DERMATOPHYTOMYCOSES IN CHILDREN IN RURAL KENYA - THE IMPACT OF PRIMARY HEALTH-CARE

In a survey of 5780 children from 13 schools in rural Kisumu District (western Kenya) in 1993, a prevalence rate of dermatophytomycoses of 1 0.1% was found. Three-quarters of the affected children suffered from tinea capitis (prevalence rate 7.8%), caused by Microsporum audouinii var. langeronii, Trichophyton violaceum and Microsporum canis. In 1994 , dermatology programme within the primary health care system was star ted. Twelve community health workers (CHW's), trained in diagnosis and treatment of the most common skin diseases, carried out regular schoo l visits once a week. All dermatophytomycoses, dry forms of tinea capi tis included, were treated locally with Whitfield's ointment. In 1995 the prevalence rate of fungal skin infections in the same schools was found to be 9.3%; the difference to 1993 was not significant. Only tin ea capitis, with a prevalence rate of 5.8%, showed a significant reduc tion (P<0.05). Altogether, a distinctive improvement regarding the ext ent and the severity of dermatophytomycoses could be noticed. In the c ultures from tinea capitis, Microsporum canis was not found to be pres ent. Trained community health workers are capable of the diagnosis and treatment of fungal skin infections of children in rural areas, which leads to a reduction in the prevalence of tinea capitis.