الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure,Activity limitation is a difficulty encountered by an individual in executing a task or action and participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.
Disabled children may be particularly susceptible to skin disorders, sometimes as a direct consequence of their disability, which prevents them from undertaking normal care of their skin, or because they lack awareness regarding personal and environmental hygiene. All of these may result in skin problems, which add to the child’s physical and emotional distress.
School years bring exposure to a wide variety of infections and contagions, such as measles, chickenpox, impetigo, warts, molluscum contagiosum, scabies and head lice. There is also a gradual increase in contact with potential irritants: at school during lessons, in sporting activities such as swimming and team games and in hobbies.
The objectives of this work were to investigate the prevalence and types of skin diseases among disabled school children in Sohag Governorate, Egypt. and to study the socidemographic and environmental factors that may affect such distribution. The total number of examined students was1107 of 1871(62.16%).
In this cross sectional study, out of the1107 students included in this study, 607 (54.83%) were young children (6-14) years old; 721(65.13%) students were males and 513(46.34%) students were residents in the school. The overall prevalence of skin diseases among the 3 groups of students with disabilities is 68. 29% with highest prevalence among mentally retarded students (69.78%); among males (44.54%),in the age group 6-14 years (36.5%) and among students who were residents in the school(32.52%).
Among diseased students, 79.76% had single disease with highest prevalence among mentally retarded students; 17. 86% had 2 disease with highest prevalence among deaf–mute students and 2.38 % had three disease with highest prevalence among deaf–mute students.Non Infectious diseases had a prevalence of 57.18%representing 83.73%of the total skin diseases with highest prevalence amongresident students, (46.48%);the deaf–mute students,8.24% and the age group 6-14 years, (53.17%).
Infectious diseases had a prevalence of 16.98%representing 24.67% of the total skin diseaseswith highest prevalence amongamong resident students, (48.78%); blind students,18.18% and in the age group 6-14 years,(56.10%).
Among these, Allergic diseases, had the highest prevalence25.84% representing 45.18% of the non Infectious diseases with highest prevalence among mentally retarded students 28.36%; Eczema was the most frequentallergic disease in our study and on the top of the list of skin diseases, with overall prevalence of 13.01% representing50.35% of all allergic diseases with highest prevalence among deaf-mute students,13.51%.
Infectious skin diseases were the second most common skin disease,represented 24.67% of total number of skin diseases. parasitic infestationwere the most prevalent infectious disease, 8.58% with highest prevalence among blind students,followed by bacterial infections, 3.70% with highest prevalence among mentally retarded students,followed byfungal infections, 3.07% , with highest prevalence among mentally retarded students and lastly viral infections,2.53% with highest prevalence among deaf–mute students.The lower prevalence of infectious diseases than previous similar studies may be due to presence older students.
Acne vulgaris was the second most common non infectious disease; the third common skin disease, with a prevalence of 10.93%, representing 19.12% of the non infectious diseases with highest prevalence among deaf–mute students, 12.03% followed by blind students, 11.11% and lastly mentally retarded students, 7.78%. High prevalence of acne vulgaris is due large number of adolescent students in the study.
Pigmentary disorders had a prevalence of 4.70%, representing 8.21% of the non infectious diseases with highest prevalence among deaf–mute students, 5.54%followed by blind students 4.04%, and lastly mentally retarded students,2.61%.this may be due to exclusive occurrence of Waardenburg syndrome among deaf–mute students.Vitiligo was the most prevalent pigmentation disorder with a prevalence of 2.62% representing 55.77% of the pigmentation disorders. It was highest, 2.84% among deaf-mute students followed by mentally retarded students, 2.02% and lastly,blind students, 2.24%.
Ichthyosis had a prevalence of 4.52%, representing 7.90% of the non infectious diseases with highest prevalence among deaf–mute students, 5.00% followed by mentally retarded students, 4.10% and lastly blind students 2.02%.
Hair disorders had a prevalence of 4.25%, representing 7.43%of the non infectious diseases with highest prevalence among deaf–mute students4.32% followed by blind students, 4.04% and lastly mentally retarded students, 3.73%. Cicatricial alopecia was the most prevalent hair disorder, with a prevalence of 1.36%, representing 31.92% of the all hair disorders with highest prevalence of 2.61% among mentally retarded students. This high prevalence may be due to frequent trauma in disabled students or self injurios behavior.
Traumatic scars and keloids had a prevalence of 4.16%, representing 7.27% ofthe non infectious diseases with highest prevalence among deaf–mute students4.59% followed by 4.48% among mentally retarded students.This may be related to frequent movement of older students causing frequent traumatization and lack of awarness of avoiding traumatic behavior specially among mentally retarded students.
Xerosis had a prevalence of 3.34%, representing 5.85% of the non Infectious diseases with highest prevalence among mentally retarded students, 4.48% followed by 3.03% among blind students and lastly 2.97% among deaf–mute students.
Mucous membrane disorders had a prevalence of 2.62%, representing 4.58% of the non infectious diseases with highest prevalence among mentally retarded students 2.98% followed by 2.70% among deaf–mute students and 1.01% among blind students. This may be attributed to frequent licking, lack of hygiene and poor nutrition. Cheilitis was the most prevalent mucous membrane disorders with overall prevalence of 1.63% representing 62.07% of all mucous membrane disorders.
Follicular disorders (phrynoderma and pseudofolliculitis) had a prevalence of 1.54%, representing 2.69%of the non infectious diseases with highest prevalence among mentally retarded students,2.24% .
Nail disorders had a prevalence of 1.17%, representing 2.05% of the non infectious diseases with highest prevalence among mentally retarded students,1.49%.
Papulosquamous diseases had a prevalence of 0.90%, representing 1.58% of the non infectious diseases with highest prevalence among mentally retarded students,1.49%. Pityriasis Rubra Pilaris was the most prevalent papulosquamous disease.
Genodermatoses (3 cases of Neurofibromatosis and 1 case of each of TSC, Epidermolysis bullosa simplex, plantar and palmoplanter keratoderma) had a prevalence of (0.81%), representing (1.42%) of the non infectious diseases with highest prevalence among mentally retarded students,1.49%.
Sweat glands disorders (almost hyperhydrosis) had a prevalence of 0.63%, representing 1.11% of the non infectious diseases with highest prevalence among deaf–mute students0.81%.Naevi, dscoid lupus erythematous, drug reactions, callosities, pyogenic granuloma and syringoma were present sporadically in very few students.
In conclusion, the overall prevalence of skin diseases among the 3 groups of students with disabilities is 68. 29% with highest prevalence among mentally retarded students; among males, in the age group 6-14 years and among school residents.Allergic skin diseases, infectious skin diseases and acne vulgaris were the most prevalentdermatoses. Frequent trauma, self injurious behavior, bad hygiene and lack of nutritional care are the major causes of skin diseases among disabled children.
Recommendations
Schools of disabled students represent a generous field for research; with multiple goals of improving quality of life for those important vulnerable sector of our community. Firstly, the prevalence, types, causes and burden of each type of disability can be studied according to each locality. Secondly providing measures for preventing as much as possible of disabilities e.g. infectious and familial causes by educating physicians methods of detecting any abnormality, adequate treatment of infections specially during pregnancy and childhood together with mass education of the families regarding protecting their siblings from trauma, avoiding consanginous marriage and adequate treatment of infections .Thirdly, enhancing the medical, nutritional and psychosocial conditions of such students by regular follow up by school physicians and medical missions. Fourthly, ensuring adequate access to health care services (e.g. ensuring adequate school health program, proper training and education of health care providers and psychiatric specialists responsible for those students and referral to specialized centers or hospitals), entertainments and sharing athletic activities.Fifthly determining creative aspects of those students for future employment, talent enhancement and protecting them from any mean of abuse at the school, community and work levels.