Prevalence of scabies and its relation to hygiene

In Al-mostkbal PHC unit

The Final Project Report

Al-mostkbal Health Care Unit

By /

-:Prepared by:- Supervisors

Salwa Ahmed El-kelany Prof/ Mostafa Fouad -1
Omar Mahmoud Shehata Dr/ Yasser Youssf -2
Athar Yehia Al-hadary Dr/ Basma Abd El- -3
hadi
Jaydaa Hassan -4
Ahmed Saber El-tabeay -5
Merna Waleed Nabel -6
Aml Atif Hosny -7
Abdalla Essam -8

Faculty of Medicine
Suez Canal University
2013
 Acknowledgement

My sincere gratitude should be submitted first to "Allah" Who always helps

and cares for me. I always feel indebted to "Allah", the most kind and most
merciful.

Words can never express my hearty thanks, indebtedness, and I wish to express
deepest gratitude and sincere appreciation to:

Prof/ Mostafa Fouad

Dr/ Yasser Youssf
Dr/ Basma Abd El-hadi

Of. Who initiated the idea for this research study and participated in the
perusal of this study to lighting and for her effort, guidance and suggestion.

1
 Introduction and rationale

Definition:
Scabies is a contagious skin infection caused by the mite Sarcoptes scabiei. The
mite is a tiny and usually not directly visible parasite, which burrows under the
host's skin, causing intense allergic itching. The infection in animals is caused
by a different but related mite species, and is called sarcoptic mange.(1)

Transmission of scabies:
Scabies is classified by the World Health Organization as a water-related
disease. The disease may be transmitted from objects but is most often
transmitted by direct skin-to-skin contact, with a higher risk with prolonged
contact. Initial infections require four to six weeks to become symptomatic.
Reinfection, however, may manifest symptoms within as little as 24 hours.
Because the symptoms are allergic, their delay in onset is often mirrored by a
significant delay in relief after the parasites have been eradicated. Crusted
scabies, formerly known as Norwegian scabies, is a more severe form of the
infection often associated with immunosuppression.(2)

Signs and symptoms:

The characteristic symptoms of a scabies infection include intense itching and
superficial burrows.[3] The burrow tracks are often linear, to the point that a
neat "line" of four or more closely placed and equally developed mosquito-like
"bites" is almost diagnostic of the disease.
Itching:
In the classic scenario, the itch is made worse by warmth and is usually
experienced as being worse at night, possibly because there are fewer
distractions.[3] As a symptom, it is less common in the elderly.(3)
Rash:
The superficial burrows of scabies usually occur in the area of the hands, feet,
wrists, elbows, back, buttocks, and external genitals.[3] Except in infants and
the immunosuppressed, infection generally does not occur in the skin of the face
or scalp. The burrows are created by excavation of the adult mite in the
epidermis.[3]

Cause:

2
the mite now called Sarcoptes scabiei, variety hominis, is the cause of scabies.
Sarcoptes is a genus of skin parasites and part of the larger family of mites
collectively known as scab mites. These organisms have eight legs as adults, and
are placed in the same phylogenetic class (Arachnida) as spiders and ticks.
Sarcoptes scabiei are microscopic, but sometimes are visible as pinpoints of
white. Pregnant females tunnel into the dead, outermost layer (stratum
corneum) of a host's skin and deposit eggs in the shallow burrows. The eggs
hatch into larvae in three to ten days. These young mites move about on the skin
and molt into a "nymphal" stage, before maturing as adults, which live three to
four weeks in the host's skin. Males roam on top of the skin, occasionally
burrowing into the skin. In general, there are usually few mites on a healthy
hygienic person infested with non-crusted scabies; approximately eleven
females in burrows can be found on such a person.[4]

Diagnosis:
Scabies may be diagnosed clinically in geographical areas where it is common
when diffuse itching presents along with either lesions in two typical spots or
there is itchiness of another household member.[5] The classical sign of scabies
is the burrows made by the mites within the skin.[5] To detect the burrow, the
suspected area is rubbed with ink from a fountain pen or a topical tetracycline
solution, which glows under a special light. The skin is then wiped with an
alcohol pad. If the person is infected with scabies, the characteristic zigzag or S
pattern of the burrow will appear across the skin; however, interpreting this
test may be difficult, as the burrows are scarce and may be obscured by scratch
marks.[5] A definitive diagnosis is made by finding either the scabies mites or
their eggs and fecal pellets.[5] Searches for these signs involve either scraping a
suspected area, mounting the sample in potassium hydroxide, and examining it
under a microscope, or using dermoscopy to examine the skin directly.[3]

Prevention:
Mass treatment programs that use topical permethrin or oral ivermectin have
been effective in reducing the prevalence of scabies in a number of populations.
[5] There is no vaccine available for scabies. The simultaneous treatment of all
close contacts is recommended, even if they show no symptoms of infection
(asymptomatic), to reduce rates of recurrence.[5] Asymptomatic infection is
relatively common.[5] Since mites can only survive for two to three days without
a host, objects in the environment pose little risk of transmission except in the
case of crusted scabies, thus cleaning is of little importance.[5] Rooms used by
those with crusted scabies require thorough cleaning.[6]
Management:

3
A number of medications are effective in treating scabies; however, treatment
must often involve the entire household or community to prevent re-infection.
[5] Options to improve itchiness include antihistamines.[7]
Permethrin:
Permethrin is the most effective treatment for scabies[8] and the treatment of
choice.[5][9] It is applied from the neck down usually before bedtime and left on
for about eight to fourteen hours, then showered off in the morning.[5] One
application is normally sufficient for mild infections. For moderate to severe
cases, another dose is applied seven to fourteen days later.[5][9][10] Permethrin
causes slight irritation of the skin, but the sensation is tolerable.[3] The
medication, however, is the most costly of topical treatments.[3]

Ivermectin :
Ivermectin is an oral medication shown by many clinical studies to be effective
in eradicating scabies, often in a single dose.[2][5] It is the treatment of choice
for crusted scabies and is often used in combination with a topical agent.[3][5] It
has not been tested on infants and is not recommended for children under six
years of age.[3]
Topical ivermectin preparations have been found to be effective for scabies in
adults and are attractive due to their low cost, ease of preparation, and low
toxicity.[11] It has also been useful for sarcoptic mange (the veterinary analog
of human scabies).[12]
Others:
Other treatments include lindane, benzyl benzoate, crotamiton, malathion, and
sulfur preparations.[3][5] Lindane is effective; however, concerns over potential
neurotoxicity has limited its availability in many countries.[3] It is approved in
the United States for use as a second-line treatment.[13] Sulfur ointments or
benzyl benzoate are often used in the developing world due to their low cost;[3]
10% sulfur solutions have been shown to be effective,[14] and sulfur ointments
are typically used for at least a week.[3] Crotamiton in limited studies has been
found to be less effective than permethrin.[3] Crotamiton or a sulfur
preparation is often recommended instead of permethrin for children, due to
concerns over dermal absorption of permethrin.[5]

4
 Research Aim
To contribute to the reduction of catching the scabies by awareness of the importance
of hygiene and sanitation for scabies prevention.

Study objectives
Primary objective:
To assess knowledge, altitude and practice of people towards scabies in Almostakbl
primary
health unit
Secondary objective:
To measure the level of their concern with hygiene and whether their negligence
helps in
further spreading of the disease

Subjects and methods

Study design:
Descriptive study that will be carried out to assess the knowledge of people about
scabies and their limit of knowledge

Study setting:
Our study will be in Almostakbl primary health care unit in Ismailia

Study subject:
Target population: children attending almostakbl primary health care unit in ismailia
aging from 13 to 60 years old
there are no exclusion nor inclusion criteria

Sampling size and techniques:

There is convenient sampling.

List of tables
5
‫نسبة كل من الجنسين المشاركين في االستبيان‬
‫‪Sex‬‬
‫‪Valid‬‬
‫‪Frequency‬‬ ‫‪Percent‬‬
‫‪Valid‬‬ ‫‪0‬‬ ‫‪15‬‬ ‫‪24.2‬‬
‫‪1‬‬ ‫‪47‬‬ ‫‪75.8‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة الذكور المشاركين حوالي ‪ % 22.7‬اما نسبة االناث المشاركين حوالي ‪% 71.2‬‬

‫متوسط االعمار للمشاركين في االستبيان‬

‫‪Age‬‬

‫‪Frequency‬‬ ‫‪Valid Percent‬‬

‫‪Valid‬‬ ‫‪2 1‬‬ ‫‪1.6‬‬
‫‪16 1‬‬ ‫‪1.6‬‬
‫‪17 1‬‬ ‫‪1.6‬‬
‫‪18 2‬‬ ‫‪3.2‬‬
‫‪19 4‬‬ ‫‪6.5‬‬
‫‪20 3‬‬ ‫‪4.8‬‬
‫‪21 4‬‬ ‫‪6.5‬‬
‫‪22 1‬‬ ‫‪1.6‬‬
‫‪23 4‬‬ ‫‪6.5‬‬
‫‪24 3‬‬ ‫‪4.8‬‬
‫‪27 1‬‬ ‫‪1.6‬‬
‫‪28 4‬‬ ‫‪6.5‬‬
‫‪29 2‬‬ ‫‪3.2‬‬
‫‪30 5‬‬ ‫‪8.1‬‬
‫‪32 4‬‬ ‫‪6.5‬‬
‫‪33 2‬‬ ‫‪3.2‬‬
‫‪34 1‬‬ ‫‪1.6‬‬
‫‪35 2‬‬ ‫‪3.2‬‬
‫‪36 2‬‬ ‫‪3.2‬‬
‫‪37 1‬‬ ‫‪1.6‬‬

‫‪6‬‬
 ‫‪38 2‬‬ ‫‪3.2‬‬
‫‪45 3‬‬ ‫‪4.8‬‬
‫‪46 1‬‬ ‫‪1.6‬‬
‫‪50 1‬‬ ‫‪1.6‬‬
‫‪56 1‬‬ ‫‪1.6‬‬
‫‪57 1‬‬ ‫‪1.6‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نالحظ ان اكثر متوسط االعمار المشاركة تبلغ من العمر حوالي ‪ 30‬عاما بنسبة ‪ ,, %7.6‬يليهم‬
‫من يبلغون من العمر ‪ 21 & 23‬عاما بنسبة ‪ % 6.1‬لكل منهم‬

‫نسبة االصابة بالمرض في المشاركين في االستبيان‬

‫‪Q1‬‬
‫‪Valid‬‬
‫‪Frequency‬‬ ‫‪Percent‬‬
‫‪Valid‬‬ ‫‪1 3‬‬ ‫‪4.8‬‬
‫‪2 59‬‬ ‫‪95.2‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫عدد المصابين بمرض الجرب سابقا ‪ 3‬حاالت بنسبة ‪ % 4.5‬بينما باقي المشاركين في‬
‫االستبيان لم يصابوا بالمرض ونسبتهم حوالي ‪ % 89.4‬من اجمالي المشاركين‬

‫نسبة االصابة بالمرض في عائالتهم‬

‫‪Q2‬‬
‫‪Valid‬‬
‫‪Frequency‬‬ ‫‪Percent‬‬
‫‪Valid‬‬ ‫‪1 6‬‬ ‫‪9.7‬‬
‫‪2 56‬‬ ‫‪90.3‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة االصابة بالمرض في عائالت المشاركين في االستبيان حوالي ‪ % 9.1‬بينما غير المصابين‬
‫‪% 84.8‬‬

‫‪7‬‬
 ‫نسبة الوعي بامكانية انتقال المرض عبر المالبس‬
‫‪Q3‬‬
‫‪Valid‬‬
‫‪Frequency‬‬ ‫‪Percent‬‬
‫‪Valid‬‬ ‫‪1 52‬‬ ‫‪83.9‬‬
‫‪2 10‬‬ ‫‪16.1‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة الوعي بامكانية انتقال المرض عبر المالبس حوالي ‪ % 78.8‬في مقابل ‪ 15.2‬ال يعون ذلك‬

‫نسبة الوعي بامكانية انتقال المرض عبر استعمال‬

‫االدوات الشخصية‬
‫‪Q4‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 57‬‬ ‫‪91.9‬‬
‫‪2 5‬‬ ‫‪8.1‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة الوعي بامكانية انتقال المرض عبر استخدام االدوات الشخصية حوالي ‪ % 86.4‬بينما‬
‫حوالي ‪ % 7.6‬اليعون ذلك ‪.‬‬

‫نسبة الوعي بان التهوية تقلل من احتمالية االصابة‬

‫بمرض الجرب‬
‫‪Q5‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 59‬‬ ‫‪95.2‬‬
‫‪2 3‬‬ ‫‪4.8‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة الوعي بان التهوية تقلل من امكانية االصابة بالمرض حوالي ‪ % 89.4‬في مقابل ‪4.5‬‬
‫اليدركون ذلك‬

‫نسبة الوعي بأساليب العالج الممكنة‬

‫‪8‬‬
 ‫‪Q6‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 24‬‬ ‫‪38.7‬‬
‫‪2 36‬‬ ‫‪58.1‬‬
‫‪3 2‬‬ ‫‪3.2‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة الوعي بأساليب العلاج الممكنة حوالي ‪ % 36.4‬في مقابل ‪ % 54.5‬ال يدركون طرق العالج‬

‫مصادر المعلومات عن المرض‬

‫‪Q7‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪0 7‬‬ ‫‪11.3‬‬
‫‪1 10‬‬ ‫‪16.1‬‬
‫‪2 5‬‬ ‫‪8.1‬‬
‫‪3 40‬‬ ‫‪64.5‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة وسائل االتيان بالمعلومات عن المرض حوالي ‪ % 10.6‬لديهم معلومات من الطبيب‬
‫المختص بعالجه بينما ‪ % 15.2‬اتوا بالمعلومات من الوحدة الصحية في مقابل ‪ 7.6‬من مصادر‬
‫اخرى‬

‫االلتزام بالعالج الذي تم تحديده‬

‫‪Q8‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪0 27‬‬ ‫‪43.5‬‬
‫‪1 3‬‬ ‫‪4.8‬‬
‫‪2 32‬‬ ‫‪51.6‬‬
‫‪9‬‬
 ‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة االلتزام بالعالج الذي تم تحديده ‪ %40.9‬لم يتناول العالج لعدم اصابته بالمرض ‪ 48.5 ...‬تم‬
‫االلتزام بالعالج المقدم ‪ ..‬بينما ‪ 4.5‬لم يلتزم بالعالج‬

‫تطبيق العالج بطريقة صحيحة‬

‫‪Q9‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪0 5‬‬ ‫‪8.1‬‬
‫‪1 27‬‬ ‫‪43.5‬‬
‫‪2 30‬‬ ‫‪48.4‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة المعرفة بكيفية تطبيق العالج بطريقة صحيحة حوالي ‪ % 40.9‬بينما ‪ 45.5‬ال يعلمون كيفية‬
‫تطبيقه‬

‫نسبة المعرفة بمدى العواقب التي تنتج نتيجة‬

‫عدم االلتزام بالعالج‬
‫‪Q10‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 31‬‬ ‫‪50.0‬‬
‫‪2 31‬‬ ‫‪50.0‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫نسبة المعرفة بالعواقب الناتجة عن عدم االلتزام بالعالج ‪%47‬‬

‫نسبة المعرفة بكيفية االصابة بالمرض‬

‫‪Q11‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬

‫‪10‬‬
 ‫‪Valid‬‬ ‫‪1 43‬‬ ‫‪69.4‬‬
‫‪2 19‬‬ ‫‪30.6‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫حوالي ‪ 65.2‬يعلمون كيفية االصابة بالمرض في حين ‪ % 28.8‬ال يعلمون كيفية االصابة بالمرض‬

‫نسبة عدد افراد االسرة‬

‫‪Q12‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 11‬‬ ‫‪17.7‬‬
‫‪2 44‬‬ ‫‪71.0‬‬
‫‪3 7‬‬ ‫‪11.3‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫حوالي ‪ % 16.7‬عدد افراد اسرتهم اقل من ‪ 4‬افراد ‪ 66.7 ,,‬يتراوح عدد افراد االسرة مابين ‪6-4‬‬
‫افراد ‪ ,,‬وحوالي ‪ % 10.6‬عدد افراد االسرة اكثر من ‪ 6‬افراد‬

‫نسبة عدد حجرات المنزل‬

‫‪Q13‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 3‬‬ ‫‪4.8‬‬
‫‪2 51‬‬ ‫‪82.3‬‬
‫‪3 8‬‬ ‫‪12.9‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫حوالي ‪ % 4.5‬لديهم حجرة واحدة ‪ %77.3 ,,‬من ‪ 4-2‬حجرات ‪ ,,‬حوالي ‪ %12.1‬اكثر من ‪ 4‬حجرات‬

‫نسبة العلم بان زيادة عدد االفراد في الحجرة يزيد من‬

‫احتمالية االصابة بالمرض‬
‫‪Q14‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 53‬‬ ‫‪85.5‬‬
‫‪2 9‬‬ ‫‪14.5‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬

‫‪11‬‬
 ‫‪Total‬‬ ‫‪66‬‬
‫‪ % 80.3‬يعلمون ان زيادة عدد افراد االسرة في الحجرة يزيد من االحتمالية باإلصابة بينما‬
‫حوالي ‪ % 13.6‬ال يعلمون ذلك‬

‫نسبة العلم بان المياه الملوثة قد تؤدي الى‬

‫االصابة بالمرض‬
‫‪Q15‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 49‬‬ ‫‪79.0‬‬
‫‪2 13‬‬ ‫‪21.0‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫‪ % 74.2‬يعلمون ذلك بينما ‪ 19.7‬ال يعلمون خطورة المياه الملوثة على انتقال المرض‬

‫مدى جودة المياه المتوفرة‬

‫‪Q16‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 55‬‬ ‫‪88.7‬‬
‫‪2 7‬‬ ‫‪11.3‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫‪ % 83.3‬يتوفر لديهم مياه جيدة ‪ ,,‬بينما ‪ 10.6‬ال يتوفر لديهم مياه صالحة‬

‫نسبة وجود المياه بصورة دائمة‬

‫‪Q17‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 53‬‬ ‫‪85.5‬‬
‫‪2 9‬‬ ‫‪14.5‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫‪ % 80.3‬يوجد لديهم المياه بصورة دائمة ‪ ,,‬بينما ‪ % 13.6‬تنقطع المياه باستمرار‬

‫نسبة المصادر البديلة للمياه في حالة انقطاعها‬

‫‪Q18‬‬
‫‪12‬‬
 ‫‪ % 9.1‬ال تنقطع المياه لديهم ‪ % 40.9 ,,‬اعتمادهم على مياه الخزانات ‪ ,,‬حوالي ‪ 43.9‬يعتمدون‬
‫على المياه المعدنية‬

‫نسبة وجود اماكن متخصصة للتخلص من القمامة‬

‫خارج المنزل‬
‫‪Q19‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 51‬‬ ‫‪82.3‬‬
‫‪2 11‬‬ ‫‪17.7‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫‪% 77.3‬لديهم اماكن مخصصة للقمامة ‪ ,,‬بينما ‪ 16.7‬ال توجد لديهم اماكن للتخلص من القمامة‬

‫التخلص من القمامة من الشوارع بصورة مستمرة‬

‫‪Q20‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 44‬‬ ‫‪71.0‬‬
‫‪2 18‬‬ ‫‪29.0‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫‪ % 66.7‬يتم التخلص من القمامة بصورة مستمرة في الشوارع لديهم بينما ‪ % 27.3‬ال يتخلصون‬
‫منها‬

‫وجود شبكة صرف صحى جيدة‬

‫‪Q21‬‬
‫‪Frequency‬‬ ‫‪Valid Percent‬‬
‫‪Valid‬‬ ‫‪1 55‬‬ ‫‪88.7‬‬
‫‪2 7‬‬ ‫‪11.3‬‬
‫‪Total‬‬ ‫‪62‬‬ ‫‪100.0‬‬
‫‪Missing‬‬ ‫‪System‬‬ ‫‪4‬‬
‫‪Total‬‬ ‫‪66‬‬
‫‪ % 83.3‬توجد لديهم شبكة صرف صحي جيدة ‪ ,,‬بينما حوالي ‪ 10.6‬ال توجد لديهم شبكات جيدة‬
‫للصرف الصحى‬

‫أداء عمال النظافة فى المنطقة السكنية المحيطة‬

‫‪13‬‬
 Q22
Frequency Valid Percent
Valid 1 24 38.7
2 38 61.3
Total 62 100.0
Missing System 4
Total 66
‫ غير راضون عنها‬% 57.6 ‫ بينما حوالي‬,, ‫ راضون عن اداء عمال القمامة‬% 36.4

List of figures

14
15
16
17
18
19
20
21
22
23
24
25
 Results

The percentage of the male participants account about 22.7% and that of the female
participants account about 72.2%.
The average age of the participants is 30 years old (accounting about 7.6%)and the next in
a row are those in the range between 21 to 23 years old(accounting 6.1% together)
Fortunately. we 'have found only 3 participants who have been diagnosed with
scabies(about 4.5%) while the rest of the participants have never been infected (about
89.4%).
The percentage of participants whose family members have been previously infected with
scabies is 9.1% and that of participants whose family member4s never got scabies is
89.8%.
The percentage of participants’ awareness that scabies can be transmitted through the
exchange of clothes is ant those who are unaware is 78.8%
The percentage of participants’ awareness that scabies can be transmitted through the
exchange of personal stuff and cosmetics is 86.4% and those who are unaware is 7.6%
The percentage of participants’ awareness that ventilation decreases from the probability
and the risk of being infected with scabies is 89.4% and those who are unaware is 4.5%
The percentage of participants’ awareness of proper treatment for scabies is 36.4% and
those who don’t is 54.5 % Source of participants’ information:
10.6% from personal doctor,7.6 %from primary health care unit and 15.2%from other
sources
The percentage of participants’ commitment to treatment:
48.5%committed, 4.5%didn’t commit and 40.9%didn't commit because they weren’t
infected
The percentage of the participant's awareness of how to apply the treatment:40.9%know
how to apply it properly and 45.5%don’t know
The percentage of the family members in a single house:
66.7% have 4-6 members,% have 16.7less than 4 members and 10.6% have more than 6
members
The percentage of the number of the rooms that the participants possess in a single house
12.1% more than 4 rooms, 77.3% 2-4 rooms and 4.5% possess only one room
The percentage of participants’ awareness that risk of scabies increases as the number of
people in a single room increases is 80.3 % and that who don’t is 13.6%
The percentage of participants’ awareness that scabies can be transmitted through polluted
water is 74.2 %and those who are unaware is19.7 %
10.6% receives polluted water and 83.3% receives unpolluted water
77.3% have certain places where they get rid of garbage and 16.4% don’t
83.3%has a good sewage network and 10.6% don’t
36.4% of the participants say that the performance of the street cleaners is satisfactory and
57.6% say it is not
26
 Conclusions and Recommendations for future work

Although the percentage of being infected with scabies is low but that doesn’t
mean that it should be neglected and excluded. Some of those participants
didn’t even know what is scabies, or what are the risks of scabies and how it
can be transmitted. The number of people increases with an extraordinary rate
which increases the risk of infection, not just with scabies but with any other
skin diseases that are transmitted through direct or indirect contact. Also most
of the people think that proper ventilation and sunlight exposure are trivial
things and don’t deserve to be such an issue.
We think that the he main problem is the prevalence of ignorance in such
communities as l mostakbl city and the negligence of the Egyptian society of
such diseases considering it as something trivial and unworthy of social
attention. The people want to improve their conditions and they want to save
themselves and their children so they are willing to do something but they just
want someone to guide them and take their hand to the right track.

Accordingly, we decided to take the first step and be their guide in mostakbl
city. We are thinking of organizing certain health educations programs and
campaigns about scabies, how it can be transmitted, its causes , its symptoms
and how not to confuse it with some other skin diseases. We will be like a role
model for others to start this step in other communities like the mostakbl city
in order to raise awareness and grab the society’s attention everywhere to how
important this issue is. These campaigns should be repeated every certain
interval of time with improved aspects each time and interestingly attractive
factors that help to gather people and actually encourage them to begin to fix
the problems themsleves .

27
 Literature review

Scabies ,also called Norwegian scabies or colloquially the seven-year itch, is a

contagious skin infection caused by the mite Sarcoptes scabie,. The mite is a tiny and
usually not directly visible parasite, which burrows under the host's skin, causing intense
allergic itching. The infection in animals other than humans is caused by a different but
.related mite species, and is called sarcoptic mange
Scabies is classified by the World Health Organization as a water-related disease. The
disease may be transmitted from objects but is most often transmitted by direct skin-to-skin
contact, with a higher risk with prolonged contact. Initial infections require four to six
weeks to become symptomatic. Reinfection, however, may manifest symptoms within as
little as 24 hours. Because the symptoms are allergic, their delay in onset is often mirrored
by a significant delay in relief after the parasites have been eradicated. Crusted scabies,
formerly known as Norwegian scabies, is a more severe form of the infection often
associated with immunosuppression (15)
:Scabies signs and symptoms include
 Itching, often severe and usually worse at night

 Thin, irregular burrow tracks made up of tiny blisters or bumps on your skin

The burrows or tracks typically appear in folds of your skin. Though almost any part of
:your body may be involved, in adults scabies is most often found
 Between fingers

 In armpits

 Around your waist

 Along the insides of wrists

 On your inner elbow

 On the soles of your feet

 Around breasts

 Around the male genital area

 On buttocks

 On knees

 On shoulder blades

:In children, common sites of infestation include the

 Scalp
28
  Face

 Neck

 Palms of the hands

 Soles of the feet

The eight-legged mite that causes scabies in humans is microscopic. The female mite
burrows just beneath your skin and produces a tunnel in which it deposits eggs. The eggs
hatch in three to four days, and the mite larvae work their way to the surface of your skin,
where they mature and can spread to other areas of your skin or to the skin of other people.
The itching of scabies results from your body's allergic reaction to the mites, their eggs and
.their waste(16)
Close physical contact and, less often, sharing clothing or bedding with an infected person
.can spread the mites
Dogs, cats and humans all are affected by their own distinct species of mite. Each species
of mite prefers one specific type of host and doesn't live long away from that preferred
host. So humans may have a temporary skin reaction from contact with the animal scabies
mite. But people are unlikely to develop full-blown scabies from this source, as they might
.from contact with the human scabies mite(17)
Scabies is a global problem and a significant source of morbidity in nursing home residents
and workers because of its highly contagious nature. It is also a problem in hospitals that
care for the elderly, the debilitated, and the immunocompromised. New outbreaks continue
to occur, despite controlling the recurrent epidemics. Scabies manifests as papules,
pustules, burrows, nodules, and occasionally urticarial papules and plaques. Most of the
patients with scabies experience severe pruritus. A subset of patients have crusted or
Norwegian scabies. These patients, who are usually debilitated or immunocompromised,
do not experience the urge to scratch, and therefore do not scratch their own skin.
Diagnosis of scabies is based on patient history, physical examination, and demonstration
of mites, eggs, or scybala (black or brown football-shaped masses of feces of scabies) on
.microscopic examination(18)
Scabies can be treated with topical or oral therapies. Topical treatments include 5%
permethrin cream, 1% lindane (gamma benzene hexachloride) lotion, 6% precipitated
sulfur in petrolatum, crotamiton, malathion, allethrin spray, and benzyl benzoate.
Ivermectin, the only oral treatment, is not approved for scabies in the US. Most authorities
advocate using a scabicide several times, specifically once a week over a period of 2–3
weeks. In an outbreak of scabies in a nursing home, residents, staff, and frequent visitors
should all be treated even if they are not symptomatic. Ivermectin is useful in treating
patients with Norwegian or crusted scabies, or who are debilitated. Ivermectin has no
serious reported adverse effects. Model treatment plans to stop scabies epidemics have
been developed. These plans coordinate treatment of all persons exposed (including
ivermectin for debilitated patients), isolation of infected patients, disinfection of objects
that patients have come into contact with, and education and reassurance of the medical

29
staff. Failure to coordinate notification, education, treatment, and disinfection leads to
failure to control scabies epidemics. Control of epidemics of institutional scabies requires
attention to treatment effects and logistics. Treatment is low risk, but cumbersome because
many individuals need be treated. It is advisable to restrict, where possible, the number of
staff members that deal with scabies patients to limit the spread of the scabies. Prolonged
surveillance is required for the eradication of institutional scabies. While the foregoing
plans require coordination of all involved personnel and sustained efforts, they are
necessary to halt the spread of scabies to patients and staff, to enhance their morale, and to
.prevent deterioration of labor and public relations(19)

30
 Discussion

-: The proportion of people infected with scabies

In our study, The number of people diagnosed with scabies previously is 3 cases by 4.5%,
while the rest of the participants in the questionnaire did not have the disease and
accounted for approximately 89.4% of the total participants But this result is larger than
the global ratio of contracting this disease , this global ratio does not exceed 1.5% For
example, 0.0032% (414) of hospital consultant episodes were for scabies in England 2002,
This difference in the results may be due to the spread of this kind of diseases in El-
mostakbal city as one of the rural areas which are characterized by lack of concern for
hygiene and sanitation, and the lack of clean water for drinking and also characterized by a
.low level of health education and awareness of such diseases

-: The rate of awareness of the possible treatment methods of scabies

The global proportion of awareness of the treatment methods for scabies ranging from 59%
to 79%, but in our study, we find that the percentage of awareness of the treatment
methods does not exceed approximately 36.4% on other hand 54.5% do not realize the
treatment methods and that is evident that there is a big difference in the people knowledge
about how to deal with this disease and its treatment and this is due to the decline in the
level of awareness of these people in el-mostakbal city and lack of health education they
.have

-:The rate of knowledge about how the scabies passes

About 65.2% know how the disease passes while 28.8% do not know, in our study. but this
ratio is less than the normal global ratio which reaches 71% , And so, this is the main
reason for the spread of scabies because the lack of knowledge of how the scabies passes
make its transmission between them easy and also only 78.8 % of people know that this
.disease passes through the clothes

References

31
1)^ Gates, Robert H. (2003). Infectious disease secrets (2. ed.). Philadelphia: Elsevier,
Hanley Belfus. pp. 355
2)"WHO -Water-related Disease". World Health Organization. Retrieved 2010-10-10.
3)Hay RJ (2009). "Scabies and pyodermas—diagnosis and treatment". Dermatol Ther 22
(6): 466–74
4)Walton, SF; Currie, BJ (April 2007). "Problems in Diagnosing Scabies, a Global Disease
in Human and Animal Populations". Clinical Microbiology Reviews 20 (2): 268–79.
5)Andrews RM, McCarthy J, Carapetis JR, Currie BJ (December 2009). "Skin disorders,
including pyoderma, scabies, and tinea infections". Pediatr. Clin. North Am. 56 (6): 1421–
40.
6)CDC—Prevention and Control—Scabies". Center for Disease Control and Prevention.
Retrieved 2010-10-09.
7)doi:10.3949/ccjm.75.7.474 Cleveland Clinic Journal of Medicine July 2008 vol. 75 7
474–478
8)Strong M, Johnstone PW (2007). Strong, Mark. ed. "Interventions for treating scabies".
9)"Scabies". Illinois Department of Public Health January 2008. Retrieved 2010-10-07.
10)The Pill Book. Bantam Books. 2010. pp. 867–869.
11)Victoria J, Trujillo R (2001). "Topical ivermectin: a new successful treatment for
scabies". Pediatr Dermatol 18 (1): 63–5.
12) "Parasitology Research, Volume 78, Number 2". SpringerLink. Retrieved 2010-11-14.
13)"FDA Public Health Advisory: Safety of Topical Lindane Products for the Treatment of
Scabies and Lice". Fda.gov. 2009-04-30. Retrieved 2010-11-14.
^14)Jin-Gang A, Sheng-Xiang X, Sheng-Bin X, et al. (March 2010). "Quality of life of
patients with scabies". J Eur Acad Dermatol Venereol 24 (10): 1187.
Gates, Robert H. (2003). Infectious disease secrets (2. ed.). Philadelphia: Elsevier, )15
.Hanley Belfus
Chouela E, Abeldano A, Pellerano G, et al. Diagnosis and treatment of scabies: a ) 16
practical guide. Am J Clin Dermatol 2002; 3: 9–18
Haag ML, Brozena SJ, Fenske NA. Attack of the scabies: what to do when an outbreak )17
;occurs. Geriatrics 1993
Scabies. Centers for Disease Control and Prevention. )18
http://www.cdc.gov/parasites/scabies/. Accessed April 25, 2012
Scabies. American Academy of Dermatology. )19
http://www.aad.org/skin-conditions/dermatology-a-to-z/scabies. Accessed April 25, 201
Gates, Robert H. (2003).2

32
 ‫انتشار مرض الجرب وعالقته بالنظافة‬
‫الشخصية‬
‫فى الوحدة الصحية بالمستقبل‬

‫تقرير المشروع النهائى‬

‫الوحدة الصحية بالمستقبل‬

‫مقدم من ‪:‬‬ ‫تحت إشراف ‪:‬‬

‫‪-1‬‬ ‫د‪ /‬مصطفى فؤاد‬
‫سلوى أحمد الكيالنى‬

‫‪-2‬‬ ‫د‪ /‬ياسر يوسف‬

‫عمر محمود شحاته‬

‫‪-3‬‬ ‫د‪ /‬بسمة عبد الهادى‬

‫آثار يحي الحضرى‬
‫‪-4‬‬
‫ميرنا وليد نبيل‬
‫‪ -5‬أمل‬
‫عاطف حسنى‬
‫‪-6‬‬
‫جيداء حسن‬
‫‪ -7‬أحمد‬
‫صابر التابعى‬

‫‪33‬‬
‫‪ -8‬عبد‬
‫الله عصام‬

‫جامعة قناة السويس‬

‫كلية الطب البشرى‬
‫‪2013‬‬

‫المقدمة‬
‫مرض الجرب مرض جلدي معدي تسببه حشرة صغيرة وعادة ال تري مباشرة‪.‬‬
‫تدخل هذه الحشرة تحت جلد المضيف لها فتتسبب حكة شديدة ‪،‬لكن العدوى في‬
‫الحيوانات تسببها حشرة مختلفة ولكنها تنتمي لنفس الفصلية‪.‬وطبقًا لتصنيف‬
‫منظمة الصحة العالمية فإن مرض الجرب ينتقل عن طريق الماء ويمكن أن‬
‫ينتقل أيضًا عن طريق األشياء ولكنه غالبًا ينتقل عن طريق االتصال الجلدي‬
‫المباشر وتزداد خطورة انتقاله مع االتصال الجلدي لفترات طويلة وتحتاج العدوي‬
‫األولى من أربعة إلي ستة أسابيع لكي تظهر اإلعراض‪ ,‬ولكن حدوث العدوي مرة‬
‫ثانية يمكنه أن تظهر االعراض في أقل من ‪ 24‬ساعة ‪ .‬ولكون االعراض تشبه‬
‫الحساسية فأنها تستغرق وقتًا في ظهورها وتستغرق وقتًا في الشفاء منها بعد‬
‫إزالة الفطريات ‪ .‬مرض الجرب نوع قاسي من العدوي تتسبب في ضعف المناعة‬
‫‪ .‬وتتمثل أعراض المرض في الحكة والطفح الجلدي‪ .‬ويمكن تشخيص مرض‬
‫الجرب في المناطق الجغرافية حيث ينتشر هذا المرض أو عندما يصاب فرد أخر‬
‫في المنزل ‪ .‬تستخدم برامج عالجية واسعة لتقليل انتشار مرض الجرب فى تعداد‬
‫السكان‪ ,‬ويفضل معالجة كل االشخاص المتصلين بالمصاب حتى فى حالة عدم‬
‫ظهور االعراض عليهم ‪ ,‬ويمكن الوقاية من المرض باالهتمام بتنظيف البيئه‬
‫‪ .‬المحيطه‬

‫‪ :-‬الهدف من البحث‬
‫االسهام فى تقليل االصابة بمرض الجرب عن طريق توعية الناس بأهمية النظافه‬
‫الشخصية ونظافة البيئه المحيطه للوقايه من هذا المرض‬

‫‪ :‬أهداف الدراسة‬
‫‪ :‬الهدف االولى‬
‫تقيم المعرفه والسلوك والممارسه لدى الناس فى مدينة المستقبل تجاه هذا‬
‫‪.‬الموضوع‬
‫‪ :‬الهدف الثانوى‬
‫قياس مستوى اهتمامهم بالنظافة الشخصية وهل إهمالهم ذلك يساعد في‬
‫‪ .‬االنتشار السريع للمرض‬

‫‪34‬‬
 ‫موضوع ووسائل الدراسة‬
‫‪ :‬تصميم الدارسة‬
‫‪.‬تتم دراسة وصفيه لتقييم معرفة الناس عن مرض الجرب وحدود معرفتهم بذلك‬
‫‪ :‬إعداد الدراسة‬
‫تتم الدراسة في الوحدة الصحية بمدينة المستقبل بمحافظة االسماعيلية‬
‫‪ :‬موضوع الدراسة‬
‫تتراوح أعمار الفئة المنشورة للدراسة من ‪ 13‬إلى ‪ 60‬سنة ممن يترددون على‬
‫‪ .‬الوحدة الصحية بمدينة المستقبل‬
‫‪ .‬ال توجد معايير لضم أو استبعاد السكان‬

‫الخاتمة والتوصيات‬
‫بالرغم من أن المصابين بمرض الجرب عدد قليل ولكن هذا ال يعنى‬
‫إهماله وعدم االهتمام به ‪ .‬حيث أن بعض المشاركين في الدراسة ال‬
‫يعلمون حتى ما هو مرض الجرب أو أخطار المرض وطريقه‬
‫انتقاله ‪.‬يزداد عدد السكان بمعدل أكثر من الطبيعى مما يزيد خطورة‬
‫العدوى ليس فقط بمرض الجرب ولكن بأى مرض جلدى أخر ينتقل‬
‫عن طريق االتصال المباشر أو غير المباشر ‪.‬يعتقد بعض الناس أن‬
‫التهوية الجيدة والتعرض للشمس أمور ال تستحق أن تكون قضية‬
‫للبحث والدراسة‪ .‬نعتقد أن المشكلة الرئيسية هى انتشار الجهل في‬
‫هذه المجتمعات كمدينة المستقبل وإهمال المجتمع المصري لهذه‬
‫االمراض باعتبارها شىء تافه ال يستحق االهتمام االجتماعى ‪.‬يريد‬
‫الناس تحسين أحوالهم وحماية أنفسهم وأطفالهم ليكونوا مستعدين‬
‫لفعل شىء ولكنهم محتاجين لمن يرشدهم ويأخذ بأيديهم للطريق‬
‫‪ .‬الصحيح‬
‫لذلك قررنا أن نخطو الخطوة األولى ونكون مرشدهم في مدينة‬
‫المستقبل ‪,‬حيث نفكر في تنظيم برامج تعليمية صحية وحمالت عن‬
‫مرض الجرب وكيفية انتقاله وأسبابه وأعراضه وتكرر هذه الحمالت‬
‫على فترات لزيادة الوعي وجذب انتباه المجتمع ألهمية هذا الموضوع‬
‫‪ .‬وتشجيع الناس إلصالح مشاكلهم بأنفسهم‬

‫‪35‬‬
 ‫‪Appendix‬‬

‫استبيان المشروع البحثى الطالبى‬

‫االسم ‪....................................................................................................................................... /‬‬
‫‪....‬‬
‫السن ‪........................................................................................................................................ /‬‬
‫‪....‬‬
‫‪.1‬هل سبق و تشخصت بمرض الجرب من قبل؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .2‬هل يعانى أحد من أفراد عائلتك من هذا المرض ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .3‬هل تعلم ان هذا المرض ينتقل عن طريق تغيير المالبس من شخص مصاب‬
‫آلخر ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .4‬هل تعلم أن استخدام األدوات الشخصية للمصاب تسبب العدوى ؟‬
‫□ نعم‬
‫□ ال‬

‫‪36‬‬
 ‫‪ .5‬هل تعلم أن التهوية فى المنزل تقلل من نسبة اإلصابة باألمراض‬
‫الجلديه ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .6‬هل تعلم ما هى أساليب العالج الالزمة ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .7‬من أين أتيت بمثل هذه المعلومات ؟‬
‫□ الدكتور المختص بعالجك‬
‫□ الوحدة الصحية‬
‫□ مصدر آخر‬
‫‪ .8‬هل تم االلتزام بالعالج المفترض تحقيقه ؟‬
‫□ نعم‬
‫□ ال‬
‫‪.9‬هل تعرف طيف تطبق العالج بطريقة صحيحة ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .10‬هل تعلم ما هى العواقب التى تنتج من عدم االلتزام بالعالج ؟‬
‫□ نعم‬
‫□ ال‬

‫هل تعلم كيف يمكن الوقاية من مرض الجرب ؟‬ ‫‪.11‬‬

‫□ نعم‬
‫□ ال‬
‫ما عدد أفراد األسرة بالمنزل ؟‬ ‫‪.12‬‬
‫□ أقل من ‪4‬‬
‫□‪4-6‬‬
‫□ أكثر من ‪6‬‬
‫ما عدد حجرات المنزل ؟‬ ‫‪.13‬‬
‫□ حجرة واحده‬
‫□ ‪ 2-4‬حجرات‬
‫□ أكثر من ‪4‬‬
‫هل تعلم أن زيادة عدد االفراد فى الحجرة يزيد من معدل االصابة‬ ‫‪.14‬‬
‫بالمرض ؟‬
‫□ نعم‬
‫□ ال‬
‫هل تعلم أن المياه الملوثة يمكن أن تسبب األمراض الجلدية ؟‬ ‫‪.15‬‬
‫□ نعم‬
‫□ ال‬
‫ما مدى جودة المياه المتوفرة لديك ؟‬ ‫‪.16‬‬
‫□ نقية‬
‫‪37‬‬
 ‫□ معكرة‬
‫‪ .17‬هل توجد المياه بصورة دائمة ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .18‬ما المصدر البديل للمياه فى حالة انقطاعها ؟‬
‫□ خزانات مياه‬
‫□ شراء مياه معدنية‬
‫‪ .19‬هل يوجد أماكن مخصصة للتخلص من القمامة خارج المنزل ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .20‬هل يتم التخلص من القمامة من الشوارع بصورة مستمرة ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .21‬هل يوجد شبكة صرف صحى جيدة ؟‬
‫□ نعم‬
‫□ ال‬
‫‪ .22‬ما رأيك فى أداء عمال النظافة فى المنطقة السكنية المحيطة ؟‬
‫□ مرضى‬
‫□ غير مرضى‬

‫‪38‬‬