The article was published in the Indonesian Journal of Advanced Research in 2026. Although the study was conducted in October 2016, its findings offer insight into the relationship between hygiene habits and nail health in a rural setting.
What Is Tinea Unguium?
Tinea unguium, also known as onychomycosis, is a fungal infection affecting the nail plate. It can be caused by dermatophytes, non-dermatophyte fungi, or yeasts. The infection commonly affects toenails and may cause changes in nail color, thickness, and shape.
Nail fungal infections can be difficult to manage and may persist for a long time without treatment. The article notes that fungal nail infections are a public health concern worldwide. It cites hospital-based data indicating an estimated global prevalence of around 11%, with reported rates varying across regions.
In Indonesia, data from four teaching hospitals in Bandung, Jakarta, Surabaya, and Yogyakarta recorded tinea unguium in 4.7% of fungal skin disease cases and 0.5% of all skin disease cases examined. These figures provide a point of comparison for the findings from Air Merah Village, where the researchers actively examined participants.
A Rural Community with Limited Healthcare Access
Air Merah Village is located in Arma Jaya Sub-district, North Bengkulu Regency. Most residents in the study population worked as farmers. At the time of the study, the village did not have a local community health center, and the nearest health service was approximately 16 kilometers away.
The researchers examined whether personal hygiene practices were associated with tinea unguium among local residents. They used an analytical observational design with a cross-sectional approach, meaning that hygiene habits and infection status were assessed during the same study period.
A total of 53 residents aged 20 to 64 years participated. They were selected through cluster random sampling from three village hamlets. Participants completed a structured questionnaire about personal hygiene. The researchers also examined their nails and collected nail scrapings for microscopic testing using a 10% potassium hydroxide (KOH) solution.
Most Participants Reported Poor Personal Hygiene
The findings showed that 45 of the 53 participants, or 84.9%, were classified as having poor personal hygiene. Only eight participants, or 15.1%, were classified as having good hygiene.
Several everyday practices contributed to the poor-hygiene classification. The researchers reported that:
- 92.5% did not bathe after completing activities.
- 90.6% did not dry their feet with a towel after washing.
- 92.5% did not clean their bedsheets before using them.
- 88.7% rarely changed their bedsheets.
- 79.2% washed their hands without soap.
- 75.5% cut their nails only when they had become long.
These habits may increase opportunities for dirt, moisture, and microorganisms to remain on the hands, feet, or surrounding environment. The article emphasizes the importance of consistent hygiene, especially after physical work and activities that expose the body to soil or moisture.
Nail Fungal Infection Found in 37.7% of Participants
Microscopic examination identified tinea unguium in 20 participants, representing 37.7% of the sample. The remaining 33 participants, or 62.3%, tested negative.
All identified infections affected toenails. The participants with positive results reported that their symptoms had lasted for at least one year, and none had previously received treatment for tinea unguium.
The 37.7% figure was higher than the 4.7% reported in the Indonesian hospital-based data cited by the authors. However, the figures should not be interpreted as a direct comparison of the same population. The studies involved different settings and methods, and the Air Merah study included active examination of a specific rural community.
A Significant Association, but Not the Only Possible Cause
The statistical analysis found a significant association between personal hygiene and tinea unguium, with a Fisher’s exact test result of p = 0.016.
Among participants classified as having good personal hygiene, none tested positive for the infection. In contrast, 20 of the 45 participants with poor personal hygiene had tinea unguium. The researchers also reported a Phi correlation coefficient of 0.17, which they described as a very weak negative correlation.
The findings suggest that hygiene practices are relevant to nail health, but they do not establish that poor hygiene alone causes the infection. Tinea unguium can be influenced by multiple factors, and the study’s cross-sectional design cannot determine cause and effect.
The authors also noted that 88.3% of participants with tinea unguium had poor hygiene practices related to their hands, nails, and feet. This reinforces the importance of paying attention to nail and foot care as part of daily hygiene.
Practical Steps to Support Nail Health
The researchers recommend improving hand, nail, and foot hygiene. Practical measures include washing hands and feet with soap after activities, drying the feet thoroughly, and maintaining clean bedding and personal surroundings.
The article also recommends that healthcare providers and village authorities offer periodic education about skin health. In communities where healthcare services are not easily accessible, clear information about prevention and early treatment may help residents recognize symptoms and seek care when needed.
Further studies could investigate other factors that may contribute to nail fungal infections, including the types and duration of daily activities, additional occupations, water quality, and flooring materials. The authors also suggest that future research could use cohort or case-control designs and fungal culture to provide more detailed evidence.
Study Limitations
The study involved a relatively small sample from one village and used a cross-sectional design. It therefore cannot establish whether poor hygiene preceded the infection. The researchers also did not collect detailed information about participants’ activities immediately before examination, possible causes of nail damage among participants who tested negative, or additional jobs that might affect exposure.
Despite these limitations, the study provides local evidence connecting personal hygiene practices with nail fungal infection. Its findings underline the value of routine hygiene education and accessible health services in rural communities.
About the Authors
Wellyan Rahmat Adillio, Enny Nugraheni, and Wahyu Sudarsono are affiliated with the Faculty of Medicine and Health Sciences, University of Bengkulu, Indonesia. Wellyan Rahmat Adillio is the corresponding author.
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