role to solve the school problems through scientific and research methods have been regarded. Third, use of the educational potentials using families, which led not to impose financial burden on families have been noticed, country health services, and school management. Forth, to reduce of anxiety around the stressful situation for the parents and teachers, those were in daily contact with the infested pupils.
One of the notable points in this regard, there have not been ever conducted such studies on female elementary school students in this area. So, the findings of this study could increase our knowledge from the epidemiological aspects of disease, and could change the authorities' attitude and focus from expensive case therapy toward cheap group training
There are some limitations in our study that deserve mention: the collected data was a self-report by mothers and students files, thus recall bias is warranted. Also, we performed the studied in one urban area of Iran, thus our findings may have limited generalizability to other regions and cultures.