Vol 4 No 3 full text.indd Althea Medical Journal. 2017;4(3) 456 AMJ September 2017 Relationship between Knowledge, Attitude and Practice of Student’s Personal Hygiene with Scabies Incidence in Pesantren Darul Fatwa, Jatinangor, West Java, Indonesia Karinna Dwi Purnama,1 Dedi Rachmadi Sjambas,2 Oki Suwarsa3 1Faculty of Medicine Universitas Padjadjaran, 2Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, 3Department of Dermato- venerology, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung Abstract Background: Scabies is a parasitic infection caused by Sarcoptesscabiei Hominis varian and Acarina order. Sarcoptes scabiei infects both male and female in any age groups, ethnics, and socio-economic levels. Transmission of scabies can pass through by a direct contact from skin-to-skin or indirect contact through sharing bed, clothes, and towels. Pesantren as an educational institution supplies facilities that are shared thus making students susceptible to scabies infection. This study was conducted to discoverrelationshipbetween knowledge, attitude, and practice of student’s personal hygiene with scabies incidence. Methods: An analytic observational study was conducted from October to November 2015 in Pesantren Darul Fatwa, Jatinangor. Study was conducted with cross-sectional design and total sampling for the sample size. Total of 37 students whoparticipated in this study were 22 malesand 15 females. This study was begun with a stand alone-questionnaire, fill out on knowledge, attitude, and practice of personal hygiene that was supervised by researcher, and physical examination for scabies diagnosis that was performed by doctors. Results: Based on history taking and physical examination, 15 out of 37 students were diagnosed with scabies positive. All of them were males, dominated by 13 year old students, 1st and 2nd Junior High School students. Statistical analysis with chi-square test showed that there were no relationship between knowledge, attitude and practice of student’s personal hygiene with scabies incidence. Conclusions: There is no relationship between knowledge, attitude and practice of student’s personal hygiene with scabies incidence in Pesantren. Keywords: Attitude, hygiene, knowledge, practice, scabies Correspondence: Karinna Dwi Purnama, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang Km.21, Jatinangor, Sumedang, Indonesia, Email: karinnarinn@gmail.com Introduction Scabies prevalences around the world exceed 300 million people.1-3 Scabies is caused by Sarcoptesscabiei which lives on stratum corneum layer of the human skin. Lesion characteristic caused by this infection is pruritic papular eruption.4 An epidemiological study showed that scabies incidences in developing countries in Asia are high, about 17% in schools in Timor Leste and 31% in orphanages in Malaysia.5 Sarcoptesscabiei migrates from the infected body to the new host by odour and body heat stimulation. In order to have enough stimulation, a person must live in a place that has very close skin-to-skin contact, such as a crowded pesantren.6,7 Pesantren is an institution that provides some facilities that are shared together as the student’s types of personal hygiene varies. This makes them susceptible to be infected with scabies.8 A study showed that Sarcoptesscabiei infected about 10% of general population and 59% children on rural community.9 A study conducted at Madrasah in Dhaka City, Bangladesh also reported that in 2011, scabies is hyper endemic at the Madrasah, 98% of 492 students at Madrasah are diagnosed with scabies positive.10 Thus, this researcher was attracted to conduct a study about relationship between knowledge, attitude, and practice of student’s personal hygiene with scabies incidence in Pesantren. AMJ. 2017;4(3):456–60 ISSN 2337-4330 || doi: http://dx.doi.org/10.15850/amj.v4n3.1198 Althea Medical Journal. 2017;4(3) 457 Methods This study was carried out from October to November 2015 in Pesantren Darul Fatwa Jatinangor. The type of study was analytic observational with cross-sectional design. Sampling method used was total sampling method, which 37 students participated in this study (15 females and 22 males). Every student was needed to be in the inclusion and exclusion criteria parameters to participate the study. Inclusion criteria in this study were both male and female students in Junior High School who lived at Pesantren Darul Fatwa Jatinangor. Students were obligated to fill the inform consent form as an agreement to participate in this study. Students who had mental disorder were included into exclusion criteria because they disturbed communication process. The method of this study was unpaired categorical comparative analytic. This study was approved by Health Research Ethics Commitee Faculty of Medicine Universitas Padjadjaran No.538/ UN6.C1.3.2/KEPK/PN/2015. Tested variables were knowledge, attitude, and practice of student’s personal hygiene as the independent variables, and scabies incidence as the dependent variable. Data collection was begun from study instruments preparation, such as questionnaire and physical examination tools. Questionnaire used as a tool was validated in a pesantren in Jatinangor that had similar characteristics with this research location. The alpha-Cronbach’s scores were: α=0.733 for personal hygiene knowledge, α=0.716 for personal hygiene attitude, and α=0.701 for personal hygiene practice. Scoring criteria division for each knowledge, attitude, and practice were divided into three categories, which were good (respondent’s answer percentage was 76%–100% from total score), moderate (respondent’s answer percentage was 56%–75% from total score), and poor (respondent’s answer percentage was <56% from total score).11 Subjects who were eligible to participate the study were given inform consent first, and then filled the questionnaire autonomously as the researcher supervised fulfillment process. Next step, the respondents were interviewed and examined by doctors. The doctors who examined the students were from Department of Dermato-venerology of Dr. Hasan Sadikin General Hospital Bandung. They have been standarized and were competent for this study. Physical examination was conducted by male doctor who examined male students, and female doctor who examined female students. History taking and physical examination were conducted to diagnose scabies infection on students, determine lesion efflorescence, and microscopic examination of Sarcoptes scabiei with cellophane tape method. The data were not normally distributed after Table 1 Respondent’s General Characteristics Characteristics Scabies Total Yes No Gender Male 15 7 22 Female 0 15 15 Age (year) 11 0 1 1 12 2 2 4 13 7 1 8 14 3 5 8 15 3 12 15 17 0 1 1 Grade in Junior High School 1st 6 5 11 2nd 6 13 19 3rd 3 4 7 Karinna Dwi Purnama, Dedi Rachmadi Sjambas, Oki Suwarsa: Relationship between Knowledge, Attitude and Practice of Student’s Personal Hygiene with Scabies Incidence in Pesantren Darul Fatwa, Jatinangor Althea Medical Journal. 2017;4(3) 458 AMJ September 2017 running a normality test, Saphiro-Wilk, so Chi- square and Fisher test on statistical program that were used to test relationship among two categorical variables. Confidence interval value was 95% with mean determined by p value, in which p value <0.05 showed that the result had a meaning or there was an relationship among two tested variables. Results Thirty seven data were collected from this study, 15 students were diagnosed with scabies. Respondents of this study were Table 2 Distribution of Lesion Efflorescence On Scabies Sufferers Type of Lesion Number of Scabies Sufferers Excoriation 13 Erosion 2 Hiper pigmentation 7 Crust 14 Papule 15 Table 3 Distribution of Lesion Location on Scabies Sufferers Type of Lesion Number of Scabies Sufferers Finger webs of hand 15 Volar of lower arm 11 Abdomen 9 Genital 9 Table 4 Analysis of Relationship between Knowledge, Attitude, and Practice of Student’s Personal Hygiene with Scabies Incidence in Pesantren Independent Variables Scabies (n=37) Total p Value Yes No Knowledge of Personal Hygiene p=0.708 Good 17 10 27 Moderate 5 5 10 Poor 0 0 0 Total 22 15 37 Attitude of Personal Hygiene p=1.000 Good 18 12 30 Moderate 4 2 6 Poor 0 1 1 Total 22 15 37 Practice of Personal Hygiene p=1.000 Good 2 2 4 Moderate 17 11 28 Poor 3 2 5 Total 22 15 37 Althea Medical Journal. 2017;4(3) 459Karinna Dwi Purnama, Dedi Rachmadi Sjambas, Oki Suwarsa: Relationship between Knowledge, Attitude and Practice of Student’s Personal Hygiene with Scabies Incidence in Pesantren Darul Fatwa, Jatinangor dominated by male students. All of scabies sufferers were males, dominated by 13 years old students, 1st and 2nd Junior High School students (Table 1). Statistical differences between knowledge, attitude, and practice of student’s personal hygiene with scabies incidence resulted p value>0.05 . This result showed that there was no relationship between knowledge, attitude, and practice of student’s personal hygiene with scabies incidence. Discussion This study discovered that more than 50% students were diagnosed with positive scabies. This result was similar with the epidemiological study in 2013 which showed that scabies incidence in developing countries in Asia was high, about 17% in schools in Timor Leste and 31% in orphanage in Malaysia.5 It was reported that high number of scabies sufferers lived in an institution that accomodated many people in one place (Pesantren, Orphanage), were high for scabies transmission because there were so many people living in the same place. Due to the phenomena, direct contact from skin to skin can be easily established and often occured. This study showed that scabies sufferers efflorescence distribution and lesion location are appropriate with the given theories. A study reported that lesion efflorescence scabies sufferers are pruritic papule, pustule, vesicle, nodul, excoriation, and crust.12 Characteristics of lesion distribution are on predilection area of the body, which are finger webs, dorsum and palm, axilla, periumbilicus, genital, and sole.12 This study discovered that most of personal hygiene knowledge and attitude degree of respondents were good. In contrast, most of personal hygiene practice degree were at moderate level. There were 27 out of 37 respondents having good knowledge, 30 out of 37 having good attitude, while 28 out of 37 having moderate practice. These results are similar to other studies conducted in 2012 about the characteristics of knowledge, attitude, and practice in preventing transmission of scabies in Pesantren.13 Based on this study analysis of pesantren situation and questionnaire result, respondents’ knowledge, attitude, and practice of personal hygiene are good because most students understand about personal hygiene itself. However, most of the practice of personal hygiene was at moderate level. These results might be as a consequence of the minimal facilities in Pesantren. Pesantren does not have laundry service so every student must wash their own clothes. There is also no health facility, thus sick students seldom get cure and has minimum knowledge about prevention strategies of scabies. In addition, students also sleep together in their room, share towels and clothes each other. Students who live together in a room can be influenced by personal hygiene practice of other students. However, this study discovered that there was no relationship between knowledge, attitude, and practice of students’ personal hygiene with scabies incidence in Pesantren. This result was contradicted with theory that stated scabies can transmit if students do not understand about personal hygiene.14 Another theory claimed that students are vulnerable to get scabies because of students’ personal hygiene varieties.8 A study reported that the poor knowledge of student’s personal hygiene can increase scabies incidence which contradicts with this study.15 In this study, the causes of scabies incidence might be caused by the students who live together with other friends in one crowded room (close contact), so that the students with good knowledge, attitude, and practice of personal hygiene can be transmitted by the students with moderate and poor knowledge, attitude, and practice of personal hygiene. The limitations of this study are small sample size and less detail questionnaire. The study hereafter needs to consider the sample size, elaborate, and develop the questionnaire, and focus on the preventive and management strategies of scabies. The conclusion of this sudy is the tested hypothesis which is rejected. It means there is no relationship between knowledge, attitude and practice of student’s personal hygiene with scabies incidence at Pesantren Darul Fatwa, Jatinangor. References 1. Chosidow O. Scabies. N Engl J Med. 2006;354(16):1718–27. 2. Capobussi M, Sabatino G, Donadini A, Tersalvi CA, Castaldi S. Control of scabies outbreaks in an Italian hospital: an information-centered management strategy. Am J Infect Control. 2014;42(1):316–20. 3. Ly F, Caumes E, Ndaw CAT, Ndiaye B, Mahe A. Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized Althea Medical Journal. 2017;4(3) 460 AMJ September 2017 controlled trial. Bull World Health Organ. 2009;87(1):424–30. 4. Aboud KA, Aboud DA. 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