European Journal of Cardiovascular Medicine

Skin infections are among the most prevalent health concerns affecting school-aged children globally, particularly in resource-limited settings. These infections, which include bacterial, fungal, and parasitic dermatoses, are frequently recurrent and may lead to significant morbidity, discomfort, absenteeism, and poor academic performance if left untreated [1,2]. School environments, characterized by close interpersonal contact and shared facilities, serve as hotspots for the transmission of skin infections.

Poor personal hygiene practices such as irregular bathing, infrequent nail trimming, sharing of personal items, and inadequate washing of clothes are strongly associated with an increased risk of skin infections among children [1,3]. Factors such as low socio-economic status, lack of parental awareness, and limited access to clean water and hygiene supplies further exacerbate this burden [1,3].

Bacterial infections, particularly those caused by Staphylococcus aureus, are a major cause of recurrent skin conditions in children and their household contacts [2,4]. Infections such as impetigo, folliculitis, and cellulitis are commonly encountered, often requiring repeated treatment due to reinfection or colonization [4]. Fungal infections like tinea and parasitic infestations such as scabies also contribute substantially to the overall prevalence of childhood skin diseases [5].

Despite the high incidence and preventable nature of these infections, few community-based studies have focused on the hygiene-related risk factors for recurrent skin infections among school-going children.

This study was undertaken to assess the prevalence of recurrent skin infections among school-going children and to examine their association with various hygiene-related practices. By identifying specific hygiene behaviors linked with increased risk, the findings aim to inform public health interventions targeting this age group.

Study Design and Setting:
This was a cross-sectional observational study conducted at Government Medical College (GMC), Pulivendula, in collaboration with selected nearby schools. The study was carried out over a period of five months, from October 2023 to February 2024.

Study Population:
The study included school-going children aged between 6 and 14 years who were enrolled in local primary and upper primary schools in the vicinity of GMC Pulivendula. Children whose parents/guardians provided informed consent and who were present on the day of the survey were included in the study.

Sample Size:
A total of 50 children were selected using simple random sampling from the school registers. The sample size was determined based on feasibility and expected prevalence of skin infections in the region.

Data Collection Tools:
A structured and pre-tested questionnaire was used to collect data on demographic characteristics, hygiene practices (bathing frequency, nail trimming, clothing habits, sharing of personal items), and history of recurrent skin infections. The questionnaire was administered in the local language.

Data Collection Procedure:
Face-to-face interviews were conducted with the children under the supervision of their teachers, and visual inspection was done to confirm the presence of skin infections where necessary. Data on hygiene behaviors were cross-verified with parental inputs wherever possible.

Data Analysis:
Data were entered into Microsoft Excel and analyzed using SPSS software version 25. Descriptive statistics were calculated for demographic and clinical variables. Chi-square test was used to assess the association between hygiene practices and recurrent skin infections. A p-value of <0.05 was considered statistically significant.

Ethical Considerations:
The study was approved by the Institutional Ethics Committee of Government Medical College, Pulivendula. Informed written consent was obtained from the parents or legal guardians of the children. Confidentiality and anonymity were maintained throughout the study.

A total of 50 school-going children were included in the study. The age distribution showed that the majority of participants were between 9 and 11 years (40%), followed by those aged 12–14 years (32%) and 6–8 years (28%). Males constituted 56% of the sample, while females made up the remaining 44% (Table 1).

Table 1: Demographic Characteristics of Study Participants (n = 50)

The prevalence of recurrent skin infections among the participants was found to be 36% (n = 18), while 64% (n = 32) reported no history of recurrent infections (Table 2).

Table 2: Prevalence of Recurrent Skin Infections

An analysis of hygiene practices revealed statistically significant associations between recurrent skin infections and several hygiene-related behaviors. Children who did not bathe daily (p = 0.042), did not trim their nails regularly (p = 0.031), shared towels or clothing (p = 0.017), or did not wear freshly washed clothes daily (p = 0.023) were more likely to have recurrent skin infections. However, the use of soap while bathing was not significantly associated with infection status (p = 0.056) (Table 3).

Table 3: Association Between Hygiene Practices and Recurrent Skin Infections

*p < 0.05 considered statistically significant; NS: Not Significant

Among the children who had recurrent skin infections (n = 18), fungal infections such as tinea were the most commonly observed (44.4%), followed by bacterial infections like impetigo (33.3%), scabies (16.7%), and other unspecified skin conditions (5.6%) (Table 4).

Table 4: Types of Recurrent Skin Infections Observed (n = 18)

This cross-sectional study aimed to explore the relationship between hygiene practices and recurrent skin infections among school-going children in the vicinity of Government Medical College, Pulivendula. The findings revealed a substantial burden of recurrent skin infections, with a prevalence of 36%, highlighting the pressing need for targeted interventions in this age group.

Poor hygiene behaviors such as irregular bathing, infrequent nail trimming, sharing of towels or clothing, and not wearing freshly washed clothes were found to be significantly associated with the occurrence of recurrent skin infections. These results are consistent with previous studies that emphasize the critical role of personal hygiene in preventing skin infections among children [6,9]. In particular, hand hygiene and cleanliness of clothing have been directly linked to reduced microbial colonization and infection risk [6].

Fungal infections, particularly tinea, emerged as the most common type of recurrent skin infection (44.4%), followed by bacterial infections like impetigo (33.3%) and scabies (16.7%). These findings are in line with the epidemiological patterns reported in other regional and international studies [9,10]. Climatic conditions, overcrowding, and lack of access to hygiene facilities have been cited as contributing factors to this distribution [11].

Staphylococcal skin infections, particularly those caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), remain a growing concern due to their recurrent nature and difficulty in eradication [7,8]. Decolonization strategies and education on avoiding the sharing of personal items have been shown to reduce recurrence rates [8].

A limitation of this study is the small sample size (n = 50), which may limit the generalizability of the findings. Additionally, reliance on self-reported hygiene behaviors may introduce reporting bias, though efforts were made to validate responses with teachers and parents.

In conclusion, this study reinforces the importance of hygiene education and behavioral interventions as critical public health strategies to reduce the burden of recurrent skin infections in children. School-based programs that promote hygiene awareness, regular screening, and parental involvement may significantly improve skin health outcomes in this vulnerable population [11].

This study highlights a significant association between poor hygiene practices and recurrent skin infections among school-going children. Key behaviors such as irregular bathing, infrequent nail trimming, sharing of personal items, and not wearing freshly washed clothes were significantly linked to increased infection risk. Fungal infections were the most common, followed by bacterial infections and scabies. These findings underscore the need for school-based hygiene education programs and regular health checkups to promote better hygiene practices. Strengthening awareness among children, parents, and teachers can play a vital role in preventing recurrent skin infections and improving overall child health and school attendance in similar resource-limited settings.

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