偏鄉學童頭蝨篩檢與防治－以東部一所小學為例

Screening and Managing School Children's Head Lice in a Remote Area: Experience in a Primary School in Eastern Taiwan

10.3966/168232812018062802003

邱雲柯(Yun-Ke Chiu)；王英偉(Ying-Wei Wang)；葉日弌(Jih-I Yeh)

頭蝨 ； 偏鄉健康 ； 自我照顧 ； 校園內篩檢 ； head lice ； rural health ； school-based-screening ； self care

台灣家庭醫學雜誌

28卷2期（2018 / 06 / 01）

76 - 85

繁體中文

目的：在台灣偏鄉，頭蝨仍是學童常見的問題。然而由於頭蝨照護資源和人力的缺乏，在家庭內頭蝨的篩檢和治療仍有不足，以校園為主的防治方式成效也不明確。本研究目的是觀察不同的篩檢策略在學童頭蝨診斷上的適用性，並評估以校園內篩檢為基礎的頭蝨治療方案成效。方法：以東部地區某偏鄉國小93名學童為對象，透過頭蝨防治資源引進和志工培養，我們在校園進行四週次共計362人次的篩檢。篩檢策略為階段性使用目視法、乾梳法至溼梳法，並以活頭蝨感染作為治療與否指標。治療方式採用必去蝨洗劑，並以學童自主乾梳法做輔助。主要分析內容包括篩檢和治療結果，以及和頭蝨有關的社會文化議題。結果：在四週活動期間，共有65人(69.9%)曾有過活頭蝨感染，其中有62人接受二次以上的必去蝨治療配合學童自主乾梳法後，有54人(87.1%)治癒。在發現活頭蝨感染的112人次中，有3人次(2.7%)是靠目視法篩出，有92人次(82.1%)是靠後續的乾梳法篩出，第三階段的溼梳法則再找到了17人次(15.2%)。照顧責任的歸屬和污名化是較常被提到的社會文化議題，也會影響照顧者參與頭蝨防治的意願。結論：透過適當的資源引進、志工參與以及學童訓練，以校園內篩檢為基礎的學童頭蝨防治模式仍有一定的成效，而乾梳法加上輔助的溼梳法是相對省時且有效率的篩檢方式。本次研究僅限於單一學校的短期經驗，對於多所校園、長期的頭蝨防治，衛生單位積極參與、穩定的資源取得、照顧者間的溝通以及學童的衛教，仍是未來的工作重點。

Purpose: Head lice infestation has remained common in schoolchildren in some remote areas in Taiwan. Lack of resources and caregivers for effective management leads to unsatisfactory result in eradicating head lice infestation both in household and on campus. The study aimed to examine different screening strategies and evaluate the efficacy of a school-based screening program for managing head lice among school children. Methods: A total of 93 schoolchildren in a rural elementary school were enrolled. Essential resources were introduced and volunteers recruited and trained to help initiate head lice screening and management. A weekly screening was performed for 4 consecutive weeks, and a total of 362 screenings were completed. Visual inspection, dry combing and wet combing were used step-by- step to screen active infestation of head lice. Children with active infestation were treated with γ-Benzene Hexachloride hair emulsion and supplementary dry combing performed by themselves. The results of screening and treatment were analyzed and related sociocultural issues were discussed. Results: Of the 65 (69.9%) participants diagnosed with active infestation of head lice, 62 had completed at least twice γ-Benzene Hexachloride hair emulsion plus self-performed dry combing, and 54 (87.1%) of those who completed the treatment were cured. Among the 112 positive screening results of active infestation of head lice, only 2.7% (n=3) were detected by visual inspection, 82.1% (n=92) by dry combing, and 15.2% (n=17) by subsequent wet combing. Attribution of the responsibility of preventing and managing head lice and the stigma associated with head lice infestation were common issues raised by caregivers as these concerns may affect their willingness of participating in head lice management. Conclusion: By introducing appropriate resources, encouraging volunteer involvement, and training schoolchildren, the school-based head lice screening program proved to be viable, and dry combing supplemented by wet combing appeared to be an efficient as well as effective screening strategy. This study, however, was mainly a short-term experience deriving from one single school. Greater involvement from health authorities, better accessibility of resources, more active communication and collaboration between caregivers and health educators for school children are needed to help to develop effective long term projects applicable to multiple campuses.

1. Bachok, N,Nordin, R,Awang, C,Ibrahim, N,Naing, L(2006).Prevalence and associated factors of head lice infestation among primary school children in Kelantan, Malaysia.Southeast Asian J Trop Med Public Health,37,536-43.
2. Balcioglu, C,Burgess, IF,Limoncu, ME(2008).Plastic detection comb better than visual screening for diagnosis of head louse infestation.Epidemiol Infect,136,1425-31.
3. Community Hygiene Concern: The Bug Buster Kit - the best way to beat head lice. http://www.chc.org/homedir/thebugbusterkit.cfm. Accessed March 16, 2018.
4. Counahan, M,Andrews, R,Büttner, P,Byrnes, G,Speare, R(2004).Head lice prevalence in primary schools in Victoria, Australia.J Paediatr Child Health,40,616-9.
5. Counahan, ML,Andrews, RM,Weld, H,Helen, W,Speare, R(2007).What parents in Australia know and do about head lice.Rural Remote Health,7,687.
6. De, Maeseneer, J,Blokland, I,Willems, S,Vander Stichele, R,Meersschaut, F(2000).Wet combing versus traditional scalp inspection to detect head lice in schoolchildren: observational study.BMJ,321,1187-8.
7. Falagas, ME,Matthaiou, DK,Rafailidis, PI,Panos, G,Pappas, G(2008).Worldwide prevalence of head lice.Emerg Infect Dis,14,1493-4.
8. Fan, PC,Chung, WC,Fan, CK,Huang, P,Yen, CW(1999).Prevalence and treatment of Pediculus capitis infestation among aboriginal school children in northern Taiwan.Kaohsiung J Med Sci,15,209-17.
9. Frankowski, BL(2004).American Academy of Pediatrics guidelines for the prevention and treatment of head lice infestation.Am J Manag Care,10,S269-72.
10. Gutiérrez, MM,González, JW,Stefanazzi, N,Serralunga, G,Yañez, L,Ferrero, AA(2012).Prevalence of Pediculus humanus capitis infestation among kindergarten children in Bahía Blanca city, Argentina.Parasitol Res,111,1309-13.
11. Handbook Of Non Drug Intervention (HANDI) Project Team(2013).Wet combing for the eradication of head lice.Aust Fam Physician,42,129-30.
12. Hansen, RC,O'Haver, J(2004).Economic considerations associated with Pediculus humanus capitis infestation.Clin Pediatr,43,523-7.
13. Hill, N,Moor, G,Cameron, MM(2005).Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom.BMJ,331,384-7.
14. Ibarra, J,Fry, F,Clarice, W(2007).Overcoming health inequalities by using the Bug Busting 'whole-school approach' to eradicate head lice.J Clin Nurs,16,1955-65.
15. Jahnke, C,Bauer, E,Hengge, UR,Feldmeier, H(2009).Accuracy of diagnosis of pediculosis capitis: visual inspection vs wet combing.Arch Dermatol,145,309-13.
16. Koch, E,Clark, JM,Cohen, B(2016).Management of head louse infestations in the United States - a literature review.Pediatr Dermatol,33,466-72.
17. Mumcuoglu, KY,Friger, M,Ioffe-Uspensky, I,Ben-Ishai, F,Miller, J(2001).Louse comb versus direct visual examination for the diagnosis of head louse infestations.Pediatr Dermatol,18,9-12.
18. Mumcuoglu, KY,Meinking, TA,Burkhart, CN,Burkhart, CG(2006).Head louse infestations: the "no nit" policy and its consequences.Int J Dermatol,45,891-6.
19. Nash, B(2003).Treating head lice.BMJ,326,1256-7.
20. Nolan, K,Kamrath, J,Levitt, J(2012).Lindane toxicity: a comprehensive review of the medical literature.Pediatr Dermatol,29,141-6.
21. Nutanson, I,Steen, CJ,Schwartz, RA,Janniger, CK(2008).Pediculus humanus capitis: an update.Acta Dermatovenerol Alp Panonica Adriat,17,147-154+156-157+159.
22. Paredes, SS,Estrada, R,Alarcon, H,Chavez, G,Romero, M,Hay, R(1997).Can school teachers improve the management and prevention of skin disease? A pilot study based on head louse infestations in Guerrero, Mexico.Int J Dermatol,36,826-30.
23. Price, JH,Burkhart, CN,Burkhart, CG,Islam, R(1999).School nurses' perceptions of and experiences with head lice.J Sch Health,69,153-8.
24. Roberts, RJ(2002).Clinical practice. Head lice.N Engl J Med,346,1645-50.
25. Sciscione, P,Krause-Parello, CA(2007).No-nit policies in schools: time for change.J Sch Nurs,23,13-20.
26. Speare, R,Buettner, PG(1999).Head lice in pupils in Australia and implications for control.Int J Dermatol,38,285-90.
27. Venna, S,Fleischer, AB, Jr,Feldman, SR(2001).Scabies and lice: review of the clinical features and management principles.Dermatol Nurs,13,257-62.