A study of dermatological disorders in relation to personal hygiene and nutritional indicators among govt. high school children of age group 11-16 yrs.
Information gathered from school children can provide insight into the community prevalence in this age group.
School surveys are useful indicators of prevalence of various skin diseases and status of health and hygiene of the society. All the children have atleast one or more skin disease. 
Skin of a child is more susceptible for skin diseases; dermatoses being one of the major causes of morbidities. It has been neglected by both by the community and health personnels in India. 
A survey of school children for skin diseases provides information regarding the epidemiology of diseases like pyodermas, leprosy, infestations and acne vulgaris that are particularly common in that age group. It also results in the early detection of diseases like leprosy. 
The prevalence of skin disease of public health importance, scabies has been estimated as 11.4% in a study conducted in Chandigarh. 
Indian school health programs focuses on determinants of health like sanitation, hygiene, nutrition, safe drinking water, gender and social concern. The School Health Programme intends to cover 12, 88, 750 Government and private aided schools covering around 22 Crore students all over India; yet the health of school children is still lagging behind. 
AIMS AND OBJECTIVES:
1. To find out the prevalence of dermatological disorders among the high school children.
2. To enumerate the socio-demographic determinants of dermatological disorders.
3. To elicit the relationship of personal hygiene and nutritional status with dermatological disorders.
MATERIALS AND METHODS: A health check-up program for govt. high school children studying in class VI to IX was organized by the researcher over a period of 1 week (19th to 25 th Nov 2013) after taking permission from principal at the Musheerabad Govt. School. Health checkup was conducted in the free periods without disturbing the regular classes. The school is a co-education school with English, Telugu and Urdu media, where children from neighboring slum and urban-slum locality study including children from SC and BC hostel near-by. Because of the board exams, students of class X were excluded. The age of study participants ranged from 11-16 yrs. A total of 124 students were enrolled from 4 sections (2 English medium and 2 Urdu medium), of which there were 24 absentees. Thus, a total of 100 students participated in the study.
The tools included a pre-designed questionnaire, weighing machine, measuring tape, magnifying lens. General physical examination of the students was conducted. The children were also interviewed about personal hygiene practices like regular brushing and bathing, regular head bath, hand washing before eating and after using toilet, bowel movements, physical exercise. The nutritional status of the children was assessed using BMI-for-age charts designed by World Health Organization.
Studies from India reveal wide variations in prevalence of skin disease among children ranging from 38.8% to 76.65%. [1,3,6,7,8]
After reviewing the literature, prevalence(P) of skin diseases among children was taken as 55% for estimation of minimum sample size using the formula, n = 4PQ/L2 (where, P=55%, Q=100-P, L (allowable error) = 20% of P). Thus, the minimum sample size estimated was 82. 
Any dermatological morbidity (skin, hair and nails) suffered by the students at the time of study was recorded. The data thus collected was subjected to statistical analysis using proportions and chi-square test with the help of MS Excel 2007 and EpiInfo version 3.2.
RESULTS AND DISCUSSION: Out of 100 students, 77 students are suffering from at least one dermatological disorder. Therefore, the overall prevalence of skin disease is 77% which is almost similar to the studies conducted by Dr. Libu GK in Kerala (70.5%) and S. Gatha Rao and et al study (76.65%). 
The study included 13 boys and 87 girls, majority of the participants were aged between 1416 yrs.
The common skin morbidities among the children in the present study were Pytiriasis simplex capilliti (27%), acne vulgaris (22%), Pediculosis capitis (18%), Pytiriasis alba (14%), scabies (11%), mosquito bite allergy (3%), phrynoderma (1%), Tinea versicolor (1%).
However, the prevalence of P. simplex in the present study (27%) was comparable to the study (33.3%) conducted by NL Sharma and et al in Himachal Pradesh; while the prevalence of P. capitis in the present study was much lower (18%) when compared to 74% in Himachal Pradesh study and 52.6% in Kerala study. [1,2]
The prevalence of scabies in the present study was 11% which is coinciding with the study conducted by Dogra. S and et al in Chandigarh (11.4%). 
P. alba was elicited in 14% of the children in the present study as compared to 12% in Varanasi study (Valia RA and et al), 11.9% in Kerala study. 
(Table 1) AGE: Among the total no. of students suffering from dermatological disorder 57 students (85%) belong to 14-16 yrs age group while 20 students (60.6%) belong to 11-13 yrs age group. A higher proportion of dermatological disorders were observed in mid adolescent age group and this difference is statistically significant. (Chi-square= 7.47, p<0.05). This difference may be attributed to the fact that they get exposed to newer risk factors as they grow older; elder children become more independent and parental care also decreases, hence hygienic practices by the child may be insufficient especially in girls with long hair and the boys become more negligent in maintaining their personal hygiene. 
GENDER (Table 2): Among the total males (13), 7(53.9%) were suffering from dermatological disorder. Among the total females (87), 70(80.5%) were suffering from dermatological disorder. This was comparable with Kerala study conducted by Dr. Libu and et al (78.9% in girls and 65.9% in boys).  A higher female proportion is suffering from skin disease when compared to males. This difference is statistically significant (Chi-square=4.52, p<0.05)). This may be due to difficulty in managing their long hair and adolescent age group leading to higher prevalence of P. simplex and Acne vulgaris respectively.
HOSTEL RESIDENCE (Table 3): out of 44 students residing in hostel, 39(88.6%) were suffering from dermatological disorder; while out of 56 non-hostlers 38(67.9%) had dermatological disorders. A higher proportion of students with dermatological disorders were hostlers which is statistically significant (chi-square=6.01, p<0.05). As most of the hostlers were taking bath irregularly and due to overcrowding, scabies and Pediculosis capitis were more common among them.
OCCUPATION (Table 4): Among the total no. of students suffering from dermatological disorders (77 students), 12(66.7%) students had fathers who are sedentary workers and 65 (79.3%) students had fathers who are heavy workers. A higher proportion of students whose fathers are heavy workers are suffering from dermatological disorder when compared to other group.
Similarly, among total no. of students who have working mothers (59), 49 (83.1%) are suffering from dermatological disorders. Among the students whose mothers are housewives (41), 28 (68.3%) have dermatological disorders. A higher proportion of students with dermatological disorders belonged to mothers who are working.
The above findings were falling short of any statistical significance.
BMI-FOR-AGE (Table 5): The total no. of students with dermatological disorders who were underweight were 5 (62.5%), whose proportion was almost similar to normal/overweight students i.e. 72 (78.3%). Yet no statistically significant association was found.
PERSONAL HYGEINE (Table 6): Almost all the students (90/100) were using soap for washing hands before eating and after using toilet. Among the total no. of students with dermatological disorders, the proportion of children who were washing hands with soap and without soap was almost similar.
Out of 45 students who were regularly bathing and out of 55 students who were irregularly bathing, the no. of students with dermatological disorders were 37 (82.2%) and 40 (72.7%) respectively which was almost similar.
Out of 37 students who were taking head bath >/= 3 times/week, 25 (67.6%) had dermatological disorders while out of 63 students who were taking head bath <3 times/week, 52 (82.5%) were suffering from dermatological disorders. A higher proportion of children who were taking infrequent head bath were suffering from dermatological disorder.
All the above three findings were falling short of statistical significance.
CONCLUSION: Prevalence of dermatological disorders is considerably high among high school children. Most common skin morbidities elicited were Pytiriasis simplex, Acne, Pediculosis capitis, P. alba and scabies. The significant socio-demographic determinants of dermatological disorders in high school children were mid-adolescent age group (14-16 yrs), female gender and hostel residence. Majority of the children with dermatological disorders belong to working mothers, may be due to lack of monitoring regarding personal hygiene practices. Nutritional status of the children does not have any relation with skin morbidities in this age group. Children who have infrequent head bath and those who were not using soap for hand wash had more dermatological disorders when compared to others.
RECOMMENDATIONS: School Health Programme should focus on screening for dermatological disorders with special focus on mid-adolescents as this age group is important for cultivating good personal hygiene practices. Hostlers should be encouraged to take bath regularly and improve their health seeking behavior. Working mothers have to put extra efforts in teaching their children about hygienic practices due to lack of time when compared to housewives. Finally, regular school health check-ups combined with health education and proper treatment facilities will improve the health status of this most vulnerable yet vital segment of our population.
[1.] Dr. Libu G. K., Dr. Thomas Bina, Dr. Lucy Raphael, Dr. Shyam E. Balakrishnan, Dr. Biju George, Dr. Joan Felicita Samson, Dr. Bindu V. Prevalence and socio-demographic determinants of skin disease among lower primary school children in Calicut, Kerala, Kerala Medical journal, www.imakmj.com, Vol 10, Issue 5, Sep 2010, 185-190.
[2.] Sharma NL, Sharma RC. Prevalence of dermatologic diseases in school children of a high altitude tribunal area of Himachal Pradesh. Indian J Dermatol Venereol Leprol 1990; 56: 375-6.
[3.] Bhatia V. Extent and pattern of paediatric dermatoses in rural areas of central India. Indian J Dermatol Venereol Leprol 1997; 63: 22-5.
[4.] Valia RA, Pandey SS, Kaur P, Singh G. Prevalence of skin diseases in Varanasi school children. Indian J. Dermatol Venereol Leprol 1991; 57: 141-3.
[5.] Dogra S, Kumar B. Epidemiology of skin diseases in school children: a study from northern India. Pediatr Dermatol. 2003; 20: 470-3.
[6.] Ministry of Health & Family Welfare, A.P., Guidelines of school health programme; Available from: http://mohfw.nic.in/WriteReadData/1892s/2099676248file5.pdf.
[7.] Rao SG, Kumar P, Kuruvilla M. Prevalence of various dermatoses in school children. Indian J Dermatol Venereol Leprol 1999; 65: 126-7.
[8.] Sharma N. K, Garg B K and Goel M: Pattern of skin diseases in urban school children, Ind J Dermatol Venereol Leprol, 1986; 52: 330-1.; available from http://www.ijdvl.com.
[9.] Methods in bio-statistics: For medical students and research workers, BK Mahajan, Jaypee publications, 7th edition: 2008, pg. 84.
Kiran Mai B (1), Niharika B (2), K. V. S. Murty (3)
1. Kiran Mai B.
2. Niharika B.
3. K. V. S. Murty
PARTICULARS OF CONTRIBUTORS:
(1.) Associate Professor, Department of Community Medicine, Gandhi Medical College, Secunderabad.
(2.) Senior Resident, Department of Community Medicine, Anantapur.
(3.) Professor, Department of Community Medicine, Gandhi Medical College. Secunderabad.
FINANCIAL OR OTHER COMPETING INTERESTS: None
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Niharika B, S2, Block I, Medical College Teaching Staff Residential Quarters, Beside Power Office, Jesus Nagar, Anantapuramu-515001, Andhra Pradesh. E-mail: firstname.lastname@example.org
Date of Submission: 23/01/2015. Date of Peer Review: 24/01/2015. Date of Acceptance: 07/02/2015. Date of Publishing: 14/02/2015.
TABLE 1 Age Group DD+ * DD- (#) Total 11-13 Yrs 20(60.6%) 13(39.4%) 33 14-16 Yrs 57(85%) 10(15%) 67 Total 77 23 100 Chi-square = 7.47, P = 0.006 (<0.05), significant * Dermatological disorder Present (#) Dermatological disorder Absent TABLE 2 Sex DD+ DD- Total Males 7(53.9%) 6(46.1%) 13 Females 70(80.5%) 17(19.5%) 87 Total 77 23 100 Chi-square = 4.52, P = 0.033 (<0.05), significant TABLE 3 Residence DD+ DD- Total Hostlers 39(88.6%) 5(11.4%) 44 Non-hostlers 38(67.9%) 18(32.1%) 56 Total 77 23 100 Chi-square=6.01, P=0.014(<0.05), significant. TABLE 4 Occupation DD+ DD- Total Father's Occupation Sedentary workers 12 (66.7%) 6 (33.3%) 18 Heavy workers 65 (79.3%) 17 (20.7%) 82 Mother's occupation Working 49(83.1%) 10(16.9%) 59 Housewife 28(68.3%) 13(31.7%) 41 Occupation Chi-square P value Significance Father's Occupation 1.323 0.249 Not significant Sedentary workers Heavy workers Mother's occupation 2.975 0.084 Not significant Working Housewife TABLE 5 BMI-for-Age DD+ DD- Total Normal & Overweight 72(78.3%) 20(21.7%) 92 Underweight 5(62.5%) 3(37.5%) 8 Total 77 23 100 Chi-square = 1.032, P = 0.309(>0.05), not significant TABLE 6 PERSONAL HYGEINE DD+ DD- Total Hand wash With soap 69(76.7%) 21(23.3%) 90 Without soap 8(80%) 2(20%) 10 Bathing Regular 37(82.2%) 8(17.8%) 45 Irregular 40(72.7%) 15(27.3%) 55 Head Bath >or =3 times in a week 25(67.6%) 12(32.4%) 37 <3 times in a week 52(82.5%) 11(17.5%) 63 PERSONAL HYGEINE Chi-square P value Significance Hand wash 0.056 0.812 Not significant With soap Without soap Bathing 1.259 0.261 Not significant Regular Irregular Head Bath 2.950 0.085 Not significant >or =3 times in a week <3 times in a week
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Kiran, Mai B.; Niharika, B.; Murty, K.V.S.|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Article Type:||Clinical report|
|Date:||Feb 16, 2015|
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