Edited by: Venkataramana Kandi, Kaloji Narayana Rao University of Health Sciences, India
Reviewed by: Angel Gonzalez, University of Antioquia, Colombia
Roshan Kumar Mahat, Dharanidhar Medical College and Hospital, India
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Dermatophytosis, commonly known as tinea, poses a significant public health concern worldwide, especially in environments with poor hygiene and overcrowding, such as prisons. Despite its prevalence and impact on quality of life, there is a lack of research on the knowledge and hygiene practices regarding dermatophytosis among prisoners, particularly in Nepal.
The study aimed to assess prisoners’ knowledge, hygiene practice and infection status regarding dermatophytosis in Central Prison, Nepal.
A descriptive cross-sectional study with a sample size of 184 respondents was designed to collect data using a validated pre-tested questionnaire from September 2023 to January 2024. The collected data was then analyzed using IBM SPSS version 21. Knowledge and hygiene practices were measured on an eight and 11-point scale and rated as poor (≤4) and sound (>4), bad (≤6), and good (>6), respectively. Summary data were presented by descriptive, while Chi-square and logistic regression were used for inferential statistics at
The findings revealed moderate knowledge among prisoners regarding dermatophytosis, with significant gaps in understanding its spread and prevention. While most prisoners recognized the importance of treatment, there were misconceptions about the inevitability of contracting dermatophytosis and the role of personal hygiene.
Despite good knowledge levels, adherence to recommended hygiene practices was suboptimal, highlighting the need for targeted interventions. The study underscores the importance of addressing knowledge gaps, changing attitudes, and promoting hygienic practices to mitigate the burden of dermatophytosis among prisoners.
Dermatophytosis, also called “tinea,” is a contagious disease caused by a fungus called dermatophytes. Dermatophytes cause superficial and self-limiting infections that can be disfiguring and uncomfortable. Contact with spores, along with skin injury, high temperature, and humidity, increases the susceptibility to infection (
Prisons in developing countries have poor living conditions, lack of personal hygiene, sharing of personal items, and overcrowding, due to which skin diseases are pretty common among inmates (
Dermatophytosis patients experience psychosocial stress and challenges. A study showed significant impairment of quality of life in dermatophytosis patients, where most reported symptoms of itching, embarrassment, and self-consciousness (
Using structured questionnaires, a descriptive cross-sectional study was carried out between September 2023 and January 2024 among 184 Central Prison, Nepal prisoners. Simple random sampling was used to select the participants, and the minimum required sample size was determined using Cochran’s formula:
Where,
Substituting,
Taking a 10% non-response rate, the final sample size was 122.
The study purposely selected Central Prison, Nepal. The list of prisoners was obtained from the administrative record, and the required number of participants was obtained using a random number table.
The study focused on a vulnerable and high-risk population, with participation limited to prisoners who provided written consent. Research assistants also engaged with prison inmates in their dormitories to ensure respondent confidentiality. However, the study did not include individuals who were severely ill or on assignment outside the prison during the survey period.
The pre-tested standardized questionnaire used in this study consisted of three sections, filled out by the interviewer by interviewing participants:
Section A: Socio-demographic characteristics such as age, gender, level of education, marital status were included.
Section B: This section included eight items on source of information, knowledge on transmission, signs and symptoms, and prevention of dermatophyte infection. Eight questions had “Yes” or “No” answers. Knowledge scores were further categorized into two categories: good knowledge and poor knowledge.
Section C: An 11-item question on general hygiene practice focusing on the general hand-washing and showering practices, undergarments drying, nail trimming, frequency of washing towels and other practices such as sharing hair-brush and clothes. They were evaluated based on responses “Yes” (given as one mark) and “No” (given as zero marks). A cut-off point using its mean value was used to categorize the scores into excellent and poor hygiene practices.
Infection Status: It was assessed based on previous diagnosis. The diagnosis was done by the dermatologist based on the history, clinical examination, and relevant laboratory investigations.
Analysis was conducted using IBM Statistical Package for Social Sciences (SPSS) version 21.0 for Windows. Continuous variables were summarized using means and standard deviations, while categorical data were presented as proportions and percentages in summary tables and charts. The relationship between socio-demographic characteristics and relevant variables was assessed using Chi-square (
The mean age of respondents was 35.70 years, ranging between 19 and 77. The percentage of male respondents was 70.1%, whereas 29.9% were female. In addition, more than ⅔ of respondents (70.1%) were married, and 61.5% had education equivalent to secondary level and above (
Socio-demographic characteristics of the study population.
| Characteristics | ||
|---|---|---|
| Age category | <20 Years | 6 (3.3) |
| 20–40 Years | 126 (68.5) | |
| 40–60 years | 43 (23.4) | |
| >60 Years | 9 (4.9) | |
| Gender | Male | 129 (70.1) |
| Female | 55 (29.9) | |
| Ethnicity | Brahmin | 24 (13) |
| Chhetri | 36 (19.6) | |
| Janajati | 87 (47.3) | |
| Dalit | 13 (7.1) | |
| Others | 24 (13) | |
| Religion | Hindu | 137 (74.5) |
| Buddhist | 32 (17.4) | |
| Muslim | 5 (2.7) | |
| Christianity | 10 (5.4) | |
| Marital status | Married | 129 (70.1) |
| Unmarried | 55 (29.9) | |
| Education | Illiterate | 18 (9.8) |
| Primary | 51 (27.7) | |
| Secondary | 58 (31.5) | |
| Campus | 57 (31) | |
Respondents’ knowledge of dermatophytosis.
| SN | Questions | Yes (%) | No (%) |
|---|---|---|---|
| 1 | Does it spread from person to person? | 80.4 | 19.6 |
| 2 | Is it seasonal? | 45.7 | 54.3 |
| 3 | Is sweating related to this infection? | 72.8 | 27.2 |
| 4 | Does sharing of clothes and objects spread it? | 77.2 | 22.8 |
| 5 | Does collective soaking and washing of clothes of all family members increase the risk of getting infected? | 73.9 | 26.1 |
| 6 | Knowledge of possible sites of dermatophytosis | 48.4 | 51.6 |
| 7 | Can certain occupations increase the risk of dermatophytosis? | 36.4 | 63.6 |
| 8 | Can dermatophytosis affect hair? | 58.2 | 41.8 |
Dermatophytosis-related hygiene practices.
| SN | Hygiene practices | Yes (%) | No (%) |
|---|---|---|---|
| 1 | Do you bath daily? | 41.8 | 58.2 |
| 2 | Do you wash clothes after every use? | 59.2 | 40.8 |
| 3 | Do you wear ironed clothes | 26.6 | 73.4 |
| 4 | Do you wash your feet after coming from outside? | 86.4 | 13.6 |
| 5 | Do you have a bath after getting drenched in sweat? | 83.7 | 16.3 |
| 6 | Do you share clothes/towels? | 20.7 | 79.3 |
| 7 | Do you share your hairbrush/comb? | 16.8 | 83.2 |
| 8 | Are you following any prescribed treatments for fungal skin infections? | 48.4 | 51.6 |
| 9 | Clothes and undergarments drying practice | Percentage (%) | |
| a. In the sun outside | 92.9 | ||
| b. Inside rooms on stand | 7.1 | ||
| 10 | Nails trimming frequency | ||
| a. Once a week | 77.7 | ||
| b. Once every 15 days | 3.8 | ||
| c. Once a month | 18.5 | ||
| 11 | Washing towels frequency | ||
| a. Monthly | 4.9 | ||
| b. Weekly | 85.9 | ||
| c. Every 15 days | 9.2 | ||
Comparison of socio-demographic variables and knowledge on dermatophytosis.
| Variables | Dermatophytosis-related knowledge status | ||
|---|---|---|---|
| Good knowledge- |
Poor knowledge- |
||
| Age category | |||
| <20 Years | 4 (2.2) | 2 (1.1) | 0.517 |
| 20–40 Years | 80 (43.5) | 46 (25) | |
| 40–60 Years | 22 (12) | 21 (11.4) | |
| >60 Years | 6 (3.3) | 3 (1.6) | |
| Sex | |||
| Male | 89 (48.4) | 40 (21.7) | |
| Female | 23 (12.5) | 32 (17.4) | |
| Ethnicity | |||
| Brahmin | 16 (8.7) | 8 (4.3) | 0.854 |
| Chhetri | 23 (12.5) | 13 (7.1) | |
| Janajati | 50 (27.2) | 37 (20.1) | |
| Dalit | 9 (4.9) | 4 (2.2) | |
| Others | 14 (7.6) | 10 (5.4) | |
| Religion | |||
| Hindu | 84 (45.7) | 53 (28.8) | |
| Buddhist | 14 (7.6) | 18 (9.8) | |
| Muslim | 5 (2.7) | 0 (0.0) | |
| Christianity | 9 (4.9) | 1 (0.5) | |
| Education | |||
| Illiterate | 10 (5.4) | 8 (4.3) | 0.206 |
| Primary | 30 (16.3) | 21 (11.4) | |
Bold values are statistically significant. *
Comparison of socio-demographic variables and infection status.
| Variables | Infection status | B coefficient | 95%CI | ||
|---|---|---|---|---|---|
| Yes (%) | No (%) | ||||
| Age category | |||||
| <20 Years | 0 (0) | 6 (3.3) | 0.547 | 0.799–3.742 | 0.165 |
| 20–40 Years | 41 (22.4) | 85 (46.2) | |||
| 40–60 Years | 27 (14.6) | 16 (8.7) | |||
| >60 Years | 1 (0.5) | 8 (4.3) | |||
| Gender | |||||
| Male | 25 (19.4) | 104 (80.6) | 2.954 | 7.065–52.134 | |
| Female | 44 (80) | 11 (20) | |||
| Ethnicity | |||||
| Brahmin | 10 (5.4) | 14 (7.6) | 0.091 | 0.737–1.629 | 0.653 |
| Chhetri | 11 (6) | 25 (13.6) | |||
| Janajati | 33 (17.9) | 54 (29.3) | |||
| Dalit | 4 (2.2) | 9 (4.9) | |||
| Others | 11 (6.0) | 13 (7.1) | |||
| Religion | |||||
| Hindu | 52 (28.3) | 85 (46.2) | −0.266 | 0.401–1.465 | 0.421 |
| Buddhist | 13 (7.1) | 19 (10.3) | |||
| Muslim | 1 (0.5) | 4 (2.2) | |||
| Christianity | 3 (1.6) | 7 (3.8) | |||
| Education | |||||
| Illiterate | 7 (3.8) | 11 (6) | 0.635 | ||
| Primary | 34 (10.9) | 17 (16.8) | |||
| Secondary | 39 (12) | 19 (19.6) | |||
| Campus | 46 (10.9) | 11 (20.1) | |||
| Smoking status | |||||
| Smoker | 25 (13.6) | 71 (38.6) | −0.252 | 0.321–1.882 | 0.577 |
| Non-smoker | 44 (23.9) | 44 (23.9) | |||
| Knowledge category | |||||
| Good knowledge | 27 (14.7) | 85 (46.2) | −1.286 | 0.115–0.662 | |
| Poor knowledge | 42 (22.8) | 30 (16.3) | |||
| Practice category | |||||
| Good hygiene | 42 (22.8) | 84 (45.7) | −1.171 | 0.129–0.746 | |
| Poor hygiene | 27 (14.7) | 31 (16.8) | |||
Bold values are statistically significant. *
Assessment of prisoners’ knowledge regarding the spread of fungal infection from person to person showed that the majority (80.4%) of participants responded correctly. The study also revealed that 72.8% of prisoners reported correctly that sweating is related to infection with dermatophytosis. One-third of respondents had good knowledge regarding the spread of dermatophytosis due to collectively sharing clothes and washing. Around half of the respondents had good knowledge of the seasonal nature and possible sites of dermatophytosis infection. 63.6% of respondents did not have correct knowledge regarding occupation-related dermatophyte infection.
About 41.8% of respondents said they bathed daily, 59.2% reported washing clothes after every use, and 26.6% stated that they wore ironed clothes. Most of them habitually washed their feet after coming from outside (86.4%) and bathed after getting drenched in sweat (83.7%). One-fifth of respondents shared their clothes/towels or comb. Most respondents (77.7%) reported trimming their nails weekly. A considerable proportion of the respondents (92.9%) revealed drying clothes in the sun outside. Only 7.1% reported drying clothes inside rooms. Most of them (85.9%) reported washing towels weekly.
The study explored the relationship between demographic factors and knowledge levels about skin diseases, revealing several significant associations. Notably, the gender exhibited a significant association (
The study’s findings provide valuable insights into the knowledge, infection status and hygiene practice on dermatophytosis among prisoners. The mean age of respondents was 35, close to that reported by Okareh et al. (
Overall, the study revealed that a significant proportion of respondents (60.9%) had good knowledge regarding the spread and prevention of dermatophytosis, with the majority correctly identifying the mode of transmission and the importance of personal hygiene practices. This could be explained by 62.5% of the respondents having education up to a secondary level or more. 80% of participants knew about the spread of fungal infection from person to person, and 95% of respondents believed that treatment is necessary for dermatophytosis. It is coherent with Yamu et al. but not consistent with SK et al. 45% had good knowledge of the seasonal nature of dermatophytosis, similar to SK et al., but differs from Yamu et al. (
The study also highlighted the importance of hygiene practices in preventing dermatophytosis. Practices such as daily bathing, washing clothes after every use, and avoiding sharing clothes/towels were associated with better knowledge levels and lower susceptibility to skin diseases. 68.5% of respondents had good hygiene practices, which might indicate satisfactory hygiene services in the prison settings (
Due to the cross-sectional study design, causal inference regarding any observed association between dependent and independent variables cannot be established. The findings are also limited in generalizability to the broader population because the study was conducted on prisoners in a specific setting. The infection status was not assessed on basis of particular diagnosis of individual disease.
In conclusion, this study provides valuable information about Nepal’s Central Prison prisoners’ dermatophytosis-related knowledge and hygiene habits. It emphasizes how a person’s age, gender, degree of awareness, and cleanliness habits significantly impact their susceptibility to dermatophytosis. Specifically, males and individuals aged 20–40 were identified as more prone to skin diseases. Moreover, poor knowledge and hygiene practices were also linked to increased dermatophytosis risk. Considering these facts highlights the critical need for comprehensive strategies for preventing and managing dermatophytosis.
Based on our research findings, we suggest special educational programs on dermatophytosis prevention and treatment for prisoners in Central Prison. These programs should address myths, promote hygienic practices, and encourage positive attitudes toward dermatophytosis management. In addition, routine screenings and timely medical care should be offered to prevent the disease from spreading inside the prison setting.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving humans were approved by the Nepal Health Research Council (NHRC)’s ethical review board. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.
BD: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing – original draft, Writing – review & editing. BS: Data curation, Investigation, Project administration, Validation, Writing – original draft, Writing – review & editing. SS: Formal analysis, Investigation, Project administration, Software, Validation, Writing – original draft, Writing – review & editing. SR: Data curation, Formal analysis, Methodology, Software, Writing – original draft, Writing – review & editing. BK: Data curation, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. PP: Formal analysis, Investigation, Project administration, Supervision, Writing – original draft, Writing – review & editing. NB: Writing – review & editing, Formal analysis, Investigation, Project administration, Software, Writing – original draft. RM: Investigation, Project administration, Supervision, Writing – original draft, Writing – review & editing. NT: Data curation, Funding acquisition, Methodology, Resources, Writing – original draft, Writing – review & editing. BZ: Data curation, Funding acquisition, Project administration, Resources, Writing – original draft, Writing – review & editing. RS: Formal analysis, Methodology, Writing – original draft, Writing – review & editing. CL: Investigation, Methodology, Writing – original draft, Writing – review & editing. DB-A: Conceptualization, Formal analysis, Methodology, Supervision, Writing – original draft, Writing – review & editing. AR-M: Data curation, Investigation, Methodology, Resources, Supervision, Writing – original draft, Writing – review & editing.
The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Universidad Continental covered the APCs for this publication.
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The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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