title: Prevalence of head lice and hygiene practices among women over twelve years of age in Sindh, Balochistan, and North West Frontier Province: National Health Survey of Pakistan, 1990-1994.
abstract: BACKGROUND
  Head lice infestation is an infection of the scalp and skin which causes blood loss, discomfort, and social and psychological distress with the possibility of secondary bacterial infections occurring at scratch sites. In Pakistan, although some small scale studies have been conducted to investigate prevalence of head lice in school children and the general population, no population based estimates have been reported. The National Health Survey of Pakistan (NHSP 1990 - 94) was a nationally representative health examination survey of the Pakistani population. The NHSP is the first population based household survey to collect data on the prevalence of head lice in adult women in Pakistan. In this paper we use data from the NHSP to present an epidemiological profile of personal hygiene practices and head lice infestation among women aged 12 years or older in three provinces of Pakistan; Balochistan, Sindh and North West Frontier Province (NWFP).
  
  
  RESULTS
  Overall about 7% women aged 12 years and older suffered from head lice infestation. Multivariable logistic regression analysis identified factors independently associated with presence of head lice. Age less than 16 years and crowding at home were associated with higher infestation-rates. The impact of household socio-economic status on infestation rates among women was different in urban and rural settings; urban women with low socio-economic status were more vulnerable than similar women in rural settings. Bathing infrequently in summer was associated with higher prevalence rates only in Sindh, possibly due to the fact that among the three provinces Sindh has a hotter and more humid summer.
  
  
  CONCLUSIONS
  The results of our analysis of NHSP indicate high levels of head lice infestation among girls and women in the three Provinces. The epidemiological profile of hygienic practices of women indicated that NWFP and Balochistan as compared to Sindh, and rural as compared to urban areas were less developed with respect to access to water supply and soap for maintaining personal hygiene. Simple and cost-effective measures such as provision of water and soap, and improving awareness regarding maintaining personal hygiene can contribute significantly towards improving public health status of the women in Pakistan.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P O Box 3500, 74800 Karachi, Pakistan. sadia.mahmud@aku.edu
authors.forename: Sadia
authors.initials: S
authors.lastname: Mahmud
authors.forename: Gregory
authors.initials: G
authors.lastname: Pappas
authors.forename: Wilbur C
authors.initials: WC
authors.lastname: Hadden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D006306:Health Surveys; D006801:Humans; D006920:Hygiene; D010373:Lice Infestations / Q000453:epidemiology* / Q000469:parasitology; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010374:Pediculus / Q000254:growth & development*; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult