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Head lice A Randomised Controlled Trial

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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. – PowerPoint PPT presentation

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Title: Head lice A Randomised Controlled Trial


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
Baseline Characteristics
No with infested siblings in the same household
10
Main Outcome Measure
  • Absence of live lice at Day 14

11
(No Transcript)
12
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

13
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

14
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

15
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 (pgt.05).

16
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 (p0.041)

17
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 (p0.008)

18
Results
19
Key Findings
  • Intervention Group
  • Cumulative body count on days 1,7, 14 466
  • Reducing body count as a result of effective BB
    Intervention

20
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

21
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)
    (plt0.001)

22
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) (plt0.001)

23
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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