Scabies education in secondary schools: A multicenter study.

Background: The aim of this study was to educate secondary school students on etiology, risk factors, clinical features, treatment, and prevention of scabies; to evaluate their knowledge base on scabies before and after an educational intervention; and to reassess this knowledge base and behavioral change, 6 months after, on a second visit. Methods: Questionnaires with standard questions on scabies, graded to a maximum score of 10, were administered to students in junior secondary Classes 1 and 2 across 4 states in Nigeria. Information obtained included subjects' demographics, scabies symptomatology, risks, and preventive behaviors. Students with active scabies were diagnosed and treated. Data were analyzed with STATA. Results: The mean test scores for the pretest and posttest at first visit were 2.82 ± 1.38 and 6.30 ± 1.09, respectively. This difference was statistically significant at t = 3.95, P = 0.004. Six months later, when the same schools were re-visited, the mean test scores for the pretest and posttest were 4.63 ± 0.54 and 5.87 ± 0.25, respectively. This difference was also significant at t = 4.13, P = 0.003. The prevalence of scabies was 3.5% at first visit and 4.34% at second visit; t = 0.24, P = 0.41. Conclusions: Secondary school students lack basic education on scabies and exhibit high-risk behaviors for scabies transmission. Knowledge on scabies needs constant reinforcement.

RésuméContexte: Le but de cette étude était d'éduquer les élèves du secondaire sur l'étiologie, les facteurs de risque, les caractéristiques cliniques, le traitement et la prévention de la gale; évaluer leur base de connaissances sur la gale avant et après une intervention éducative; et de réévaluer cette base de connaissances et ce changement de comportement, six mois après, lors d'une deuxième visite. Méthodes: Des questionnaires contenant des questions standard sur la gale, notés à un score maximum de 10, ont été administrés aux élèves des classes 1 et 2 du premier cycle du secondaire dans 4 États du Nigéria. Les informations obtenues comprenaient la démographie des sujets, la symptomatologie de la gale, les risques et les comportements préventifs. Les étudiants atteints de gale active ont été diagnostiqués et traités. Les données ont été analysées avec STATA. Résultats: Les scores moyens aux tests avant et après le test lors de la première visite étaient respectivement de 2,82 ± 1,38 et 6,30 ± 1,09. Cette différence était statistiquement significative à t = 3,95, p = 0,004. Six mois plus tard, lorsque les mêmes écoles ont été revues, les scores moyens aux tests avant et après test étaient respectivement de 4,63 ± 0,54 et 5,87 ± 0,25. Cette différence était également significative à t = 4,13, p = 0,003. La prévalence de la gale était de 3,5% lors de la première visite et de 4,34% lors de la deuxième visite; t = 0,24, p = 0,41. Conclusions: Les élèves du secondaire manquent d'éducation de base sur la gale et présentent des comportements à haut risque de transmission de la gale. Les connaissances sur la gale nécessitent un renforcement constant.

Fatal Oculocutaneous Ecthyma Gangrenosum in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: Case Report and Review of the Literature.

Ecthyma gangrenosum (EG) is a rare, infective skin disease, predominantly but not exclusively caused by Pseudomonas aeruginosa. It is often seen in individuals with immunosuppression, although it has also been reported among previously healthy individuals. It was initially thought to be pathognomonic of P. aeruginosa septicemia, but this assertion was discarded following several reports on EG without bacteremia and EG with varied bacterial and fungal etiologies. There are scant reports of its association with human immunodeficiency virus (HIV) infection, while ocular involvement is extremely rare. An extensive search of the literature also found no report on EG, nor its relationship with HIV/acquired immunodeficiency syndrome (AIDS) from Sub-Saharan Africa. We hereby present a fatal case of multiple EG lesions in a 44-year-old Nigerian female with AIDS in the absence of bacteremia and review the literature of its association with HIV/AIDS and its concurrent orbital involvement.

Prevalence of skin infections, infestations, and papular urticaria among adolescents in secondary schools in Calabar, Nigeria.

BACKGROUND: Acne is an inflammatory disorder of the pilosebaceous gland, and the most common dermatosis in adolescents globally. Infectious dermatoses are common in the tropics, but due to the paucity of epidemiologic surveys, not much is known about the prevalence and common types found in different sub-populations including adolescents. It is however presumed that the prevalence will be high and the pattern diverse. We therefore conducted a school-based survey to ascertain the prevalence and pattern of infectious dermatoses, infestations, and papular urticaria (insect bite reactions) in teenage adolescents in Calabar, Nigeria. METHODS: A cross sectional observational survey of adolescents aged 13-19 years attending randomly selected secondary schools in Calabar, Nigeria. It involved the use of questionnaires and subsequent whole body examination. RESULTS: A total of 1447 senior secondary school students were examined. Infectious dermatoses, infestations, and papular urticaria (IDIP) were observed in 505 (34.9%) persons, among whom were 269 (53.3%) males, and 236 (46.7%) females (X2=34.87, p=<0.001). Fungal dermatoses constituted more than 90% of the diseases, the bulk of which was contributed by pityriasis versicolor [430 (79.6%)]. The six most common dermatoses in descending order of frequencies were Pityriasis versicolor, tinea, papular urticaria, candidiasis, furuncles, and viral warts. CONCLUSION: A high prevalence of cutaneous infections exists among teenage adolescents in Calabar, Nigeria. Males have a higher predisposition to fungal dermatoses. Control of the predominant cause of cutaneous infections - pityriasis versicolor, will significantly affect the prevalence of infectious dermatoses, and invariably, the burden of skin disorders in adolescents in Calabar, Nigeria. FUNDING: Self sponsored.

Skin diseases in Nigeria: the Calabar experience.

BACKGROUND: This paper reports on a 6-year study (April 2006 to April 2012) and a follow-up of a 9-month baseline survey of the pattern of dermatoses in Calabar, the capital of Cross River State in southern Nigeria. Prior to the time of this study, this region had not benefited from the services of a resident dermatologist for over a century. METHODS: Data on the age, gender, and diagnoses of 1307 consecutive new patients attending the relatively new dermatology clinic at the University of Calabar Teaching Hospital during the study period were obtained and analyzed. Most diagnoses were based on clinical findings but were supported by relevant laboratory investigations and histopathologic examinations when necessary. RESULTS: The male : female ratio of patients was 1 : 1.5. The mean ± standard deviation age of the patients was 27.7 ± 17.2 years (range: 4 weeks to 84 years). A total of 1459 diagnoses were recorded; 143 patients had more than one dermatosis. Diagnoses were broadly divided into 10 groups. Allergic/hypersensitivity diseases represented the most common group (30.4%), followed by infections/infestations (28.9%). A comparison of this study with others from various geopolitical zones of Nigeria revealed some similarities. Dermatophytosis and acne were consistent reasons for visits to dermatologists in all zones. CONCLUSIONS: Despite the wide spectrum of dermatoses observed, a small number of diseases account for a sizeable percentage of diagnoses. The pattern of dermatoses in Calabar is similar to that in other parts of the country. Climate and socioeconomic factors are synergistic in causing dermatoses that remain a major cause of morbidity in all age groups and both genders across Nigeria.

Severity and impact of acne vulgaris on the quality of life of adolescents in Nigeria.

BACKGROUND: Acne vulgaris is a common skin condition, which affects most adolescents at some point in their lives. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicide ideation. Many studies have assessed the impact of acne vulgaris on the quality of life (QoL) in different population subgroups around the world, but there is a dearth of reports from the African subcontinent. This study thus seeks to assess the severity of acne vulgaris and determine its effect on the QoL of adolescents in Lagos, Nigeria. METHODS: In a cross-sectional survey employing a two-stage sampling method, the severity of acne vulgaris and its impact on the QoL of adolescents attending a senior secondary school in Lagos, Nigeria was assessed using the Global Acne Grading Scale (GAGS) and the Cardiff Acne Disability Index (CADI), respectively. The correlation between the results of the GAGS and CADI was also determined. RESULTS: One hundred and sixty adolescent students with acne were recruited, with males accounting for 51.9% and females 48.1%. The mean and standard deviation of the GAGS severity scores were 11.3±5.4 for males and 11.9±5.4 for females. Only one student had severe acne vulgaris (GAGS, 31-38), 10% moderate (GAGS, 19-30), and 89.4% mild (GAGS, 1-18). The overall CADI score was 3.4±3.0, which suggests mild impairment in QoL; however, the solitary student with severe acne had severe QoL impairment. There was a weak positive correlation between the GAGS and the CADI score. CONCLUSION: Most adolescents in our study had mild acne vulgaris, and the overall impact on their QoL was mild. However, the correlation between the psychosocial impact and acne severity was weak. There is a need for similar studies in other parts of the country and for further studies to determine the adequacy of the existing instruments in assessing the impact of acne vulgaris in Nigerian adolescents.

Dermatologic conditions in teenage adolescents in Nigeria.

BACKGROUND: Skin disorders are common in adolescents, and the impact on quality of life can be enormous, particularly when viewed against the backdrop of the visibility of skin diseases and the psychologically vulnerable period of adolescence. However, few studies have documented the magnitude of skin disorders in this subset of individuals. We therefore estimated the point prevalence and pattern of dermatologic conditions in adolescents attending various secondary schools in Calabar, Southern Nigeria. METHODS: Using a structured questionnaire, relevant sociodemographic information was obtained from 1,447 teenage adolescents from eight secondary schools. Thereafter, a whole body examination was conducted to determine the presence and types of skin disorders seen. RESULTS: Skin diseases were seen in 929 students. The point prevalence was higher in males (72.1%) than in females (58.3%). Private schools had a higher prevalence than public schools. The six most common dermatoses were acne vulgaris, pityriasis versicolor, nevi, tinea, miliaria, and keloid/hypertrophic scars, and accounted for over 80% of the dermatoses seen. CONCLUSION: The point prevalence of dermatoses in senior secondary school adolescents was 64.2%. Although a large number of skin disorders were observed, only a handful accounted for a significant proportion of the diseases seen. This increases the ease of training community health workers in the recognition and treatment of common skin diseases. Age, race, and climatic factors are important determinants of skin diseases in adolescents in Nigeria.