Self-Diagnosis of Head Lice Infestation in Rural Nigeria as a Reliable Rapid Assessment Tool for Pediculosis

Pediculosis capitis is a common disease in industrialized countries, but there are also areas in sub-Saharan Africa where head lice infestations are highly endemic. However, there are no data available from the African continent on the accuracy of head lice diagnosis made by affected individuals. We performed a door-to-door survey in Skanko village (Kwara State, Central Nigeria). Individuals were asked to answer a question regarding their head lice status, and then wet combing with conditioner was performed to diagnose an active infestation. Active head lice infestation was observed in 144 (29.0%) of the 496 participants. Less than 1% of those without pediculosis stated being infested; and more than 90% of individuals with heavy infections did so. In contrast, only 47% of individuals with 5 lice were aware of their infestation. Overall sensitivity (73.6%), specificity (99.1%), positive predictive value (97.2%) and negative predictive value (90.2%) of self-diagnosis, as compared to wet combing were high. Our data show that interviewing individuals about their infestation status can be used as a simple rapid assessment method for diagnosing head lice in a typical rural setting in Nigeria.