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Background Headlice are prevalent worldwide, with a higher burden in rural, lower-middle income settings. They can cause intense itchiness, discomfort, and secondary bacterial infections with potentially serious consequences. Ivermectin is efficacious against headlice, and is also being evaluated as a malaria vector control tool. In this study, we explored risk factors for headlice, and assessed the efficacy of ivermectin mass drug administration (MDA) designed for malaria against headlice. Methods We conducted an open-label, assessor-blind, cluster-randomized controlled trial in Mopeia, Mozambique. A single dose of ivermectin was given monthly to eligible humans or humans and livestock (humans: 400 μg/kg, livestock: 1% injectable 200 μg/kg) in 3 consecutive months during the rainy season. The control group received albendazole (humans only). Thirty-nine clusters (13 per arm) were randomly selected for the nested assessment of headlice prevalence. 1341 treated participants were followed up at least once, 1, 2 and 3 months and 382 untreated (ineligible) participants at 3 and 6 months after the first MDA round. Headlice diagnosis was determined by scalp examination. Logistic regression was used to identify risk factors for headlice at baseline, and to estimate the treatment effect at each time point. Results A total of 1309 participants were included in the main analysis assessing ivermectin MDA efficacy, and 1332 in the risk factor analysis. The baseline headlice prevalence was 11%. Risk factors included living with a household member with head itch [adjusted odds ratio (a OR ) = 48.63, 95% confidence interval ( CI ): 28.7–82.3, P -value < 0.0001], being female (a OR  = 2.25, 95% CI: 1.33–3.80, P -value < 0.01), and using surface water as the main water (a OR  = 2.37, 95% CI: 1.12–5.33, P -value = 0.04). The treated population receiving ivermectin had significantly lower odds of having headlice at 3 months compared to those receiving albendazole (a OR  = 0.19, 95% CI: 0.04–0.91, P -value = 0.04). There was no indirect effect on headlice among children ineligible for treatment. Conclusions In a highly endemic setting, mass drug administration with ivermectin significantly reduces headlice infestation prevalence among those who receive the drug for three sequential months. The lack of effect among untreated, ineligible children implies that additional interventions would be needed to interrupt local transmission. Trial registration This study is registered with ClinicalTrials.gov (NCT04966702). Graphical Abstract

Pediculosis is a common parasitic infestation in students worldwide, including Iran. This condition is more prevalent in populous and deprived communities with poor personal hygiene. This study sought to assess the efficacy of peer education for adopting preventive behaviors against pediculosis in female elementary school students based on the Health Belief Model (HBM). A total of 179 female fifth grade students were selected using multistage random sampling and were randomly allocated to control and intervention groups. A standard questionnaire was designed and administered to collect baseline information. An educational intervention was then designed based on the conducted needs assessment. The educational program consisted of three sessions, held by peers for the intervention group. The questionnaire was re-administered one month after the intervention. Independent and paired t-test, Pearson's correlation coefficient, and regression analysis were applied as appropriate. The two groups had no significant differences in the scores of knowledge, HBM constructs, or behavior before the intervention. After the intervention, however, the mean scores of all parameters significantly improved in the intervention group. Peer education based on HBM is an effective strategy to promote preventive behaviors against pediculosis in among fifth grade female elementary school students in Iran.

Purpose The patient impact of chemotherapy-induced alopecia (CIA) is high. Scalp cooling is applied to reduce CIA. The potential optimum post-infusion cooling times (PICTs) are currently unknown. Methods Scalp cooling was applied in 53 patients receiving docetaxel chemotherapy with 90-min PICT (observational part). Also 15 non-scalp-cooled patients were included. If hair preservation was observed in >80 % of the patients, randomisation between 45 and 90-min PICT was planned. Patients reported tolerance of scalp cooling and use of head covering. Results Observational study: 81 % of scalp-cooled patients did not require head covering versus 27 % of non-scalp-cooled patients. Randomised study: 79 % of 38 patients with 90-min PICT did not need head covering versus 95 % of 38 patients with 45-min PICT ( p  = 0.04). Scalp cooling was very well tolerated (visual analogue scale = 79). Conclusion A 45-min PICT can be recommended in 3-weekly docetaxel regimens with a dose of 75 or 100 mg/m 2 , administered in 60 min. The shorter PICT is a major advantage in time investment for patients. Patients (women and men) who receive docetaxel, except combined with doxorubicin and cyclophosphamide (taxotere, adriamycin and cyclophosphamide (TAC)) should be informed about the protective effect and high tolerability of scalp cooling in avoiding CIA.

To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis (head lice) in resource-poor communities. We studied 132 children without head lice who lived in a slum in north-eastern Brazil. We randomized the households of the study participants into an intervention and a control group and prospectively calculated the incidence of infestation with head lice among the children in each group. In the intervention group, all of the children's family members who lived in the household were treated with ivermectin; in the control group, no family member was treated. We used the chi(2) test with continuity correction or Fisher's exact test to compare proportions. We performed survival analysis using Kaplan-Meier estimates with log rank testing and the Mann-Whitney U test to analyse the length of lice-free periods among sentinel children, and we used Cox regression to analyse survival data on a multivariate level. We also carried out a subgroup analysis based on gender. Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group. The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11-45), as compared to 14 days (IQR: 11-25) in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005). After treatment with ivermectin, the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys. Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period. In an impoverished community, girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation. To decrease the number of head lice episodes per unit of time, control measures should include the treatment of all household contacts. Mass treatment with ivermectin may reduce the incidence of head lice infestation and associated morbidity in resource-poor communities.

Abstract Objective To compare the effectiveness of the Bug Buster kit with a single treatment of over the counter pediculicides for eliminating head lice. Design Single blind, multicentre, randomised, comparative clinical study. Setting Four counties in England and one county in Scotland. Participants 133 young people aged 2-15 years with head louse infestation: 56 were allocated to the Bug Buster kit and 70 to pediculicide treatment. Interventions Home use of proprietary pediculicides (organophosphate or pyrethroid) or the Bug Buster kit. Main outcome measure Presence of head lice 2-4 days after end of treatment: day 5 for the pediculicides and day 15 for the Bug Buster kit. Results The cure rate using the Bug Buster kit was significantly greater than that for the pediculicides (57% v 13%; relative risk 4.4, 95% confidence interval 2.3 to 8.5). Number needed to treat for the Bug Buster kit compared with the pediculicides was 2.26. Conclusion The Bug Buster kit was the most effective over the counter treatment for head louse infestation in the community when compared with pediculicides.

An important health problem in students is pediculosis capitis (head lice infestation) which causes physical, mental, and social complications. Social stigma induces feeling of shame, anger, and embarrassment for families and may prevent people from coming forward. This study was a quasi-experimental (case - control) study which was done during periods of 2008 - 2009. Data collection tools were questionnaire, checklist, and head examination. Two schools were randomly selected among female primary schools in Chabahar, where 153 students were divided into case and control groups. After collecting the data, an educational program was designed and performed in the experimental group and was evaluated after two months. The results showed a significant difference in knowledge, attitude, and practice of the students in the case group, before and after the intervention (P < 0.0001), but in the control group it was not significant (P > 0.05) .The infestation rate was 69.3% in the case group before the intervention, and 82.1 % in the control group, which decreased to 26.7% in the case group after the education (P < 0.0001), but there was no significant difference in the control group (P < 0.05). The health education program had a positive effect on the reduction of pediculosis capitis among students; thus, it is suggested to perform and evaluate educational programs in students and their parents.

Head lice infestation (HLI), caused by , is an important public health problem worldwide, especially in primary school children. The aim of this study is to investigate HLI level, related factors, and families' knowledge levels and attitudes about HLI in two primary schools in a relatively low socio-economic region in İstanbul. A questionnaire on HLI was developed initially and delivered to all children and parents in the school. A total of 340 primary school students, aged between 6-12, were enrolled in the study after the consent of their parents. Their hair were examined for HLI with special combs at their schools, and free anti-lice shampoos were given to parents of positive children. A total of 951 completed questionnaires were received and evaluated with chi-square test using the SPSS 17.0 program, and the differences of p<0.05 were considered significant. Number of boys in the study was slightly higher than the girls (176 vs. 164). HLI was detected in 32 (9.4%) of 340 children; seven had live adult lice on their hair while 25 had only the nits. HLI was obviously more common in girls (16.4%), compared to boys (2.8%). Analysis of 951 questionnaires revealed a statistically significant difference between HLI and infrequent bathing (p<0.05). The differences between HLI and the education levels of parents, income, the number of siblings and in contact with animals were not found to be significant (p>0.05). HLI is still a common health problem, especially in girls in primary schools. Parents are aware of the relationship between the hygiene and prevention against HLI, but low socio-economic resources seem to be important determinants. Regular combing and training activities in primary schools, in coordination with the local authorities and parents are no doubt useful in reducing the incidence of HLI among the children.

The human head louse, Pediculus humanus capitis (Anoplura: Pediculidae), is an ectoparasite confined to the scalp and human hairs. The repeated use of insecticides for the control of head lice during past decades has resulted in the development of marked levels of resistance. Natural compounds such as essential oils (EOs) have been suggested as alternative sources for insect control agents. In order to introduce a new pediculicide based on EOs, the effectiveness of the product and their effects on human being must be analyzed. In consequence, the biological activity of EOs from the leaves and fruits of Schinus areira (Anacardiaceae) and the leaves of Thymus vulgaris (Lamiaceae), Aloysia polystachya and Aloysia citriodora (Verbenacea) were evaluated against the eggs and adults of P. humanus capitis by fumigant and contact toxicity bioassays. Additionally, dermal corrosion/irritation tests were performed on New Zealand albino rabbits. In a fumigant bioassay, EOs from the leaves and fruits of S. areira were the most toxic against P. humanus capitis adults while these EOs and T. vulgaris were the most effective against the eggs. In contact bioassay, the EO from T. vulgaris was the most toxic against both stages. In the corrosion/irritation tests, the EOs did not produce dermal effects. According to the results, the essential oils from the leaves of T. vulgaris would be a valid tool for the management of P. humanus capitis. This EO produces a high knockdown effect in adults (followed by mortality) and toxicity in the eggs when it is applied for 21 min at a low concentration.

Head lice infestation (HLI) caused by Pediculus humanus capitis has been a public health problem worldwide. Specially designed combs are used to identify head lice, while anti-lice products are applied on the scalp for treatment. In the present study, we aimed to test whether combing only by precision detection comb (PDC) or metal pin comb (MPC) could be effective alternatives to the use of anti-lice products in children. A total of 560 children from two rural schools in Turkey were screened. In the PDC trial, children were combed every second day for 14 days, while in the MPC trial, combing was performed once in every four days for 15 days. Children were divided into two groups (dry combing and wet combing) for both trials and results were compared. The results showed no significant differences between dry and wet combing strategies for both combs for the removal of head lice (p > 0.05). The number of adult head lice declined significantly on each subsequent combing day in both approaches, except on day 15 in the MPC trial. In the end, no louse was found in 54.1 and 48.9 % of children in the PDC and MPC trials, respectively. Since family members of infested children were not available, they were not checked for HLI. Four times combing within 2 weeks with MPC combs was found effective for both treatment of low HLI and prevention of heavy HLI. In conclusion, regular combing by special combs decreases HLI level in children and is safely applicable as long-term treatment.

Head lice is the most commonly reported complaint by parents and teachers to schools and up to one quarter of primary school aged children have head lice at any one time. New South Wales (NSW) Health, in collaboration with the NSW Department of Education and Communities and the NSW Federation of Parents and Citizens Associations, has previously implemented the 'Nitbusters Head Lice in Schools Program' across 28 schools in NSW, many located within disadvantaged communities. The program uses a whole-school approach in educating teachers, school support staff, children and parents about head lice and how to remove them. Importantly, Nitbusters promotes the use of the conditioner and comb treatment method, a cheap, accessible and effective method of head lice control. This program has not been formally evaluated, but similar initiatives undertaken in the United Kingdom have led to a decrease in the prevalence of head lice in disadvantaged areas.