8/13/2019 16_2_2010_0209_0213_2

1/5

209

Prevalence of skin disorders among primary-schoolchildren in Baghdad governorate, IraqK.A. Khalifa,1T.S. Al-Hadithi,2F.H. Al-Lami2and J.K. Al-Diwan2

ABSTRACT To determine the prevalence of skin diseases among primary-school children in Baghdad, Iraq, a totalof 2160 schoolchildren were randomly selected from 30 primary schools. Sociodemographic data were collectedfrom each pupil and exposed parts of the body of each child were clinically examined. The overall prevalence ofskin diseases was 40.9%. A significant association between the prevalence of skin diseases with education level ofparents was demonstrated. The prevalence rates of transmissible and nontransmissible skin diseases were 8.8%and 33.7% respectively. The high prevalence rate may reflect prevailing low socioeconomic conditions.

Prvalence des affections cutanes parmi les enfants dcole primaire du gouvernorat de Bagdad, Iraq

RSUM Afin de dterminer la prvalence des affections cutanes parmi les enfants des coles primaires Bagdad (Iraq), 2 160 coliers ont t slectionns au hasard dans 30 coles. Les donnes socio-dmographiquesont t recueillies auprs de chaque lve et les parties du corps exposes de chacun dentre eux ont texamines sur le plan clinique. La prvalence globale des affections cutanes tait de 40,9 %. Une associationsignificative entre la prvalence des affections cutanes et le niveau dducation des parents a t tablie. Le tauxde prvalence des affections cutanes contagieuses et non contagieuses tait de 8,8 % et 33,7 % respectivement.Ce taux de prvalence lev peut reflter les mauvaises conditions socio-conomiques observes dans le pays.

1Directorate of Public Health and Primary Health Care, Ministry of Health, Baghdad, Iraq.2Department of Community Medicine, College of Medicine, Baghdad University, Baghdad, Iraq (Correspondence to T.S. Al-Hadithi: talhadithi@yahoo.com).

Received: 04/07/07; accepted: 14/11/07

302160: . . )%40.9( .)%33.7( ))%8.8

.

8/13/2019 16_2_2010_0209_0213_2

2/5

EMHJ Vol. 16 No. 2 2010 Eastern Mediterranean Health JournalLa Revue de Sant de la Mdiderrane orientale

210

Introduction

Skin diseases are a major health prob-lem aecting a high proportion of thepopulation and causing distress and

disability [1]. ey are more frequentamong primary-school children in bothdeveloping and industrialized countries[2]. Unfortunately, no previous studyconcerning the overall burden of skindiseases among primary-school chil-dren in Baghdad, Iraq, has been carriedout. However, studies on the prevalenceof pediculosis [3,4] and atopic derma-titis [5] are available. A prevalence of31.8% of skin diseases among students

was reported in Basra,, Iraq [6].is study was designed to deter-

mine the prevalence of skin diseasesamong primary-school children inBaghdad, and to describe their asso-ciation with various sociodemographicfactors such as age, sex, residence andeducation level of parents.

Methods

is cross-sectional survey was conduct-ed from 10 February to 26 April 2004.

A mult i-stage, stra tied samp le of2160 schoolchildren from 30 primaryschools in Baghdad governorate wasrandomly selected for the study. In therst sampling stage primary schools

were classied into 4 groups accordingto sex and residence. ey were catego-

rized into urban male schools, urbanfemale schools, rural male schools,and rural female schools. en usingthe appropriate allocation method ofsampling, 20 schools were randomlyselected from the urban groups and10 schools from the rural schools. Inthe second sampling stage 12 pupilswere selected from each grade by sim-ple random sampling. Sample size wasdetermined using a condence level of

95%, with 10% degree of precision of theexpected proportion and an estimatedprevalence of 16%.

A self-administered, closed-endedquestionnaire was designed by theresearchers. e questionnaire wassubjected to a pilot trial on 50 children

before it was distributed in its nal form.

Analysis revealed that the questionnairewas consistent, reliable and easy to an-swer. en the questionnaire form wasdistributed to each selected pupil to beanswered by his parents. Verbal consentwas obtained from the chil dren, whowere asked to bring wrien con sen tfrom their parents for participation inthe study. All questionnaires were re-turned with completed responses. Datacollected included general sociodemo-

graphic information such as age, sex,residence (urban or rural), number ofhousehold members, number of roomsand educational level of parents. House-hold crowding index was calculated

by dividing the number of householdmembers by the number of rooms.

e exposed parts of the body ofeach child were clinically examined

by a consultant dermatologist and thedermatological ndings were recorded.

Woods light examination was used toconrm the diagnosis of tinea capitis,pityriasis versicolor and vitiligo. Skindiseases were classied into transmis-sible and nontransmissible diseases ac-cording to the classication adopted byother workers [7,8]. Transmissible skindiseases were categorized into bacte-rial (impetigo and boils), viral (herpessimplex and warts), supercial mycotic(tinea versicolor and tinea capitis)

and parasitic infections (pediculosiscapitis). Nontransmissible diseases in-cluded dermatitis/eczema (eczema, at-opic dermatitis, pityriasis alba, lip-lickingdermatitis), skin appendages disorders(alopecia areata, hypertrichosis, acne

vulg aris ), papi llos quamous disorder s(psoriasis, lichen nitidus, lichen planus,pityriasis rubra pilaris, ichthyosis), pig-ment disorders (vitiligo, freckles, naevi)and insect bites.

e chi-squared test was used forstatistical analysis. P 0.05 was consid-ered statistically signicant.

Results

e age of selected pupils ranged be-tween 6 and 15 years, with a mean age of9.1 (standard deviation 3.6) years and a

male to female ratio of 0.97:1.Skin disorders were noted in 883children, giving an overall prevalenceof 40.9%. ere was no signicantassociation between the prevalence ofskin diseases and age (P= 0.06), sex (P= 0.74), residence (P= 0.06) or crowd-ing index (P= 0.42) (Table 1). e edu-cation level of parents was signicantlyassociated with the prevalence of skindiseases (P= 0.04).

e prevalence rates of transmissibleand nontransmissible skin diseases were8.8% and 33.7% respectively. Analysisof association of both categories withage revealed that there was a gradual,nonsignicant (P= 0.68) decline in theprevalence of transmissible skin dis-eases with increasing age, while there

was a signicant (P< 0.001) increase inthe prevalence of nontransmissible skindiseases with age (Figure 1).

Discussion

is study revealed an overall prevalenceof skin diseases of 40.9%. is is higherthan the previously reported prevalence(33.5%) among older students in Bagh-dad in 1987 [9]. is dierence could

be aributed to a decline in the generalsocioeconomic conditions of most

groups of Iraqi people and a deteriora-tion in the health and teaching services,and consequently a lack of cooperation

between health and teaching authori-ties which followed the 1991 Gulf War,economic sanctions and the invasionof Iraq by Allied Forces in 2003, withthe accompanying internal conict.However, this rate is higher thanthat reported among primary-schoolchildren in Basrah, Iraq in 2004 (31.8%)

[6]. It is twice than that reported in Jor-dan (19.3%) [10] and slightly higherthan in Malaysia (34.4%) [11] and

8/13/2019 16_2_2010_0209_0213_2

3/5

211

Nigeria (35.2%) [12]. e rate is lowerthan that reported in Turkey (49.3%)[13] and much lower than in Ethiopianschoolchildren (96.8%) [14]. ese

varia tions in the pre valence of skindiseases may be related to genetic andracial dierences, social and hygienefactors, nutrition status, climate factors,state of industrialization, age structureof the study sample and other socio-economic factors [15].

Our nding that there was nosignicant association between theprevalence of skin diseases and age isin agreement with previous reports on

primary-school children in Iraq [6] andRomania [16]. No signicant sex varia-tions in the prevalence of skin diseases

were demons tra ted , a nd ing whi chis consistent with that reported fromRomania [16]. However, other workersreported a higher prevalence amongfemale children in Saudi Arabia [15]and Kuwait [17].

To study the association of preva-lence rates with socioeconomic status,prevalence rates were analysed inrelation to residence, crowding indexand education level of parents, as noproper acceptable classication of so-cioeconomic level is available for theIraqi population. No signicant associa-tion between residence and prevalence

of skin diseases was demonstrated, anding which is inconsistent with thatreported in Ethiopia [14] and Taiwan

[18]. In both these countries skin dis-eases were more prevalent in rural thanurban areas. A higher prevalence of skindiseases among children living in homes

with a high crowding index was shown

in our study, but the dierence was notsignicant. However, a signicant as-sociation between prevalence rates ofskin diseases and crowding index wasreported in Turkey [13]. e signicantassociation of skin diseases with educa-tion level of parents was expected as loweducation contributes to a low socio-economic status of the family. In Basrah,Iraq, a high prevalence of skin diseasesin regions of low socioeconomic status

was reported [6]. High prevalence rateswere also reported in poor developingcountries, which may reect prevailinglow socioeconomic conditions in suchareas [7,14,19,20].

In this study the prevalence of trans-missible skin diseases was 8.8%, whichis lower than that previously reportedin Basrah, Iraq (12.6) [6] and Turkey(16.2%) [13]. High rates varying be-tween 50% and 60% were reported in

Ethiopia [7] and Ghana [21]. Rates of28.8% and 20.3% were reported among

bli nd and dea f pup ils respectiv ely inSaudi Arabia [1]. ese dierences may

be aributed to variations in personaland environmental hygiene and degreeof exposure.

e prevalence of nontransmis-sible skin diseases was 33.7%, whichis lower than that reported in Saudi

Arabia (82.3%) [1] and Turkey (57.5%)[13]. However, it is higher than thatreported in Hong Kong (27%) [22].ese variations may be due to dier-ences in the way the clinical examination

was carried out, i.e. whether it coveredonly the exposed parts of the body orthe whole body. Other factors, e.g. racialand genetic dierences, may also con-tribute to these variations.

e decline in the prevalence of

transmissible skin diseases with agemay be aributed to beer personalhygiene and health care practised by

Table 1 Prevalence of skin diseases in relation to selected sociodemographicvariables (n =2160)

Variable Totalexamined

Positive skin disease P-value

No. No. %

Age (years)

67 681 255 37.4

89 652 264 40.5

1011 583 251 43.1

1215 244 113 46.3 0.06

Sex

Male 1066 432 40.5

Female 1094 451 41.2 0.74

Residence

Urban 1440 568 39.4

Rural 720 315 43.8 0.06

Household crowding index 3 1440 580 40.3

> 3 720 303 42.1 0.42

Education level of father

Illiterate 67 31 46.3

Primary school 648 272 42.0

Secondary school 1008 427 42.4

Higher educationa 437 153 35.0 0.04

Education level of mother

Illiterate 278 114 41.0

Primary school 953 413 43.3

Secondary school 758 301 39.7

Higher educationa 171 58 33.9 0.04

Total 2160 883 40.9aDiploma and BSc degrees and graduate qualifications.

8/13/2019 16_2_2010_0209_0213_2

4/5

EMHJ Vol. 16 No. 2 2010 Eastern Mediterranean Health JournalLa Revue de Sant de la Mdiderrane orientale

212

older school children. Other workersreported a similar trend in some trans-missible diseases such as tinea capitisand pediculosis capitis in Iraq [4,2325]and in other countries [14,2629]. Onthe other hand, the signicant increasein the prevalence of nontransmissibleskin diseases with age may be due toincreased exposure to environmentalpollutants, chemicals and allergens. Inaddition, the reduction in the prevalence

of transmissible diseases as a conse-quence of improvements in personalhygiene and environmental sanitationmay have contributed to the increase inthe prevalence of nontransmissible dis-eases [30]. Similar ndings have beenreported in Iraq [6] and other countries[13,16,31].

is study indicates that skindisorders are very common amongprimary-school children in Baghdad

governorate, which may reect prevail-ing low socioeconomic conditions and apoor level of awareness of these diseasesor their health implications by parentsand teachers. Improved school healthprogrammes would lead to a decline inthe prevalence of such disorders amongschoolchildren. Routine inspection ofpupils for skin disorders by their teach-ers and school health personnel should

be incorporated in such a programme.

Abolfotouh MA, Bahamadan K. Skin diseases among blind and1.

deaf male students in southwestern Saudi Arabia. Annals ofSaudi medicine, 2000, 20:1619.

Laughter D et al. The prevalence of atopic dermatitis in Oregon2.school children.Journal of the American Academy of Dermatol-ogy, 2000, 34:64955.

Hassan AT.3. Astudy of the prevalence of pediculosis capitis amongprimary school children[diploma dissertation]. Baghdad, Iraq,Faculty of Medicine, Al-Mustansiriya University, 2000.

Al-Kubaisy WA, Al-Rubauie MG, Al-Rawi JR. The prevalence of4.head louse among primary school pupils in Baghdad city.Jour-nal of the Faculty of Medicine Baghdad, 1994, 36:66570.

Jassim RK.5. Prevalence of atopic dermatitis among primary schoolchildren in Baghdad, Al-Karkh district[MSc thesis]. Baghdad,Iraq, Faculty of Medicine, Al-Mustansiriya University, 2004.

Al-Rubaiy KK, Habib OS, Ebrahim S. Pattern of skin diseases6.among primary school children in Basrah, southern Iraq.Medi-cal journal of Basrah University, 2004, 12:402.

References

Dagnew MB, Erwin G. Epidemiology of common transmissible7.

skin diseases among primary school children in north-westEthiopia. Tropical and geographical medicine, 1991, 43:1525.

Bahmadan K et al. Skin infection among adolescent boys in8.Abha, Saudi Arabia. International journal of dermatology, 1996,35:4057.

Abdul Hussain HM.9. Morbidity rates of skin diseases in Baghdadcity[diploma dissertation]. Baghdad, Iraq, Faculty of Medicine,Baghdad University, 1987.

Shakkoury WA, Abu-Wandy E. Prevalence of skin disorders10.among male school children in Amman, Jordan. Eastern Medi-terranean health journal, 1999, 5:9559.

Mahe A et al. Skin diseases of children in Mali: a public health11.problem. Transactions of the Royal Society of Tropical Medicineand Hygiene, 1995, 89:46770.

Ogunbiyi AO, Owoaje E, Ndahi A. Prevalence of skin disorders12.in school children in Ibadan, Nigeria. Pediatric dermatology,2005, 22:610.

67 89 1011 > 12Age group (years)

Prevalence(%)

50

45

40

35

30

25

20

15

10

5

0

TransmissibleNon-transmissible

Figure 1 Prevalence of transmissible and nontransmissible skin diseases among primary-school children by age group

8/13/2019 16_2_2010_0209_0213_2

5/5

213

Inanir I et al. Prevalence of skin conditions based on socioeco-13.nomic factors. Pediatric dermatology, 2002, 19:30711.

Figueroa JI et al. Tinea capitis in southwestern Ethiopia: a study14.of risk factors and carriage. International journal of dermatology,1997, 36:6616.

Parthasadhi P, Al-Gufai AF. The pattern of skin diseases in15.Hail region, Saudi Arabia. Annals of Saudi medic ine , 1999,8:55861.

Popescu R et al. Prevalence of skin conditions in Roma-16.nian school children. British journal of dermatology, 1999,140:8916.

Al-Hasawi NA, Al-Saleh QFA. A prospective survey of paediat-17.ric dermatology clinic patients in Kuwait: an analysis of 10000cases. Pediatric dermatology, 1999, 16:611.

Wa YH, Su HY, Hsieh YJ. Survey of infectious skin diseases18.and skin infestation among primary school students in Taitongcounty, eastern Taiwan.Journal of the Formosa Medical Associa-tion, 2000, 99:12834.

Figueroa JI et al. The prevalence of skin diseases among school19.children in rural Ethiopia: a preliminary assessment of derma-tologic need. Pediatric dermatology, 1996, 13:37881.

Gibbs S. Skin diseases and socioeconomic conditions in rural20.Africa, Tanzania. International journal of dermatology, 1996,35:6339.

Acheampong JW et al. Scabies and streptococcal skin infection21.in Ghana. Tropical doctor, 1998, 18:1513.

Fung WK, Lo KK. Prevalence of skin diseases among school22.children and adolescents in a student health service in HongKong. Pediatric dermatology, 2000, 17:4406.

Al-Mousawi T, Al-Affas NH, Al-Ramahyi AK. The incidence of23.scalp fungal infection among primary pupils in Basrah city. Iraqijournal of community medicine, 1993, 6:31 6.

Fathi HI, Al-Samarai AM. Tinea capitis in Iraq: laboratory re-24.

sults. Eastern Mediterranean health journal, 2000, 6:13848.Al-Affas NH. Incidence of head louse (pediculosis humanus25.capitis) among pupils of two schools in Basrah city. Iraqi journalof community medicine, 1993, 6:314.

Oyeka CA. Tinea capitis in Awka local government area in An-26.ambra state. West African journal of medicine, 1990, 9:1203.

Sinniah B, Sinniah D, Rajeswari B. Epidemiology and control of27.human head louse in Malaysia. Tropical geographical medicine,1988, 83:13003.

Elhan K, Budak S, Guraz AY. Pediculosis humanus capitis28.among the students of a secondary school in KansiyakiIzmir,Turkey. Journal of the Egyptian Society of Parasitologists, 1997,27:15761.

Amr ZS, Nusier MN. Pediculosis capitis in northern Jordan.29. International journal of dermatology, 2000, 39:91921.

Howarth E. Is allergy increasing? early life influences.30. Clinicaland experimental allergy, 1998, 28(Suppl 6):27.

Dogra S, Kumar B. Epidemiology of skin diseases in school31.children: a study from northern India. Pediatric dermatology,2003, 20:4703.

Ultraviolet radiation and human health

Fact sheet N 305, December 2009, available at: hp://www.who.int/mediacentre/factsheets/fs305/en/index.html

Small amounts of UV radiation are benecial to health and play an essential role in the production of vitamin D.However, excessive exposure to UV radiation is associated with dierent types of skin cancer, sunburn, accelerated skinageing, cataract and other eye diseases. ere is also evidence that UV radiation reduces the eectiveness of the immunesystem.

Children and adolescents are particularly vulnerable to the harmful eects of UV radiation. Excessive sun exposure inchildren is likely to contribute to skin cancer in later life. e mechanisms are unclear, but it may be that skin is more

susceptible to the harmful eects of UV radiation during childhood.