|Year : 2018 | Volume
| Issue : 1 | Page : 20-24
A study on superficial skin infection and their risk factors among rural population of West Bengal
Anubrata Karmakar, Bijit Biswas, Aparajita Dasgupta, Aritra Bhattacharyya, Nazrul Mallick, Ayon Ghosh
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
|Date of Web Publication||10-Sep-2018|
Dr. Bijit Biswas
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, 110, C. R. Avenue, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Superficial skin infections (SSI) are quite common but often avoidable public health problem which requires early diagnosis and prompt treatment to prevent complications. Despite the high prevalence of certain skin diseases in developing countries, they have so far not been regarded as a significant health problem in the development of public health strategies. Methodology: This was a cross-sectional clinic-based study conducted from December 2016 to January 2017 among 160 study participants attending a rural health facility in Singur block of West Bengal using a predesigned structured schedule and clinical examination. Data were collected regarding sociodemographic profile, occupational details, housing condition, personal hygiene practices, and history of any skin diseases. Data were analyzed using appropriate statistical methods using SPSS (version 16). Results: A total of 27 (16.9%) of 160 study participants were suffering from SSI. Tinea corporis and tinea cruris were the two most prevalent types of SSI. Nature of work adjusted odds ratio ([AOR]-4.88 [1.38–17.20]), water source for bathing (AOR-4.27 [1.15–15.80]), persons/room (AOR-3.22 [1.26–8.21]), poor personal hygiene (AOR-1.67 [1.18–2.36]), and diabetes (AOR-3.34 [1.08–10.31]) were found to be significant predictors of SSI. Conclusions: Superficial fungal infection is the most prevalent type of SSI in the present study. More emphasis should be given to improving hygiene practices, living conditions, controlling diabetes, and creating awareness to reduce the risk of skin infection.
Keywords: Diabetes, poor personal hygiene, risk factors, superficial skin infection
|How to cite this article:|
Karmakar A, Biswas B, Dasgupta A, Bhattacharyya A, Mallick N, Ghosh A. A study on superficial skin infection and their risk factors among rural population of West Bengal. J Datta Meghe Inst Med Sci Univ 2018;13:20-4
|How to cite this URL:|
Karmakar A, Biswas B, Dasgupta A, Bhattacharyya A, Mallick N, Ghosh A. A study on superficial skin infection and their risk factors among rural population of West Bengal. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2022 Aug 18];13:20-4. Available from: http://www.journaldmims.com/text.asp?2018/13/1/20/240899
| Introduction|| |
The skin is not a mere inactive covering of the body but a delicate active boundary and is a vital organ of social contact. Diseases of skin are becoming very common but often avoidable which requires early diagnosis, prompt treatment to prevent complications, and hospitalizations. Despite their frequent occurrence, they are often not perceived to be a significant health concern,,
Skin diseases are most commonly caused by fungal and parasitic infection. For example, scabies, tinea capitis, and tinea corporis.,
Superficial fungal infections (SFI) are the most common fungal infections, the prevalence varying between 20% and 25% worldwide. Fungal infections of the skin, hair, and nails are a common public health problem worldwide. However, a population-based survey reported that they are rarely managed.,
The pattern of skin diseases in India is influenced by the developing economy, level of literacy, lower standards of hygiene, tropical climate, overcrowding, industrialization, quality accessible health care, nutrition, and different religious ritual and cultural factors.,,,
Skin disease is seldom deadly, but they pose huge financial and psychological burden for the patients and their families. It has a great impact on the quality of life, especially when it involves disability, disfigurement, and symptoms such as pain, stinging, and itchiness.,,
However, there are very minimal data available on the prevalence of the skin disease, especially in the rural area of West Bengal. Improvement in the standard of living, education of the general public, improvement in the environmental sanitation, and good nutritious food may help us to bring down the skin diseases in this area. The present study attempts to examine the distribution of superficial skin infection (SSI) among a symptomatic group of rural population of West Bengal, with respect to sociodemographic variables and the risk factors associated with SSI.
| Methodology|| |
It was a clinic-based observational study and cross-sectional in design. The present study was conducted at outpatient department (OPD) of Diara Primary Health Centre's (PHC) in Singur block, West Bengal, during December 2016–January 2017. Diara PHC has an average OPD attendance of 80. The researcher was posted in Diara PHC 2 days a week during the study. A structured schedule was designed to collect data on sociodemographic condition, household condition, occupational details, personal hygiene practices and history of any skin disease, and diabetes. The schedule was prepared in English language and translated into local language (Bengali) using the translation–retranslation technique. The face and content validity of the schedule were checked by experts of All India Institute of Hygiene and Public Health (AIIH and PH). Before starting of the study, pretesting of the schedule was performed among patients attending a different subcenter nearby and accordingly after necessary modifications the tool schedule was finalized. During pretesting of the schedule, it was observed that at least 15 min was required for filling the schedule, examining the patient, and disbursing him/her after giving necessary management. Considering this, the researcher had decided to approach every 5th patient, from those attending OPD of Diara PHC, to participate in the study. Patients of all ages were included and those who did not give informed written consent were excluded from the study. Within the stipulated study period, it was possible to collect data from 160 participants who could be interviewed and thoroughly examined clinically. In case of minors, information was taken from accompanying guardian. The diagnosis of the SSI was done by the researcher clinically.
Few operational definitions which were used are listed next as follows:
Socioeconomic status was assessed by modified B. G. Prasad scale 2016
Diabetes – Here, we considered those who were diagnosed with diabetic for at least past 6 months
Hygiene score – was calculated by scoring ten hygiene behavior questions with satisfactory behavior receiving 0, while unsatisfactory behavior receiving 1. Those who were not bathing daily, bathing once a day, not regularly using soap during bath, not regularly cleaning private parts and groin area with soap while bathing, not carefully wiping of wet body parts to make them dry, sharing towel of other family members, wearing unwashed clothes of other family members, not changing under-wear daily, not washing under-wear with soap water, and wearing tight-fitting clothes often were considered as having poor personal hygiene practices. Minimum and maximum attainable score was 0 and 10, respectively. Higher score meant poorer hygienic practices
Persons/room – was calculated by dividing the reported number of living rooms in study participant's house with reported number of family members staying in the house.
Ethical permission was obtained from the Institutional Ethics Committee of AIIH and PH before conducting the study. Informed written consent of the study participants was taken before conducting the study, and their confidentiality was maintained throughout the study.
Data were analyzed using IBM SPSS (version 16, Corporate headquarters, Armonk, New York, United States). First, a bivariate analysis was performed to ascertain the relationship between sociodemographic condition, household condition, occupational details, and hygiene behavior with SSI. Only those which were found to be significant were entered into a multiple logistic model using forced entry method. The strength of associations was assessed by odds ratio (OR) at 95% of confidence interval (CI). Statistical significance for all analyses was set at P < 0.05.
| Results|| |
Most of them were aged between 46 and 60 years (36.3%). The mean standard deviation (SD) of the age of the study participants was 48.4 (20.6). There were equal representations from both the sexes. Majority of them were Hindu by religion (85%) and belonged to joint family (87.5%). Most of them were educated up to primary level (43.8%), and 36.3% were homemaker by occupation. Majority of them belonged to socioeconomic class III or class IV (86.2%) according to modified B. G Prasad socioeconomic scale [Table 1].
|Table 1: Distribution of patients attending outpatient departments according to their sociodemographic characteristics (n=160)|
Click here to view
Among the study participants, 33.8% reported that their work involves handling of water or chemicals. About 39.4% of them reported heavy sweating during work, where as 38.1% of them was used to take bath in pond. Majority of them were residing in semipukka house (65%). In most of their houses, the person per room ratio was between two and three [Table 2].
|Table 2: Distribution of study participants according to some possible risk factors of superficial skin infection (n=160)|
Click here to view
Among the study participants, 16.9% were suffering from SSI with tinea corporis and tinea cruris being the two most prevalent types. Trunk and groin were the two most commonly affected sites of SSI. About 24.4% of the study participants had diabetes. Most of them were suffering from the disease for the past 11–30 days with mean (SD) 9.6 (29.5). Majority of the lesions were in covered body parts and itchy in nature. Most of them reported that the lesion hampers their night sleep and social life. Nearly, 25.9% of them had family members with similar lesions and 40.7% had a history of past skin infection. 81.8% of them availed treatment from a Government health center for their past infection while others availed treatment from private practitioners. In the past episode, 72.7% were treated with topical ointments (possibly containing steroid) while others were treated with topical and oral drugs both. The time interval between the present and past episode was mean (SD) 2.9 (4.1) months. In the past episode trunk, five (45.5%) were the most common site affected followed by groin, finger, and scalp with 18.2% each. Among those suffering from SSI 40.7% was diabetic [Table 3].
|Table 3: Distribution of patients suffering from superficial skin infections according to its variables (n=27)|
Click here to view
[Table 4] depicts the hygienic behavior of the study participants.
|Table 4: Distribution of patients attending outpatient departments according to their personal hygiene characteristics (n=160)|
Click here to view
In bivariate logistic regression analysis, study participants who were living in Kachha house, work is associated with water and chemicals, reported heavy sweating during work, using pond water for bathing, having high persons/room, having high hygiene score, and diabetes had shown significantly greater odds of having SSI. In multivariable model nature of work adjusted OR ([AOR]-4.88 (1.38–17.20)], water source (AOR-4.27[1.15–15.80]), persons/room (AOR-3.22 [1.26–8.21]), hygiene score (AOR-1.67 [1.18–2.36]), and diabetes (AOR-3.34 [1.08–10.31]) were significant predictors of SSI adjusted with other significant variable in bivariate analysis [Table 5].
|Table 5: Univariate and multivariable logistic regression showing predictors of superficial skin infections (n=160)|
Click here to view
| Discussion|| |
The prevalence of SSI among the patients is quiet high (16.9%) and among these infections majority (70.3%) are caused by SFI. The overall prevalence of SFI was 11.8%, whereas in a community-based study in rural central India by Jain et al., it was 13%.
The most prevalent type among the fungal infections is tinea corporis (36.8%) in this study, which was also found by Das et al., among patients of skin OPD in School of Tropical Medicine, Kolkata (50%), whereas in rural area of Tamil Nadu, it was 78%. Most commonly affected site is trunk (40%) followed by groin.
In the present study, the skin infections had affected night sleep (59%) and social life (59%) of the patients, which was similar to the finding of Das et al. in Kolkata (65% and 68%, respectively).
We found that, most of the lesion was in the covered area of the body which is supported by similar finding in the study by Das et al. (OR 8.05, P < 0.0005).
In the present study, we found nature of work, water source, persons/room, hygiene score, and diabetes were significant predictors of SSI, whereas Das et al. found occupational types (homemaker and labourer), history of previous tinea infection, and unexposed body parts were closely associated with tinea corporis infection as it only dealt with SFI and found out the determinants of T corporis. The present study conducted among primary school children in Nigeria, by Oke et al. found males were significantly more affected than females. The findings does not corroborate with our finding, as the population was different.
The study in rural area of Turkey conducted by Metintas et al. among primary school children found older age, male gender, poor hygiene, living in dormitory, low-level mother education, history of dermatophytosis within family, and sanitary conditions were associated with dermatophytosis infection. We also found that poor personal hygiene and low living condition is associated with SSI.
The present study conducted by Adefemi et al. among primary school children aged 5–16 years in Oke-Oyi, Kwara state found age of the child, the past history of similar lesion, over-crowding in the home, heavy sweating, and badly smelling socks were significantly associated with SFI. This study also found the association of SSI with increased person/room, heavy sweating, and poor hygiene.
The present study is first of its kind in rural West Bengal, where the burden of all SSI (bacterial, fungal, and parasitic) was explored. Almost all the risk factors of SSI except nutritional status were investigated which makes the study more conclusive. This study has established that living condition, personal hygiene, and diabetes are associated with any type of SSI.
Microbiological laboratory investigation was not done to confirm the etiology of the infections. Only the patients who were already diagnosed with diabetes were considered as diabetic. Data were self-reported: there may over or under reporting. Clinic-based study – a community-based approach would have been better. Study duration only 2 months (in winter), there may be seasonal variation.
| Conclusions|| |
It appears from the present study, that SFI is the most prevalent type of SSI in a rural area of Singur, West Bengal, and low living condition, poor hygiene, and diabetes are closely associated with SSI. More emphasis should be given to improving hygiene status and living conditions to reduce the risk of skin infection. As diabetics are more prone, awareness regarding skin infection and its control measures should be created.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Villa L, Krishna G. Epidemiology and prevalence of dermatological diseases among schoolchildren of Medak district, Telangana. Int J Med Sci Public Health 2016;5:1475-8.
World Health Orangization. Epidemiology and management of common skin diseases in children in developing countries. Geneva: World Health Organization; 2005. p. 54.
Bissek AC, Tabah EN, Kouotou E, Sini V, Yepnjio FN, Nditanchou R, et al.
The spectrum of skin diseases in a rural setting in Cameroon (sub-Saharan Africa). BMC Dermatol 2012;12:7.
Abdel-Hafez K, Abdel-Aty MA, Hofny ER. Prevalence of skin diseases in rural areas of Assiut Governorate, upper Egypt. Int J Dermatol 2003;42:887-92.
dos Santos MM, Amaral S, Harmen SP, Joseph HM, Fernandes JL, Counahan ML, et al.
The prevalence of common skin infections in four districts in Timor-Leste: A cross sectional survey. BMC Infect Dis 2010;10:61.
Kumar K, Kindo AJ, Kalyani J, Anandan S. Clinico – Mycological profile of dermatophytic skin infections in a tertiary care center – A cross sectional study. Sri Ramachandra J Med 2007;1:12-5.
Jain S, Barambhe M, Jain J, Jajoo U, Pandey N. Prevalence of skin diseases in rural Central India: A community-based, cross-sectional, observational study. J Mahatma Gandhi Inst Med Sci 2016;21:111-5. [Full text]
Ramamuthie G, Verma RK, Appalasamy J, Barua A. Awareness of risk factors for skin infections and its impact on quality of life among adults in a Malaysian City: A cross-sectional study. Trop J Pharm Res 2015;14:1913-7.
Vasudevan J, Mishra AK, Singh Z. An update on B. G. Prasad's socioeconomic scale: May 2016. Int J Res Med Sci 2016;44:4183-6. [Last accessed 2017 Jun 25].
Das K, Basak S, Ray S. A study on superficial fungal infection from West Bengal: A brief report. J Life Sci 2009;1:51-5.
Lakshmanan A, Ganeshkumar P, Mohan SR, Hemamalini M, Madhavan R. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian J Med Microbiol 2015;33Suppl S1:134-6.
Oke OO, Onayemi O, Olasode OA, Omisore AG, Oninla OA. The prevalence and pattern of superficial fungal infections among school children in ile-ife, South-Western Nigeria. Dermatol Res Pract 2014;2014:842917.
Metintas S, Kiraz N, Arslantas D, Akgun Y, Kalyoncu C, Kiremitçi A, et al.
Frequency and risk factors of dermatophytosis in students living in rural areas in Eskişehir, Turkey. Mycopathologia 2004;157:379-82.
Adefemi SA, Odeigah LO, Alabi KM. Superficial fungal infection: Prevalence and risk factors among primary school pupil in Ilorin. Savannah J Med Res Pract 2012;1:29-36.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]