Epidemiological aspects of pediculosis by Pediculus humanus capitis (Phthiraptera: Pediculidae) in Minas Gerais: a systematic review / Aspectos epidemiológicos da pediculose por Pediculus humanus capitis (Phthiraptera: Pediculidae) em Minas Gerais: uma revisão sistemática

Abstract Background Head lice, or head pediculosis, is a parasitosis considered a serious public health problem that affects mainly resource-limited countries. Objective To describe epidemiological aspects of the pediculosis capitis in Minas Gerais, in Brazil. Method This systematic review was conducted through the standards established by the Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). PubMed, LILACS, and SciELO databases, as well as the gray literature, were searched. Results Nine of 1,167 studies were included, published between 1988 and 2019. These studies reported a total prevalence of parasitosis that ranged from 1.4% to 57.4%. The prevalence of head lice ranged from 0.0% to 66.7% for males and 2.3% to 57.4% for females, thus being higher in black-skinned people (1.4% to 40.3%). Regarding age, the highest prevalence was 10-12 years old (45.3%). As for the characteristics of the hair, there was a greater infestation in people with long (16.0% to 79.5%), wavy (0.0% to 44.7%), dark (0.0% to 36.6%), with low capillary density (35.4%), and thick hair (39.2%). Conclusion Head pediculosis affects both sexes, different ages, and races, representing an important health problem in Minas Gerais, not only due to the presence of ectoparasite but also to the secondary complications that can be generated from this parasitism.

Resumo Introdução A pediculose de cabeça é uma parasitose considerada um sério problema de saúde pública, afetando principalmente países com recursos limitados. Objetivo Descrever os aspectos epidemiológicos da pediculose de cabeça em Minas Gerais, Brasil. Método Revisão sistemática conduzida por meio dos padrões estabelecidos pelo Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). Foram pesquisadas as bases de dados PubMed, LILACS e SciELO, bem como a literatura cinza. Resultados Nove de 1.167 estudos foram incluídos, publicados entre 1988 e 2019. Relatou-se uma prevalência total da parasitose que variou de 1,4% a 57,4%. Ela variou de 0,0% a 66,7% para homens e 2,3% a 57,4% para mulheres, sendo maior em pessoas de cor negra (1,4% a 40,3%). Em relação à idade, a maior prevalência foi de 10 a 12 anos (45,3%). Quanto às características dos cabelos, houve maior infestação em pessoas com cabelos longos (16,0% a 79,5%), ondulados (0,0% a 44,7%), escuros (0,0% a 36,6%), com baixa densidade capilar (35,4%) e fios grossos (39,2%). Conclusão A pediculose atinge ambos os sexos, diferentes idades e raças, representando um importante problema de saúde em Minas Gerais, não só pela presença do ectoparasita, mas também pelas complicações secundárias que podem ser geradas desse parasitismo.

New Thai herbal shampoos as pediculicides for killing head louse, Pediculus humanus capitis de Geer (Phthiraptera)

Objective: To evaluate the efficacy of Thai herbal shampoos [Cartoxylum formosum (C. formosum) + eucalyptus essential oil (EO), C. formosum + citrus EO, Solanum trilobatum + eucalyptus EO, Solanum trilobatum + citrus EO, Moringa oleifera + eucalyptus EO and Moringa oleifera + citrus EO] for killing all stages of Pediculus humanus capitis (Phthiraptera). Methods: A filter paper contact method was applied with three concentrations (0.05, 0.10 and 0.20 mL/cm

New Thai herbal shampoos as pediculicides for killing head louse, Pediculus humanus capitis De Geer (Phthiraptera)

Objective:To evaluate the efficacy of Thai herbal shampoos [Cartoxylum formosum (C.formosum) + eucalyptus essential oil (EO),C.formosum + citrus EO,Solanum trilobatum + eucalyptus EO,Solanum trilobatum + citrus EO,Moringa oleifera + eucalyptus EO and Moringa oleifera + citrus EO] for killing all stages of Pediculus humanus capitis (Phthiraptera).Methods:A filter paper contact method was applied with three concentrations (0.05,0.10 and 0.20 mL/cm2) of each Thai herbal shampoo as well as permethrin pediculicide (positive control) and drinking water (negative control) against eggs,nymphs and adults of Pediculus humanus capitis.Mortality rates of the eggs were recorded after 7 days of incubation while those of nymphs and adults were recorded after 5 minutes of contact.Results:All herbal shampoos at the high concentration were highly effective against nymphs and adults,but not effective against the eggs.C.formosum + eucalyptus EO and C.formosum + citrus EO shampoos at all concentrations exhibited the highest efficacy against nymphs and adults with 100％ mortality rate at 5 min and LC50 values of 0.004 and 0.005 mL/cm2,respectively.All formulation of Solanum trilobatum and Moringa oleifera shampoos added with eucalyptus EO showed mortality rates against nymphs at 92.0％-100.0％ and 76.0％-100.0％ and against adults at 84.0％-100.0％ and 20.0％-32.0％,respectively.Permethrin pediculicide was not effective against the eggs,but showed 68.0％-92.0％ and 28.0％-60.0％ mortality rates against nymphs and adults.Conclusions:These results indicate that C.formosum + eucalyptus EO shampoo can be used as an effective nymphicide and adulticide against Pediculus humanus capitis.

Safety, Efficacy, and Physicochemical Characterization of Tinospora crispa Ointment: A Community-Based Formulation against Pediculus humanus capitis

The high prevalence of pediculosis capitis, commonly known as head lice (Pediculus humanus capitis) infestation, has led to the preparation of a community-based pediculicidal ointment, which is made of common household items and the extract of Tinospora crispa stem. The present study aimed to evaluate the safety, efficacy, and physicochemical characteristics of the T. crispa pediculicidal ointment. The physicochemical properties of the ointment were characterized, and safety was determined using acute dermal irritation test (OECD 404), while the efficacy was assessed using an in vitro pediculicidal assay. Furthermore, the chemical compounds present in T. crispa were identified using liquid-liquid extraction followed by ultra-performance liquid chromatography quadruple time-of-flight mass spectrometric (UPLC-qTOF/MS) analysis. The community-based ointment formulation was light yellow in color, homogeneous, smooth, with distinct aromatic odor and pH of 6.92±0.09. It has spreadability value of 15.04±0.98 g·cm/sec and has thixotropic behavior. It was also found to be non-irritant, with a primary irritation index value of 0.15. Moreover, it was comparable to the pediculicidal activity of the positive control Kwell®, a commercially available 1% permethrin shampoo (P>0.05), and was significantly different to the activity of the negative control ointment, a mixture of palm oil and candle wax (P<0.05). These findings suggested that the community-based T. crispa pediculicidal ointment is safe and effective, having acceptable physicochemical characteristics. Its activity can be attributed to the presence of compounds moupinamide and physalin I.

Electron Microscopic Alterations in Pediculus humanus capitis Exposed to Some Pediculicidal Plant Extracts

Head lice, Pediculus humanus capitis, infestation is an important public health problem in Egypt. Inadequate application of topical pediculicides and the increasing resistance to the commonly used pediculicides made the urgent need for the development of new agents able to induce irreversible changes in the exposed lice leading to their mortality. The aim of the present work is to evaluate pediculicidal efficacy of some natural products such as olive oil, tea tree oil, lemon juice, and ivermectin separately in comparison with tetramethrin-piperonyl butoxide (licid), as a standard pediculicide commonly used in Egypt. The effects of these products were evaluated by direct observation using dissecting and scanning electron microscopes (SEM). Results showed that after 1 hr exposure time in vitro, absolute (100%) mortalities were recorded after exposure to 1% ivermectin and fresh concentrate lemon juice. The mortalities were decreased to 96.7% after exposure to tea tree oil. Very low percentage of mortality (23.3%) was recorded after 1 hr of exposure to extra virgin olive oil. On the other hand, the reference pediculicide (licid) revealed only mortality rate of 93.3%. On the contrary, no mortalities were recorded in the control group exposed to distilled water. By SEM examination, control lice preserved outer smooth architecture, eyes, antenna, respiratory spiracles, sensory hairs, and legs with hook-like claws. In contrast, dead lice which had been exposed to pediculicidal products showed damage of outer smooth architecture, sensory hairs, respiratory spiracles and/or clinching claws according to pediculicidal products used.

Serie parasitosis en dermatología: pediculosis / Parasitosis in dermatology: pediculosis

La enfermedad producida por Pediculus humanus capitis, conocida como pediculosis, es una parasitosis específica del ser humano de distribución mundial. El contagio puede ser directo por contacto con el cuero cabelludo de una persona afectada, o por fómites contaminados con parásitos, por lo que no distingue raza, sexo, edad ni nivel socioeconómico. Presentamos el caso de una paciente de 80 años con una forma típica de pediculosis. (AU)

The disease caused by Pediculus humanus capitis, known as pediculosis, is a human specific parasitosis. It has a worldwide distribution. Transmission can be by direct contact with the scalp of an affected person or by contaminated fomites with parasites. This infestation makes no distinction of race, sex, age, or socioeconomic status. We present a case of an 80 years old patient with a typical case of pediculosis. (AU)

Determinantes sociocomportamentais e vulnerabilidade de crianças da educação infantil à pediculose / Socio-behavioral determinants and the vulnerability of children during early childhood education to pediculosis / Determinantes sociocomportamentales y vulnerabilidad de niños de la educación inicial a la pediculosis

O espaço escolar é associado à alta infestação pelo piolho de cabeça. Este trabalho objetivou caracterizar os determinantes sociocomportamentais e a vulnerabilidade de pré-escolares à infestação por Pediculus humanus capitis no município de Aracaju, estado de Sergipe. A pesquisa de campo exploratória foi realizada de junho a agosto de 2014, na microrregião do bairro Augusto Franco, no domínio familiar (unidades domésticas) e escolar (Escola Municipal de Ensino Infantil). A análise dos dados utilizou a estatística descritiva, teste Qui-quadrado de Pearson e Odds Ratio. Aproximadamente de 64% (30/47) dos entrevistados recebem até 1 salário mínimo e possuem residência própria, a quantidade de filhos foi entre 2 e 3 crianças. 30% tiveram piolho, destas, 40% realizaram tratamento medicamentoso e 13,3% catação manual. Questões como a pediculose devem ser consideradas no contexto da situação, com metodologia participativa e dialógica no contexto familiar e escolar (AU).

Schools have a high rate of head lice infestations. The aim of this study was to characterize the socio-behavioral determinants and the vulnerability of early childhood education students to infestations by Pediculus humanus capitis in the city of Aracaju, Sergipe state. The exploratory field study was conducted from June to August 2014, in the micro region of the Augusto Fanco neighborhood, in the family domain (households) and school (Municipal Early Childhood Education Center). Data analysis used descriptive statistics, Pearson's Chi-square test and Odds Ratio. Approximately 64% (30/47) of respondents receive up to 1 minimum wage and have their own residence, the number of children was between 2 and 3 per interviewee. 30% had lice, of these, 40% were treated with medication and 13.3% used manual removal. Issues such as lice infestation should be considered in the context of the situation with dialogue and a participatory methodology in the family and school context (AU).

El espacio escolar está asociado a alta infestación por el piojo de cabeza. Este trabajo tuvo la finalidad de caracterizar los determinantes ociocomportamentales y la vulnerabilidad de preescolares a la infestación por Pediculus humanus capitis en el municipio de Aracaju, estado de Sergipe. La investigación de campo exploratoria fue realizada de junio a agosto de 2014, en la microrregión del barrio Augusto Franco, en el dominio familiar (unidades domésticas) escolar (Escuela Municipal de Enseñanza Inicial). El análisis de los datos utilizó la estadística descriptiva, test Chi- cuadrado de Pearson y OddsRatio. Aproximadamente 64% (30/47) de los entrevistados ganan hasta 1 salario mínimo y poseen vivienda propia; la cuantidad de hijos está entre 2 y 3 niños. Aproximadamente 30% tuvieron piojo, de estas, 40% realizaron tratamiento medicamentoso y 13,3% quitaron manualmente. Cuestiones como la pediculosis deben ser consideradas en el contexto de la situación, con metodología participativa y dialógica en el contexto familiar y escolar (AU).

Estudio epidemiológico de la pediculosis en escuelas básicas del extremo norte de Chile / Epidemiological study of pediculosis in elementary schools of Arica, northern Chile

Introducción: La Pediculosis es una ectoparasitosis que ha recibido poca atención en el norte de Chile, a pesar de que es recurrente en la población infantil escolar. Nuestro objetivo fue determinar la prevalencia de Pediculus humanus capitis, en la población escolar básica de la Provincia de Arica. Pacientes y Método: Se estudió un grupo de 665 alumnos de enseñanza básica del sistema municipalizado, de la Provincia de Arica, durante agosto a noviembre de 2010. Se seleccionaron 467 niños que cumplían con los criterios de inclusión. Previo consentimiento informado de los alumnos y apoderados, el diagnóstico se llevó a cabo a través de la revisión a ojo descubierto de la cabeza de los escolares participantes, en dependencias de cada establecimiento, registrando la presencia de Pediculus humanus capitis, grado de infestación y estadio del ectoparásito. Resultados: De la población analizada, el 40,3 por ciento (188/467) presentó Pediculosis, afectando a las seis escuelas estudiadas. Las mujeres presentaron Pediculosis en un 55,2 por ciento (138/250) y los hombres un 23 por ciento (50/217). Conclusión: La población escolar de la Provincia de Arica está significativamente afectada por Pediculosis y su prevalencia es similar a otras regiones del país.

Pediculosis is an ectoparasitosis infestation that has not received much attention in northern Chile despite it is a common reoccurring condition among school-age children. The objective of this study is to determine the prevalence of Pediculus humanus capitis infestation in elementary schools of Arica. Patients and Method: A group of 665 elementary school students from the Province of Arica were screened between August and November 2010; 467 children who met the inclusion criteria were selected. After parents and students signed an informed consent, the diagnosis was carried out through examination of the head with naked eye in each participating school, recording the presence of Pediculus humanus capitis, infestation level and parasite stage. Results: 40.3 percent (188) of the children presented Pediculosis; the six schools studied were affected. Pediculosis infestation in girls reached 55.2 percent (138/250) and 23 percent (50/217) in boys. Conclusion: The school population of Arica is significantly affected by Pediculosis and its prevalence is similar to other regions.

PREHISTORICAL Pediculus humanus capitis INFESTATION: QUANTITATIVE DATA AND LOW VACUUM SCANNING MICROSCOPY / Infestação pré-histórica por Pediculus humanus capitis: análise quantitativa e por microscopia de varredura de baixo vácuo

A pre-Columbian Peruvian scalp was examined decades ago by a researcher from the Oswaldo Cruz Foundation. Professor Olympio da Fonseca Filho described nits and adult lice attached to hair shafts and commented about the origin of head lice infestations on mankind. This same scalp was sent to our laboratory and is the subject of the present paper. Analysis showed a massive infestation with nine eggs/cm2 and an impressive number of very well preserved adult lice. The infestation age was roughly estimated as nine months before death based on the distance of nits from the hair root and the medium rate of hair growth. A small traditional textile was associated with the scalp, possibly part of the funerary belongings. Other morphological aspects visualized by low-vacuum scanning electron microscopy are also presented here for adults and nits.

Há décadas um escalpo peruano, datado do período pré-colombiano, foi examinado por um pesquisador da Fundação Oswaldo Cruz. O Professor Olympio da Fonseca Filho descreveu lêndeas e adultos fixos a fios de cabelos e fez comentários sobre a origem da infecção por piolhos na espécie humana. Este mesmo escalpo foi enviado ao nosso laboratório e é objeto deste artigo. Sua análise mostrou maciça infestação, com nove lêndeas/cm2 em impressionante número de adultos muito bem preservados. O tempo de infestação foi estimado em cerca de nove meses antes da morte, baseado na maior distância entre lêndeas e o couro cabeludo, levando em consideração taxa média de crescimento capilar de 1 cm por mês. Um pequeno pedaço de tecido tradicional peruano foi encontrado associado ao escalpo, provavelmente pertencente ao conjunto de peças usado no ritual funerário. Aqui, apresentamos alguns aspectos morfológicos de adultos e lêndeas vizualizados por microscopia eletrônica de varredura de baixo vácuo.

Spinosad: A Newer Anti-Lice Drug.

Head lice infestation is a common and highly contagious condition caused by pediculus humanus capitis. Therapy for head lice infestation has been traditionally combing out the live lice and the unhatched eggs (nits) by a fine toothed comb along with topical chemical treatments. Emergence of resistance to these therapies compromises their effectiveness. As a result, the search for newer agents has been a clinical necessity. Recently, spinosad, a newer anti-lice drug, has been approved by US FDA as 0.9% topical suspension. Spinosad provides a useful alternative for children above 4 years of age suffering from head lice infestation.

Pediculosis capitis: An update.

Head louse infestation, or pediculosis capitis, caused by Pediculus humanus var. capitis, is a common health concern in pediatric age group. An itching of the scalp is the chief symptom, whereas presence of viable nits confirms the diagnosis of head louse infestation. Secondary bacterial infection with impetignization with cervical and occipital lymphadenopathy can complicate the clinical scenario with physician misdiagnosing pediculosis to a primary bacterial infection. Screening and treatment of all close contacts is necessary for an adequate management of pediculosis. Medical management of head louse infestation requires proper application of topical pediculicidal agents', chiefly permethrin lotion and wet combing with a fine toothcomb. Severe cases with high parasitic load justify the use of either oral cotrimoxazole or Ivermectin. Other described technique involves a single application of hot air for 30 minutes. Radical but culturally unacceptable method would be shaving of scalp in resistant cases. Environmental fogging with insecticides is neither necessary nor recommended.

Aspectos clínico-epidemiológicos sobre pediculosis capitis en arenales, Estado Falcón, Venezuela / Clinical and epidemiological aspects on pediculosis capitis in, Falcon State, Venezuela

la pediculosis capitis humana es una infestación del cuero cabelludo y del pelo, ocasionada por el Pediculus humanus capitis, la que puede producir infecciones bacterianas secundarias en el sitio del rascado, anemia y estrés social y psicológico con alteración en la calidad de vida y consternación. Entre Marzo y Julio de 2011, se realizó un trabajo para estudiar aspectos epidemiológicos y clínicos de la pediculosis capitis en 199 personas (79 varones y 120 mujeres), habitantes de diferentes grupos etéreos (0-75 años; ? ± D.S= 21,28 ± 17) de la población rural Arenales, zona semiárida del estado Falcón, región nor-occidental de Venezuela. El diagnóstico ectoparasitológico se realizó por observación directa con peine "ad hoc" de huevos (liendres), estados imaginales y/o pre-imaginales sobre el cuero cabelludo. Los insectos se clarificaron y montaron en medio de Hoyer para observación microscópica. Los resultados revelaron una prevalencia global de pediculosis capitis del 10,10% (20/199), con porcentajes de infestación significativamente mayores en las niñas (90 vs 10%) [Odds Ratio (OR) = 3,04; p = 0,01] en edad escolar (OR= 1,02; p =0,015;) con longitudes de cabello mayores de 3 cm (OR = 2,44; p = 0,004) y de tipo lisotrico (OR = 2,25; p = 0,015), sin embargo, no fueron diferentes entre grupos étnicos y color de pelo (P > 0,05). Se detectó un predominio de liendres (65%) desde 1 hasta 64/individuos, ubicadas entre 0,1 y 9 cm del cuero cabelludo en todas las regiones de la cabeza, teniendo los individuos de menor edad las mayores cargas ectoparasitarias. Los síntomas significativamente asociados a pediculosis fueron el prurito (6,53% en individuos infestados y 12,06% en los no infestados; OR =11,99; p = 0,000) y las excoriaciones (1,51% en niños infestados y 3,52% en los no infestados; OR =4,34; p = 0,03). Otros posibles factores de riesgo significativamente involucrados en la dinámica de transmisión y mantenimiento de la infestación fueron: jugar en piso de tierra (OR = 2,20; p = 0,012) y lavarse el cabello ≥2 /semana (OR = 1,01; p = 0,002). A la luz de los resultados obtenidos, es recomendable mejorar las condiciones socio-sanitarias del sector y mantener campañas de promoción y educación para la salud.

The human pediculosis capitis is a scalp and hair infestation caused by head lice Pediculus humanus capitis, which may result in bacterial secondary infections by intense scratching as well as anemia, anxiety and embarassment which are increased by children' exclusion from school under "no-nit" policy. From March to July 2011, a cross-sectional study was designed to determine the prevalence and clinical and epidemiological profiles of head lice infestation among 199 (79 males and 120 females) inhabitants of all age groups (0-75 years; ? ± D.S= 21.28 ± 17) of a rural and small town Arenales, from the semiarid region of Falcon state, north-western Venezuela.The diagnosis of head lice infestation was made by clinical naked eye inspection of scalp and hair for the presence of adult lice, nymphal stage, or eggs (nit) by line-toothed head lice comb. Lice was cleared and mounted in Hoyer’s medium for microscopic observation. All individuals were evaluated by physical examinationand a detailed, structured questionnaire. The overall prevalence of head lice infestation was 10.10% (20/199). The prevalence of infestation was significantly higher in girls (90%) than in boys (10%) [Odds Ratio (OR) = 3.04; p = 0.01] and school-aged children (OR= 1.02;p=0,015;) with hair length >3cm (OR = 2,44; p = 0.004) and lissotrichic type (OR = 2.25; p = 0.02), (OR= 2.25; 0.98 - 5.18), however, these were not significantly different among races or hair colours (P > 0.05). 65% of the individuals had only nits with 1 up to 64 per individuals, found between 0.1 and 9 cm from scalp on all anatomical regions of the head, and having school-aged children the higher ectoparasitic loads. Among clinical signs and symptoms, head pruritus (6.53 vs. 12.06%; OR =11.99; p =0.000) and excoriations (1.51% vs. 3.52%; OR =4.34; p = 0.03) showed significantly higher percentages in infested children than in uninfested ones. Other independent risk factors by logistic regression analysis signficantly associated with pediculosis captitis were playing on dust floor (OR = 2.20; p = 0.012), and frequency of hair washing ≥2 /week (OR = 1.01; p = 0.002). These results suggest that pediculosis capitis remains as a common and endemic public health problem in Venezuelan northwestern semiarid region. Thus, education campaigns by health care officials, physicians and teachers, as well as improving standards of living and personal hygiene might significantly reduce pediculosis capitis in those human populations endemically exponed.

Reemerging skin disease caused by arthropods II: louse

The aim of this article is to provide guidelines to diagnosis and therapeutics for HLI in Korea. Head lice infestation (HLI) caused by Pediculus humanus capitis is still common in Korean children in spite of an improvement since the 1980s in the country's economic status and the concepts of hygiene. HLI is troublesome and, if not treated, can lead to secondary bacterial infection as a result of scratching of the irritated scalp induced by an inflammatory reaction to injected saliva or anticoagulant. In addition, HLI causes social and psychological problems as well as physical symptoms. Confirmation of the HLI depends on identification of adult lice, nymphs, or viable nits. Nits are more commonly found at the nape of the neck and retroauricular areas. The differential diagnosis includes hair casts, dandruff, and debris by hair spray. Few chemical shampoos such as those containing lindane or pyrethrin are currently available in Korea. Although HLI is an important public health issue in Korea, little information is available on HLI. Medical doctors, school nurses, and teachers should be acquainted with HLI for the successful control of this disease, which is distressing a number of children covertly.

Risk Factors Associated with Head Louse Infestation in Korea

Head louse infestation (HLI) is one of the most frequently occurring parasitic diseases in children. This study was conducted to investigate the socioeconomic and personal factors influencing HLI in the Republic of Korea. A total of 2,210 questionnaires about various factors related to HLI were obtained from children in 17 primary schools throughout the country. The rate of HLI was significantly lower in children who lived together with mother or in a family where both parents worked. In addition, HLI was lower in children whose fathers or mothers were public officers or teachers. However, HLI was higher in children who had small families and washed their hair less often. Education levels of parents and the number of children in family were not significant. Improvement of socioeconomic factors and personal hygiene will be helpful for reducing HLI.

Prevalence of pediculosis and scabies in preschool nursery children of Afyon, Turkey

Scabies and pediculosis are ubiquitous, contagious, and debilitating parasitic dermatoses. The tendency of high prevalence of pediculosis and scabies among school and preschool age children has prompted us to conduct a head louse and scabies prevalence survey among preschool nursery children in our district. A school-based, crosssectional study was performed, with 1,134 children chosen for evaluation. All cases were evaluated by physical examination and a detailed, structured questionnaire. The infestation was found in 14 (1.2%) of 1,134 children; 9 (0.8%) with pediculosis capitis and 5 (0.4%) with scabies. We found that infestations were more frequent in children with mothers whose education levels were low. This indicates the necessity of an improvement in the economic and sociocultural status of the community and the promotion of hygiene concepts and practices in order to improve health of preschool age children.