A Study to Investigate the Prevalence of Nappy Rash among Babies Aged 0 to 36 Months Old in a Tropical Country

Research Article

Austin J Dermatolog. 2015; 2(2): 1040.

A Study to Investigate the Prevalence of Nappy Rash among Babies Aged 0 to 36 Months Old in a Tropical Country

Biranjia-Hurdoyal SD* and Pandamikum L

Department of Health Sciences, University of Mauritius, Mauritius

*Corresponding author: Biranjia-Hurdoyal SD, Department of Health Sciences, University of Mauritius, Mauritius

Received: June 26, 2015; Accepted: November 27, 2015; Published: December 01, 2015


Objective: This survey based study was designed to determine various factors which affect the prevalence of nappy rash among babies aged 0 to 36 months in a tropical country, ‘Mauritius’.

Methods: A total of 400 mother/baby pairs were randomly selected and interviewed with the help of a questionnaire.

Results: Only 380 pairs were finalized for data analysis and 303 (79.7%) babies were found to have a history of at least one episode of nappy rash, with a peak at the age of 7 to 12 months. The highest prevalence of nappy rash was found among babies who used disposable nappies exclusively. The choice of nappy was affected by household income and number of children per family (p<0.05). Area of residence with high humidity, summer season, early stopping of breast feeding and age of the baby significantly increased the prevalence of nappy rash (p<0.05). Baby girls, use of barrier cream and aeration of nappy area for more than one hour per day were associated with less nappy rash, although the associations were not significant.

Conclusion: Nappy rash occur at high prevalence in a tropical country. Parents should be educated on the importance of breast feeding and aeration of nappy area.

Keywords: Diaper; Nappy rash; Infants; Climate


Nappy rash is a consequence of contact between an infant’s diapered skin and his nappy which results in irritant contact dermatitis [1]. The common causes of nappy rash have been found to be the result of urine and faeces on the diaper area. Exposure to urine for long period of time increased the temperature, humidity and pH. Furthermore, digestive enzymes such as proteases, lipases and trypsin from the skin and faeces could accelerate skin maceration in presence of urine [2,3]. Several other factors have been reported to influence the incidence of nappy rash. These included age of baby, health status, type of nappy worn, application of barrier cream and type of feeding [4-6]. Babies were most vulnerable in the first year of life due to the incomplete epidermal skin barrier [7]. The prevalence of nappy rash has been found to vary from country to country, ranging from 15% in Italy, 16% in UK, 43.8% in China, 75% in US and 87% in Japan [4-6,8,9].

Cloth and disposable nappies are the two most common types of nappy used by babies. Cloth nappies have been used since long ago as they are washable and therefore, economical. Cloth nappies have also proved to be very comfortable during hot weather and could be best used if they were changed after each urination [5,10]. Disposable diapers are preferred because of their ability to maintain dry skin for a long period of time and could be disposed after use [11,12].

Hygiene has been recognized as an important aspect in the prevention of diaper dermatitis. The diaper area should be cleaned appropriately and diapers should be frequently changed, especially after defecation to reduce the contact between the dirtied nappy and the skin [11]. Lukewarm water mixed with irritant-free and fragrance-free soap or cleanser should be used to wash the diaper area daily [13]. However, a sanitization agent with a pH higher than that of the skin could alter its microbiota and cause skin dehydration and scaling. This effect could be lessened by using tap water which has almost a neutral pH. But, water alone would not get rid of fatsoluble substances such as faeces in contrast to alkaline soaps (pH 9.5) or detergents (pH 5.5) [14]. Increased aeration of diaper area and the use of barrier cream diminished the incidence of nappy rashes. Barrier creams should be applied after each diaper change and bathing. A suitable barrier cream should reduce skin maceration by infiltrating its lipid content in the stratum corneum and between epidermal cells to render the layer impermeable [13]. Moreover, the early introduction of cereals and change in diet in the first year of life was also found to accelerate the incidence of rashes [5]. These incidences might be most probably linked to the adaptation process of the gastrointestinal tract to nutrition.

Numerous studies have investigated the incidence of nappy rash among babies attending hospitals and the majority of them were carried out in US or European countries. This study aimed to investigate the factors which could affect prevalence of nappy rash among babies aged 0-36 months in a tropical country, Mauritius. The study was approved by the Department of Health Sciences, University of Mauritius.

Materials and Methods

The recruitment for this study was done at nurseries, child’s residence, recreation centers and working places of mothers such as offices and schools from various regions of the Mauritius. A total of 540 mothers who had children aged between 0-36 months were included in the selection and they were explained the rationale of the study. Information sheets and consent forms were provided to them. A total of 400 mother/baby pairs agreed to participate voluntarily in the study. The age distribution of the participants is shown in (Table 1). One self-administered questionnaire which was designed for the purpose of the study was distributed per infant and mothers with twins or triplets were given two or three questionnaires respectively. Parents were asked about the age at which their babies had suffered from their last episode of nappy rash, period of the year, diet of the infant, type of nappy worn, socio-economic status and family income. Statistical analysis was done using SPSS v16.0 (SPSS Inc, Chicago, IL, USA) and a p-value of less than 0.05 was considered to be statistically significant. Pearson x2 test was performed to determine whether there was any significant difference in the prevalence of nappy rash between age groups and other variables such as gender, use of barrier cream and season of the year.