head lice a randomised controlled trial comparing the effectiveness of traditional head lice lotion...
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Head lice A Randomised Controlled Trial
Comparing the effectiveness of traditional head lice lotion with the bug-busting method of managing
head lice infestation.L Plastow, M Luthra, M Marshall,
D Russell, J Wright.Mt. Pleasant Health Centre, Exeter. R Powell, Exeter & N.Devon RDSU
Aim
To compare the effectiveness of
traditional head lice lotion
(phenothrin) with the bug-busting
method of managing head lice
infestation
Intervention versus control
Control Group
Phenothrin:SmellTolerabilityApplication
Intervention versus control
Intervention Group
Bug-busting Pack:C.H.C.CombsConditioner
Context
Setting: Two semi-rural General Practices in East Devon
Participants: 30 children aged 4-16 years randomly assigned to the two intervention groups phenothrin and bug-busting
Ethical approval: granted by Exeter Ethics Committee
Funding: Northcott Foundation
Rationale
Incidence Reluctance by parents
to use traditional lotions
Trust policy- no evidence base
Cost Changing role of school
nurse
Participants
1. Recruitment – school, G.P., Pharmacy
2. Randomisation-children chose sealed envelopes
3. Parents and siblings – data included only if criteria met
Exclusion Criteria
Active symptomatic asthma Persistent skin disorder of
scalp Treated with head lice lotion
within previous 4 weeks Hair: bleached, permed,
coloured Sensitivity to pyrethroid,
organophosphate and or carbon insecticides
Sensitivity to chrysanthemums
Baseline Characteristics
69Hair length below collar
53Hair length to collar
43Hair length short
95No with non-infested siblings
56
14No of single child families
1211Sex: Female
34Sex: Male
9.27, SD 3.958.1, SD 2.56Mean Age
Control Group (Lotion)Treatment Group BBPCharacteristics
No with infested siblings in the same household
Main Outcome Measure
Absence of live lice at Day 14
Intervention
Control Group Day 1- Combed dry. Lice found stuck on CRF.
Lotion applied Day 4- no intervention Day 7 – as Day 1 Day 10- no intervention Day14 Combed dry. Lice removed stuck on CRF
Intervention
Intervention Group Day 1- Combed dry. Lice
found stuck on CRF. Conditioner applied. Combed using BBP
Day 4- Conditioner applied. Combed using BBP
Day 7 – as Day 1 Day 10- as Day 4 Day 14 Combed dry. Lice
removed stuck on CRF
Statistical Analysis
Intention to treat analysis was conducted using Mann Whitney U test (Non-parametric) for continuous data.
Where there was no evidence of skewness, Chi-squared was conducted for categorical data
Results
Day 1 Children in BBP infested
with median of 8 lice at any stage in development compared with a median of 10 in the lotion group.
This difference was not significant (p>.05).
Day Seven Results
Children in BBP were infested with a median of 3 lice at any stage in development compared with a median of 15 in the lotion group.
This difference was significant (p=0.041)
Day Fourteen Results
Children in BBP were infested with a median of 0 lice at any stage in development compared with a median of 5 in the lotion group.
This difference was significant (p=0.008)
Results
1515 1515 1515 1515 1515 1515N =
trial group - wet-combing or lotion
lotionwet-combing
160
140
120
100
80
60
40
20
0
-20
Day 1 instars
Day 1 adults
Day 7 instars
Day 7 adults
Day 14 instars
Day 14 adults
1927
538
19
27
853
1918
8
18
5
43
18
4
18
5
Key Findings
Intervention Group
Cumulative body count on days 1,7, 14 = 466
Reducing body count as a result of effective BB Intervention
Key Findings
Control Group
Cumulative body count on days 1,7, 14 = 1028
Increasing body count as a result of egg hatching and reproduction of lice not killed by lotion application
Key Findings
Intervention Group At Day 7 the number
of living nymphs was 218 (47%)
At day 14 the number of living nymphs was 29 (6%) (p<0.001)
Key Findings
Control Group At Day 7 the number
of living nymphs was 462 (45%)
At day 14 the number of living nymphs was 280 (27%) (p<0.001)
Summary
NNT 2.5 (95% CI: 2.19 to 2.81)
A minimum of two applications of lotion required for clinical effectiveness
The BBP method is likely to be more effective than traditional methods