Socioeconomic status, family background and other key factors influence the management of head lice in Norway

Abstract

How head lice infestations are managed by households is an important but generally neglected issue in head lice research. In the present study, we investigate actions taken against head lice by Norwegian households in association with socioeconomic status, family background, school-related variables and other key factors. Repeat questionnaires distributed to caretakers of the same elementary school children during a 2-year period enabled us to study both previous head lice management and any changes in this management through time. Households from 12 schools spanning the main socioeconomic variation found in Norway participated in the study. All students with active head lice infestation were treated in the four investigated periods. Most caretakers used a thorough head lice checking technique and informed others of own infestation. Checking frequency was low as most children were inspected less than monthly. The best determinant of increased checking frequency and thoroughness was personal experience with head lice. The increased awareness, however, seemed to be somewhat short-lived, as there was a decrease in checking frequency and thoroughness within 1 year after infestation. Personal experience with head lice also increased general knowledge related to the parasite. Parents born in developing countries checked their children for head lice more frequently, although less thoroughly, informed fewer contacts when infested, used pediculicides preventively more often and knew less about head lice than parents born in developed countries. Households with highly educated mothers had a lower checking frequency, but their knowledge and willingness to inform others was high. Single parents were more concerned about economic costs and kept children home from school longer while infested than other parents. As head lice management varied among socioeconomic groups and with parental background, differentiated advice should be considered in the control of head lice. The biannual focus on head lice during the 2 years of investigation increased checking thoroughness, while checking frequency remained unchanged. Based on the results, we suggest new head lice management guidelines for health authorities.

Fig. 1

Reasons why households checked their student for head lice during the three investigated periods. The exact percentage is written above each bar

Fig. 2

Checking frequencies reported at the start of the investigation in students with and without previous head lice infestations in the household (either the participating child or siblings), as well as in all students combined. The exact percentage is written above each bar. n = 2,447

Fig. 3

Checking methods reported at the start of the investigation in students with and without previous head lice infestations in the household (either the participating child or siblings), as well as in all students combined. The exact percentage is written above each bar. n = 2,291

Fig. 4

Head lice treatment methods for infested students during the four investigated periods. The exact percentage is written above each bar

Fig. 5

Pediculicide products used by infested students during the four investigated periods. The exact percentage is written above each bar

Fig. 6

Groups informed when students had head lice during the investigation. The exact percentage is written above each bar