Epidemiology of tungiasis in sub-saharan Africa: a systematic review and meta-analysis

The Effectiveness of Topical Dimethicone Together with a One Health Approach for the Control of Tungiasis in the Sanumás Communities, Yanomami Territory, Amazon Rainforest: A Real-World Study

BACKGROUND

The success of tungiasis treatment is highly dependent on adequate environmental control.

METHODS

This is a real-world observational cohort study designed to monitor the effectiveness of topical dimethicone together with a One Health approach for the control of tungiasis in the Sanumás communities, Amazon rainforest, Brazil. We followed up on 562 indigenous people and 81 domestic dogs for 1.5 years in a 3-month interval. A new molecular method for large-scale soil evaluation was also tested. The control of tungiasis was independently conducted by the Brazilian Ministry of Health and comprised topical dimethicone application (NYDA®) for humans, single-dose oral afoxolaner for dogs, and in-house soil fumigation with fipronil. The main outcome was the occurrence of tungiasis after the use of topical dimethicone together with the One Health approach.

RESULTS

A total of 49 of the 562 indigenous people had active tungiasis at enrollment (8.72%). Only three cases of tungiasis resulted in active lesions after the use of topical dimethicone together with the One Health approach, with two cases of recurrence. From the 6-month follow-up and after, soil infestation was not detected.

CONCLUSIONS

We conclude that the use of NYDA® together with animal and environmental interventions are effective measures for the control of tungiasis.

Investigation of human tungiasis cases, Sheema District, Uganda, November 2021-February 2022

Introduction

no formal surveillance system exists in Uganda for jiggers (tungiasis); however, outbreaks are frequently reported in the media. On 27th January 2022, a news alert reported a jiggers' outbreak in Sheema District, Southwestern Uganda. We investigated to establish the magnitude of the problem and identify possible exposures associated with infestation to inform control measures.

Methods

we defined a confirmed case as visible Tunga penetrans (T. penetrans) in the skin of a resident of any of 6 villages in Bwayegamba Parish, Sheema District, in February 2022. A suspected case was self-reported T. penetrans infestation during the three months preceding the interview. We visited all households in the 3 most affected villages in Bwayegamba Parish to identify cases and conducted interviews to identify possible exposures. We described cases by person, place, and time. We assessed socioeconomic status, household construction, mitigation measures against jiggers, and observed participants and their environments for hygiene. We conducted 2 case-control studies. One compared case-households (with ≥1 case) with control-households (without any cases). The second compared individual cases (suspected and confirmed) to neighbourhood controls.

Results

among 278 households, we identified 60 case-patients, among whom 34 (57%) were male. Kiyungu West was the most affected village (attack rate=31/1,000). Cases had higher odds of being male (ORMH=2.3, 95% CI=1.3-4.0), <20 years of age (ORMH=2.0, 95%CI=1.1-3.6), unmarried (ORMH=2.97, 95% CI=1.7-5.2), unemployed (ORMH=3.28, 95% CI=1.8-5.8), and having poor personal hygiene (ORMH=3.73, 95% CI=2.0-7.4) than controls. In the household case-control study, case-households had higher odds of having dirty or littered compounds (ORMH=2.3, 95% CI=1.2-4.6) and lower odds of practicing mitigation measures against jiggers (ORMH=0.33, 95% CI=0.1-0.8) than control-households.

Conclusion

males, unemployed persons, and those with poor personal or household hygiene had increased odds of tungiasis in this outbreak. Multi-sectoral, tailored interventions that improve standards of living could reduce risk of tungiasis in this area. Adding tungiasis to national surveillance reporting tools could facilitate early identification of future outbreaks.

Clinical and epidemiological survey of tungiasis in Madagascar

BACKGROUND

Tungiasis is a dermal parasitic infection, classified as a neglected tropical disease. Madagascar is one of endemic countries which have been committed for decades to control the tungiasis as a public health issue. Despite this medical importance, little is known about the prevalence and epidemiology of the disease in this country.

METHODS

A descriptive cross-sectional survey was performed in two endemic foci of Antananarivo and Toamasina.

RESULTS

In total, 2971 suspected individuals were surveyed. Of them, 643 individuals were excluded due to absence or refusing clinical examinations. Therefore, 2328 individuals with aforementioned criteria were clinically examined, 320 cases (13.7%) were found infected by Tunga penetrans. Of these 320 infected cases, 241 individuals came from rural regions against 79 from urban areas. The sex ratio of infected cases was 1.15 with an age average of 34.7 years old. Most of them were illiterate (185/320, 57.8%) with no habit of feet washing (210/320, 65.6%). The majority (198/320, 61.9%) inhabited in the houses constructed by falafa providing a suitable breeding location for Tunga ectoparasites. Based on clinical examination, most of the patients (298/320, 93.1%) had the lesions on their toes followed by those possessed the lesions on the plantar (140/320, 43.7%). The lesion stages of IV and V were observed in 49.1% (157/320) of visited patients which were more common in rural regions (86%) than in urban areas (14%). For treatment, removing the fleas using needle (122/320, 38.1%), followed by the application of petroleum (100/320, 31.2%) were among the most traditional remedies used by our patients.

CONCLUSION

This investigation highlights a high burden of tungiasis in studied endemic foci in particular in rural regions. These results can be helpful in control management strategies against this parasitosis in Madagascar.

Factors associated with tungiasis among school-age children in Kwale County, rural Kenya

BACKGROUND

The parasitic disease tungiasis, caused by the flea Tunga penetrans, remains an important public health problem among children and the elderly. The study assessed the factors influencing prevention and control of tungiasis infection among school-age children in Kwale County, Kenya.

METHODS

A cross-sectional survey was conducted in five villages in Lunga Lunga subcounty among 538 children ages 5-14 y. The study employed a mobile application tool in collecting sociodemographic, knowledge, perception and practice data on prevention and control of tungiasis with frequencies and bivariate and multivariate regression analysis used.

RESULTS

The prevalence of tungiasis was found to be 62.1% (328/528), with fathers' education level, place of residence and wearing shoes being factors associated with infection. Those who wore shoes were less likely to be infected compared with those who did not (odds ratio 0.059 [95% confidence interval 0.29 to 0.12]). Children living in Dzombo B and Kinyungu were less likely to be infected with tungiasis compared with those living in Bandu, holding other factors constant.

CONCLUSION

Creating awareness of the cause of tungiasis remains of key public importance. Hygiene promotion, including wearing of shoes and the general cleanliness of the environment at the community level, needs to be implemented.

Prevalence of Tungiasis and its risk factors of among children of Mettu woreda, southwest Ethiopia, 2020

Tungiasis is caused by the flea tunga penetrans and results in painful skin lesions, skin infections, and permanent disability. However, limited information is available that shows the magnitude of the problem and its risk factors that help for intervention in Ethiopia. The goal of this study was to determine the prevalence and risk factors of tungiasis in children aged 5 to 14 in Mettu woreda in 2020. A community based cross sectional study was conducted among randomly selected kebeles of Mettu woreda, in Southwest Ethiopia. To select study participants, multistage sampling was used. The data were collected through physical examination of the children, interview of parents/guardians of the children, and observation of the home environment using checklists and questionnaires. The descriptive analysis was done for socio-demographic characteristics, prevalence of tungiasis, and housing conditions. A logistic regression analysis was performed, and variables in multivariable regression reported odds ratios and their 95% confidence intervals once the variables were identified using a p-value of 0.05 as a risk factor of statistical significance. The prevalence of tungiasis among children 5–14 years of age in Mettu rural woreda was 52 percent (n = 821). As a risk factor, large family size (AOR: 2.9, 95% CI: 2.13, 4.40); school attendance (AOR: 1.5, 95% CI: 1.02, 2.18), floor inside the house (AOR: 3.8, 95% CI: 1.76, 8.43); having sleeping bed (AOR: 0.16, 95% CI: 0.03, 0.82); access to protected water sources (AOR: 0.24, 95% CI: 0.15, 0.39); access to improved toilet facilities(AOR: 0.63: 95% CI: 0.44, 0.89); access to electric services (AOR: 0.30, 95% CI: 0.15, 0.62); and lack of own farmland (AOR: 0.36, 95% CI: 0.26, 0.50) were found. Therefore, planning and implementation of interventions focus on those risk factors that are particularly important. Water, sanitation and hygiene interventions, and livelihood improvement interventions are required to solve the problem in the setting.

Dynamics and optimal control in transmission of tungiasis diseases

This paper aims to model the transmission of tungiasis disease and assess the optimal control schemes to stop its occurrence. Based on the development stage of fleas and propagation process of diseases, we propose a human-flea model without control, in which the susceptible-infected in latent stage-infectious populations and the egg-larva-pupa-adult stage of fleas are all in involved. In the light of the Lyapunov function method, we prove global stability of equilibria. The model is extended by reformulating it as an optimal control problem, with the use of four time-dependent controls, to assess the impact of individual protection, treatment and two flea control strategies (killing adult fleas and reduction of eggs and larvae). By using Pontryagin’s maximum principle, we characterize the optimal control. Using the data of human and flea in Brazil and Nigeri, numerical simulations are performed. The numerical results show that enhancing the protection and treatment of people and increasing the killing efficacy of flea adults would contribute to prevent and control the spread of the disease appreciably.