Dermatological disorders among primary school children in Dar es Salaam region, Tanzania

Abstract

Background: While skin diseases are very common among populations in many developing countries, they have not been regarded as a significant problem that could benefit from public health measures. According to previous studies, the prevalence of skin disorders ranges from 21 % to 87%. Although skin disorders are commonly observed in children, there are no many studies on this subject. Few studies have established the etiology of the infective skin conditions and most of them are very old. Objectives: To determine the prevalence of dermatological disorders among primary school children in Dar es salaam region. Materials and Methods: The study was conducted among primary school children from six schools {two from each municipal) of Dar es Salaam region. Multistage sampling technique was used to get the study subjects. Pupils from standard I-VII whose parents/guardians had consented participated in the study. Pupils were visited and interviewed using interview administered questionnaires and were examined for skin disorders at their schools. The examination was performed by the author and in difficult cases the diagnosis was made with the help of a dermatologist (supervisor). The diagnosis of skin disorders was based on clinical features but in some infective skin disorders (fungal and bacterial infections and scabies) laboratory confirmation was made. Specimens from lesions suspected of fungal infections (skin scrapings, hairs, nails) were collected and subjected to microscopy (KOH preparation) and Culture on Sabouraud's Dextrose agar. Identification of growth was done on the 14th and 28th days by colonial characteristics and biochemical testing. Specimens suspected of bacterial infections (pus swabs) were processed by gram staining and culture on Blood and MacConkey agars. Identification of growths was done basing on colonial characteristics and biochemical testing. Results: A total of 420 pupils were enrolled into this study, of whom 213 (51 %) were boys and 207 (49%) were girls with a mean age of 11.4±2.8 (range 6-19 years). The overall point prevalence of one or more skin disorders was 57%. Of those studied, 201/420 (48%) children had only one skin disorder, 37/420 (9%) had two, and 3/420 (1 %) had three skin disorders. Infectious skin diseases were frequently observed: Superficial skin fungal (dermatophyte) infections in 82/420 (20%), pityriasis versicolor in 36/420 (9%), pediculosis capitis in 15/420 (4%), pyoderma in 8/420 (2%), scabies in 6/420 (1 %) and viral warts in 6/420 (1 %). The other common skin disorders were acne vulgaris in 53/420 (13%), ulcers in 12/420 (3%), tropical folliculitis in 9/420 (2%), atopic eczema in 8/420 (2%), birth marks in 10/420 (2%), keratosis pilaris in 5/420 (1%), papular urticaria in 5/420 (1 %), angular cheilitis in 5/420 (1 %) and bum scars in 5/420 (1 %). Overall, skin disorders were more common in boys and in older pupils. Dermatophyte infections were more common in boys and younger pupils. Acne vulgaris and pityriasis versicolor were more common in older pupils. The majority of pupils did not seek any medical care for their skin disorders. The socioeconomic parameters that were assessed were not associated with dermatophyte and pityriasis versicolor infections or pediculosis infestation except for a large mean number of persons sleeping in one room which was significantly associated with infection with pityriasis versicolor. Microsporum canis was the most frequent isolate from fungal specimens and was also responsible for most of tinea capitis cases. Trichophyton rubrum was the most common agent for tinea pedis. Among the bacterial isolates, Staphylococcus aureus was the most common agent. Conclusions and recommendations: This study shows that skin disorders are common in children and about two thirds are affected at any given time. The finding that about 95% of the disorders can be grouped into fewer than ten categories is important in designing training programmes for medical teams involved in the delivery of primary health care services in developing countries like Tanzania. Pupils were not adequately motivated to seek medical assistance for their skin conditions despite the fact that most of the skin disorders were potentially treatable. There is need to strengthen school health programmes that exist so that regular skin examinations are performed to limit the spread of contagious skin disorders such as tinea capitis and scabies. Efforts should be made to educate families of infected pupils about seeking medical care once they find that they have skin disorders.