BACKGROUND: Pediculosis continues to be a common yet neglected public health problem especially in children. Trials to test for effectiveness for head lice interventions are heterogeneous, and a recent systematic review recommended  the use of cluster randomization and centralized administration (e.g. school) of permethrin for pediculosis trials.

OBJECTIVE: To compare the effectiveness of a school-based to a home-based intervention using permethrin 1% shampoo in treating pediculosis capitis. 

METHODS: We conducted a pragmatic, cluster-randomized trial at the Makati Elementary School. All Grade Four students  (n = 211), belonging to a total of five class sections, were invited to participate in the study. Students with a known allergic reaction to permethrin 1% shampoo, with open wounds on the scalp, or were absent on Days 1 or 10 of the intervention period were excluded. The five class sections were randomized to receive permethrin 1% shampoo to be applied either in school, or at home. The students were classified as having none, light, medium, or heavy infestation prior to Day 1 and after Day 10 treatment. Prevalence, incidence, and treatment outcomes were measured.

RESULTS: The baseline prevalence of pediculosis capitis was 58.4%. General characteristics of students were similar between groups. No significant clustering in pediculosis classification was observed. The school-based group had the same prevalence in pediculosis at Days 1 and 10, had no incident cases, and were limited to light infestation by Day 10, but had no treatment success outcomes. The home-based group had increased prevalence by Day 10, poor compliance with Day 1 and 10 shampoo,  incident cases, although it registered a higher treatment success rate.

CONCLUSION: Compared to standard home based intervention, a school-based strategy resulted in less incident cases (0% vs. 37%), reduction in pediculosis severity (p = 0.007), and higher compliance (100% vs. 58.3%). Control of pediculosis in this specific community is largely warranted because of its high prevalence rate of 59.7%.