Tinea capitis is a fungal infection of the scalp. It is an important infective  superficial  dermatological  disease of worldwide distribution among children. The fungus is either within  the  hair shaft (endothrix) or spread out over the hair surface (ectothrix). Tinea capitis usually gives dull gray, circular patches of alopecia, scaling, itching, and often with a black dot (Brooks et al., 2010).

T. capitis is much common in children, especially those of black African origin, whose scalp and hair seems more susceptible to fungal invasion (Kumar and Clark, 2009).

In the tropics, tinea capitis is usually aesthetically unacceptable, as it “can be unsightly or disfiguring” (Fathi and Al-Samarai, 2000). In Nigeria, its prevalence has been correlated with the warm humid climate, crowded living, poor sanitary condition of majority of the populace, which has been enhancing the spread of the disease (Ayanlowo et al., 2014).

T. capitis is a not a notifiable disease in Nigeria but it is a cause for concern due to its contagious nature. It inflicts a lot of psychosocial trauma due to attached social stigma as well as representing a potential source of secondary bacterial infection if not adequately treated.  It is endemic in Nigeria and many factors have been attributed to the spread of this condition which includes warm and humid conditions, poor socioeconomic status of the majority of the populace linked to poor environmental sanitary conditions (Anosike et al., 2005).

The aetiological agents vary from one geographical location to another. In Africa, Microsporum audouinii and Trichophyton soudanese are predominant (Ameen, 2010; Anosike et al., 2005; Ayanbimpe et al., 2003). In the western regions of the world, Trichophyton tonsurans has emerged the predominant cause of T. capitis (Ameen, 2010). Variations have been observed even within the country (Akinboro et al., 2011; Enendu and Ibe, 2005; Ayanbimpe et al., 2003).

Attention is not drawn to it because of the relatively benign course of the disease and also not being a notifiable disease. Thus, the actual prevalence figures are unknown in many endemic areas (Anosike et al., 2005). Variety of treatments have been formulated by the locals and applied, majority of which are largely ineffective and has contributed to its relative persistence in this community.

Ringworm of the scalp is presently one of the commonest dermatophytoses in Nigeria. Published reports are however very scanty in this area and a major study in Ile-Ife was last conducted in 1985 (Ajao and Akintunde, 1985) which focused mainly on the prevalence of the disease and the aetiological pathogens. Other studies had also looked at prevalence without relating it to hygiene. This study however intends to assess the prevailing situation of T. capitis and its relationship with level of hygiene.

Cross-sectional study was conducted at Ife Central local Government Area  of  Osun  State,  Nigeria  among  primary  school pupils during the months of March and April, 2017.  The minimum sample size was determined by using the formula for calculating sample size for single proportions (Araoye, 2003).

n – desired sample size

z –confidence level which corresponds to the standard normal deviate usually set at 1.96

p – Prevalence = 45% that is, 0.45 (Dogo et al., 2016)

σ – Error margin i.e. a degree of accuracy required and usually sets at 5% that is, 0.05

n = 380 (which was rounded off to 420 to allow for attrition of 10%)

A list of all the private and public primary schools in Ife central area was retrieved from the Local Inspectorate of Education office. It contained a total of 36 public schools and 20 private schools. Multi-stage sampling technique was employed to select the respondents. At the 1st stage, schools were stratified into private and public thereafter at the 2nd stage, 4 schools each were selected from both public and private schools from a list of schools making a total of 8 schools using a simple random sampling technique. At the 3rd stage, 210 pupils each were selected to participate from public and private schools using sampling proportionate to size based on enrolment in each school. In each of the schools, pupils from all levels were selected randomly from class list.

Pupils of public and private primary schools whose head teachers accepted to participate in the study were enrolled in the study while pupils who were ill or not willing to participate in the study were excluded. An interviewer-administered questionnaire was used to assess the pupils’ personal and school hygiene. The questionnaire contained 2 sections: biodata and hygiene practices of pupils. Information on the educational status of the mother and the job description of the respondent’s father was also collected and used for socioeconomic stratification into social class 1 to 5 (Oyedeji, 1985).

In this study, class 1 and 2 were grouped as upper social class, class 3 as middle social class while class 4 and 5 were grouped as lower social class to aid data analysis. Personal hygiene score was calculated by scoring individual pupil’s bathing frequency, frequency of washing hair with soap, comb sharing, frequency of hair-do, playing with sand and playing with domestic animals. The scores were categorized as poor (0 to 2), average (3 to 5), good (6 to 9). The internal consistency was assessed using Cronbach’s alpha and split half technique. Cronbach alpha was 0.51 which was fair and split half had equal loading.

A physical examination was also conducted to assess students for T. capitis by a public health physician who assessed the following characteristics (scaly patches on the scalp, with or without hair loss; partial hair loss with broken-off hairs, brittle and lusterless hair strands, annular lesions with fairly sharp margins, massive scaling and folliculitis). Skin scrapings from the active edge of the lesion were taken into a sterile blotting paper using the edge of a glass slide from those with features suggestive of T. capitis. Samples were thereafter taken for mycological examination. Identification of all specimens taken from the scalp were done by direct microscopy with 10% potassium hydroxide. Specimens were cultured in sabouraud dextrose agar impregnated with chlorhexidine and the  samples  were  then  inoculated  into  separate petri dishes and incubated at 37^oC for 3 to 4 weeks. Data were analyzed using IBM-SPSS version 20. Univariate analysis was carried out to determine the socio-demographic distribution of study participants through the use of frequency tables and percentages. Chi-square test was carried out to determine significance of association while a binary logistic regression analysis was done to ascertain the determinants of T. capitis and p- value was significant at <0.05.

Ethical clearance was obtained from the Ethics committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife (HREC number: IPHOAU/12/657). Permission was taken from the Local Inspectorate of Education office and school authorities. Informed consent was obtained from parents while assent was taken from the pupils. All patients with T. capitis were treated with topical antifungal agent (Whitfield’s ointment, which contains 6% w/w benzoic and 3% w/w salicylic acid).

Table1 showed that two-fifth of the respondents (40%) were within the age group of 7 to 9 years. Majorities were of the Yoruba ethnicity (52.4%) and were in the middle social class (47.6%) while mother’s highest level of education was primary school (42.9%). Table 2 showed the prevalence of T. capitis was 21.7%. Aspergillus brasiliensis a contaminant was the highest fungal isolate (33%) while Epidermophyton floccosum (12.0%) was the commonest dermatophyte isolated followed by Microsporum gypseum and Trichophyton metangrophytes (7.7%) each.

Regarding the result of Table 3, present study showed that less than half of the respondents (47.0%) had their bath twice daily, while 52.4% shared their combs with others. Majority of the respondents (51.3%) washed their hair with soap daily. Most of the female respondents had their hair done once in a month (50.0%) while 44.2% of the boys shaved with their personal clipper. About 14% of the respondents played with sand and 42.8% played with domestic pets. Overall about half of the respondents (48.6%) have poor level of hygiene. This study revealed that  there was a statistically significant  association between social class and presence of T. capitis with 13% of pupils from upper social class having T. capitis compared to 42% of those from lower social class (p<0.001) and a statistically significantly higher proportion of pupils from public school  having T. capitis (25.7%) compared to 17.6% of pupils from private school (p=0.04). There was no statistically significant association between sex and presence of T. capitis (p=0.34) as shown in Table 4.

According to Table 5 there was a statistically significant relationship between frequency of bath and presence of T. capitis with over a third of the respondents(36.8%) who had their bath daily having T. capitis compared to 6.7% of their counterpart who had their bath more than once daily (p< 0.001). 33% of respondents who shared combs had T. capitis compared to  10% of their counterparts who do not share comb (p<0.001). 28% of the respondents who played with domestic animals/pets had T. capitis compared to 17% of those who do not (p<0.001) while 92% of those that played with sand had T. capitis compared to 10% of those that do not play with sand (p<0.001). There was a statistically significant relationship between upkeep of the hair in both sexes and presence of T. capitis (p<0.001). Use of personal clippers was also associated with T. capitis with T. capitis occurring in 11% of those who use personal clippers compared to 27% of those who do not use (p=0.003).

The principal determinants of T. capitis were school type and personal hygiene status. Pupils in a public school were four times more likely to have T. capitis than those in private schools. Pupils with good hygiene were four  times  less likely  to  have T. capitis  than  those with poor personal hygiene (Table 6).

Hygiene status of an individual’s skin has been cited as one of the risk factors associated with the acquisition of dermatophyte infections. The poorer the hygiene, the higher the chances of acquiring infection. This assertion is corroborated by our study which reported a statistically significant relationship between level of hygiene and presence of T. capitis. This finding is in keeping with findings of other previous study in Nigeria and other African countries (Amoran et al, 2011; Ali et al., 2009; Menan et al., 2002).

Prevalence of T. capitis is still high in this environment, personal hygiene and socio-economic status are important predictors of T. capitis infection. Thus, more attention needs to be paid to personal hygiene through health promotion and education interventions to reduce the scourge of T. capitis.

The authors have not declared any conflict of interests.