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Head lice A Randomised Controlled Trial

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.

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Head lice A Randomised Controlled Trial

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  1. 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

  2. Aim To compare the effectiveness of traditional head lice lotion (phenothrin) with the bug-busting method of managing head lice infestation

  3. Intervention versus control Control Group Phenothrin: Smell Tolerability Application

  4. Intervention versus control Intervention Group Bug-busting Pack: C.H.C. Combs Conditioner

  5. 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

  6. Rationale • Incidence • Reluctance by parents to use traditional lotions • Trust policy- no evidence base • Cost • Changing role of school nurse

  7. Participants 1. Recruitment – school, G.P., Pharmacy 2. Randomisation-children chose sealed envelopes 3. Parents and siblings – data included only if criteria met

  8. 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

  9. Characteristics Treatment GroupBBP Control Group (Lotion) Mean Age 8.1, SD 2.56 9.27, SD 3.95 Sex: Male 4 3 Sex: Female 11 12 No of single child families 4 1 6 5 No with non-infested siblings 5 9 Hair length short 3 4 Hair length to collar 3 5 Hair length below collar 9 6 Baseline Characteristics No with infested siblings in the same household

  10. Main Outcome Measure • Absence of live lice at Day 14

  11. 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

  12. 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

  13. 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

  14. 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).

  15. 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)

  16. 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)

  17. Results

  18. Key Findings Intervention Group • Cumulative body count on days 1,7, 14 = 466 • Reducing body count as a result of effective BB Intervention

  19. 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

  20. 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)

  21. 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)

  22. 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

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