Epidemiology of tunga penetrans infestation in selected areas in Kiharu constituency, Murang'a County, Kenya

Developing low-cost house floors to control tungiasis in Kenya - a feasibility study

CONTEXT

Tungiasis is a neglected tropical skin disease endemic in resource-poor communities. It is caused by the penetration of the female sand flea, Tunga penetrans, into the skin causing immense pain, itching, difficulty walking, sleeping and concentrating on school or work. Infection is associated with living in a house with unsealed earthen house floors.

METHODS

This feasibility study used a community-based co-creation approach to develop and test simple, locally appropriate, and affordable flooring solutions to create a sealed, washable floor for the prevention of tungiasis. Locally used techniques were explored and compared in small slab trials. The floor with best strength and lowest cost was pilot trialed in 12 households with tungiasis cases to assess its durability and costs, feasibility of installation in existing local houses using local masons and explore community perceptions. Disease outcomes were measured to estimate potential impact.

RESULTS

It was feasible to build the capacity of a community-based organization to conduct research, develop a low-cost floor and conduct a pilot trial. The optimal low-cost floor was stabilized local subsoil with cement at a 1:9 ratio, installed as a 5 cm depth slab. A sealed floor was associated with a lower mean infection intensity among infected children than in control households (aIRR 0.53, 95%CI 0.29-0.97) when adjusted for covariates. The cost of the new floor was US$3/m2 compared to $10 for a concrete floor. Beneficiaries reported the floor made their lives much easier, enabled them to keep clean and children to do their schoolwork and eat while sitting on the floor. Challenges encountered indicate future studies would need intensive mentoring of masons to ensure the floor is properly installed and households supervised to ensure the floor is properly cured.

CONCLUSION

This study provided promising evidence that retrofitting simple cement-stabilised soil floors with locally available materials is a feasible option for tungiasis control and can be implemented through training of community-based organisations. Disease outcome data is promising and suggests that a definitive trial is warranted. Data generated will inform the design of a fully powered randomized trial combined with behaviour change communications.

TRIAL REGISTRATION

ISRCTN 62801024 (retrospective 07.07.2023).

Efficacy of an oral formulation of afoxolaner and milbemycin oxime against Tunga penetrans in naturally infected dogs

BACKGROUND

The sand flea Tunga penetrans is one of the agents of tungiasis, an important parasitic skin disease affecting humans and several mammalian species. Tungiasis is mainly observed in disadvantaged rural and peripheral urban communities in Latin America and sub-Saharan Africa. The dog is a major reservoir of Tunga fleas. Hematophagous adult female Tunga spp. embed and grow in their host's epidermis and cause cutaneous inflammatory disorders. NexGard Spectra® is an orally administered endectocide for dogs, a co-formulation of the isoxazoline afoxolaner and the macrocyclic lactone milbemycin oxime. The objective of this study was to assess the efficacy of this product against canine tungiasis.

METHODS

A blinded, negative-controlled field trial was conducted in a Brazilian community known to be highly endemic for tungiasis. Sixty-six dogs naturally infected with live T. penetrans were randomly allocated to a treated group (44 dogs) and an untreated control group (22 dogs). In a first phase, dogs from the treated group were treated on days 0, 30, and 60. Efficacy was evaluated on the basis of the macroscopic parasitic skin lesions (Fortaleza classification) on days 7, 14, 21, 30, 45, 60, 75, and 90. In a second phase, to evaluate natural reinfections, all dogs were treated on day 90 and evaluated every 2 weeks thereafter until at least 30% of dogs were infected with live sand fleas.

RESULTS

During the first phase, efficacy (reduction in live sand fleas) of 92.4% was demonstrated on day 7. From day 14 until day 90, the efficacy of NexGard Spectra® was 100%. In the second phase, all dogs were free of live T. penetrans from 15 until 45 days after the day 90 treatment; 60 days post-treatment, 11% of dogs were reinfected, and 75 days post-treatment, 40% of dogs were reinfected.

CONCLUSIONS

NexGard Spectra® was demonstrated to be highly effective against canine tungiasis. In addition to an obvious beneficial effect on the health and welfare of the treated dog, the use of this product may have a one-health benefit on human cases by controlling the main reservoir of sand fleas.

Tungiasis: Participation of Cats and Chickens in the Dispersion and Maintenance of the Disease in an Endemic Tourist Area in Brazil

Tunga spp. are fleas commonly found in impoverished tropical regions. In Vila Juerana, a tourist community in Ilheus, Bahia, Brazil, where tungiasis is endemic, dogs are the main host of fleas during their life cycle. However, there is no information about the role of cats and chickens in tungiasis in the village. Of the 272 households investigated, 112 had domestic animals, 48 had only dogs, 28 had only cats, and nine had only chickens. Of the 27 households with cohabitation among species, 16 had cats and dogs, eight had chickens and dogs, and three had dogs, cats, and chickens. The injuries due to tungiasis were ranked according to the Fortaleza classification, considering stages I, II, and III as viable lesions. The paws/feet of 71/111 (63.9%) cats and 173/439 (39.4%) chickens were inspected. Dogs that lived with positive cats and chickens also were inspected. Among the 38% (27/7; 95% IC 26.74-49.32) positive cats, 16 cohabited houses with infected dogs but none lived with positive chickens. Of the chickens, 2.3% (4/173; 95% IC 0.07-4.5) had lesions caused by tungiasis. In each household where a cat was infected, the dog was also positive. Two chickens cohabited with an infected dog and the other two did not coexist with other species. Cohabitation with infected dogs and the absence of house confinement restrictions in Vila Juerana make cats important carriers that spread tungiasis in this community. Chickens had a low frequency of tungiasis lesions despite living in proximity to infected dogs and cats.

High Level of Knowledge about Tungiasis but Little Translation into Control Practices in Karamoja, Northeastern Uganda

Tungiasis is a neglected tropical disease (NTD) that can cause significant suffering and disability. Health promotion is an important pillar in NTD control programs, assuming that better knowledge contributes to reduced risk behavior and reduced risk of infection. The study objective was to assess tungiasis-related knowledge and its translation into control practices in a rural and highly endemic setting in Karamoja, Northeastern Uganda. We applied a mixed-methods design on household and community level. A semi-quantitative questionnaire on knowledge, practices, and attitudes (KAP) regarding tungiasis was administered to 1329 individuals with the main caring responsibilities in the household. Additionally, eight community dialogue meetings were held and analyzed. Overall, knowledge of tungiasis in humans was high but knowledge of tungiasis in animals was low. Most questionnaire respondents knew the causative agent and clinical presentations of tungiasis in humans, risk factors, and preventive measures. This tungiasis-related knowledge was translated into simple prevention measures. However, adequate tungiasis control was impeded due to a lack of resources, such as access to water and effective medical treatment. In conclusion, health promotion campaigns should be integrated with support towards adequate tungiasis control measures, such as provision of safe treatment, hardening of non-solid floors in the houses, and improved access to water.

Non-target effects of chemical malaria vector control on other biological and mechanical infectious disease vectors

Public health insecticides play a crucial role in malaria control and elimination programmes. Many other arthropods, including mechanical and biological vectors of infectious diseases, have similar indoor feeding or resting behaviours, or both, as malaria mosquitoes, and could be exposed to the same insecticides. In this Personal View, we show that little is known about the insecticide susceptibility status and the extent of exposure to malaria interventions of other arthropod species. We highlight that there is an urgent need to better understand the selection pressure for insecticide resistance in those vectors, to ensure current and future active ingredients remain effective in targeting a broad range of arthropod species, allowing us to prevent and control future outbreaks of infectious diseases other than malaria.

Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures

BACKGROUND

Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans. Female fleas penetrate the skin, particularly at the feet, and cause severe inflammation. This study aimed to characterize disease burden in two highly affected regions in Kenya, to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping, targeting, and monitoring interventions.

METHODS

From February 2020 to April 2021, 3532 pupils age 8-14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms. Of the infected pupils, 266 were quasi-randomly selected and their households visited, where an additional 1138 family members were examined. Inflammation was assessed using infra-red thermography. A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots.

RESULTS

The overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3% [95% confidence interval (CI): 8.4-10.3]. Based on mixed effects logistic models, the odds of infection with tungiasis among school pupils was three times higher in Kwale (coastal Kenya) than in Siaya [western Kenya; adjusted odds ratio (aOR) = 0.36, 95% CI: 0.18-0.74]; three times higher in males than in females (aOR = 3.0, 95% CI: 2.32-3.91) and three times lower among pupils sleeping in a house with a concrete floor (aOR = 0.32, 95% CI: 0.24-0.44). The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third (aOR = 0.32, 95% CI: 0.19-0.53) of that when schools were closed due to COVID-19 restrictions and approximately half (aOR = 0.44, 95% CI: 0.29-0.68) in surveys done after school re-opening (round 3). Infection intensity was positively correlated with inflammation as measured by thermography (Spearman's rho = 0.68, P < 0.001) and with the clinical score (rho = 0.86, P < 0.001). Based on the two-level classification, severe cases were associated with a threefold higher level of pain (OR = 2.99, 95% CI: 2.02-4.43) and itching (OR = 3.31, 95% CI: 2.24-4.89) than mild cases.

CONCLUSIONS

Thermography was a valuable addition for assessing morbidity and the proposed two-level classification of disease severity clearly separated patients with mild and severe impacts. The burden of tungiasis was considerably higher in households surveyed during COVID-19 restrictions suggesting underlying risks are found in the home environment more than in school.

Modeling the impact of public health education on tungiasis dynamics with saturated treatment: Insight through the Caputo fractional derivative

Public health education is pivotal in the management and control of infectious and non-infectious diseases. This manuscript presents and analyses a nonlinear fractional model of tungiasis dynamics with the impact of public health education for the first time. The human population is split into five classes depending on their disease status. The infected population is split into two subgroups; infected but unaware and infected but aware. The model focuses on the impacts of public health education, contact and treatment contact on tungiasis transmission dynamics. Notably, public health education is important for containing as well as reducing disease outbreaks in communities. The Caputo fractional derivative is utilised in defining the model governing equations. Model equilibrium points existence and stability are investigated using simple matrix algebra. Model analysis shows that tungiasis is contained when the reproduction number is less than unity. Otherwise, if it is greater than unity, the disease persists and spread in the population. The generalised Adams-Bashforth-Moulton approach is utilised in solving the derived tungiasis model numerically. The impacts of public health education, treatment and contact rate on overall disease dynamics are discussed through numerical simulations. From the simulations, we see that for given fractional order, public health education and treatment increase the quality of life plus reduce equilibrium numbers of tungiasis-infected individuals. We observe that population classes converge quicker to their steady states when α is increased. Thus, we can conclude that the derivative order α captures the role of experience or knowledge that individuals have on the disease's history.

Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda

Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3-64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5-14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9-18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles.

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.

Environmental and Household-Based Spatial Risks for Tungiasis in an Endemic Area of Coastal Kenya

Tungiasis is a cutaneous parasitosis caused by an embedded female sand flea. The distribution of cases can be spatially heterogeneous even in areas with similar risk profiles. This study assesses household and remotely sensed environmental factors that contribute to the geographic distribution of tungiasis cases in a rural area along the Southern Kenyan Coast. Data on household tungiasis case status, demographic and socioeconomic information, and geographic locations were recorded during regular survey activities of the Health and Demographic Surveillance System, mainly during 2011. Data were joined with other spatial data sources using latitude/longitude coordinates. Generalized additive models were used to predict and visualize spatial risks for tungiasis. The household-level prevalence of tungiasis was 3.4% (272/7925). There was a 1.1% (461/41,135) prevalence of infection among all participants. A significant spatial variability was observed in the unadjusted model (p-value < 0.001). The number of children per household, earthen floor, organic roof, elevation, aluminum content in the soil, and distance to the nearest animal reserve attenuated the odds ratios and partially explained the spatial variation of tungiasis. Spatial heterogeneity in tungiasis risk remained even after a factor adjustment. This suggests that there are possible unmeasured factors associated with the complex ecology of sand fleas that may contribute to the disease's uneven distribution.

Assessment of the role played by domestic animals in jigger infection in Kandara sub-county, Kenya (case control study)

Introduction

tungiasis is an ectoparasitosis caused by penetration of female sand flea, Tunga penetrans, into the skin of the susceptible animal and the consequent hypertrophy of the parasite. The objective of this study was to assess the association between domestic animals and jigger infection among the residents of Kandara sub-county in central Kenya.

Methods

this was a case-control study that involved 776 individuals. Half of this number entailed case group who were jigger infected while the other half was the control, composed of jigger free participants. Structured questionnaires were, administered among the heads of the households to which the participants belonged to gather information concerning the animals they kept. Univariate analysis was, applied.

Results

in this study, there were significant differences in age (P=0.008) between the two groups. Disparities in source of income (P<0.001) and level of education (P<0.001) came out as very significant factors in jigger infection. The case group was 10 times more likely to keep dogs than the control(9.6; 95% CI, 5.9-15.6). Case group was also 7 times more likely to rear chicken in comparison to the control (6.6; 95%, 4.2-10.4). The case group was 12 times more likely to let dogs loose in the compound in comparison to the control (12.1: 95%, 5.9-24.5). When compared to the control, this group was also 17 times more likely to keep chicken inside their houses (16.7: 95% CI, 6.8-35.9). Conclusion: there is a very high association between domestic animals and occurrence of tungiasis in Kandara sub-county.

Risk factors for scabies, tungiasis, and tinea infections among schoolchildren in southern Ethiopia: A cross-sectional Bayesian multilevel model

Background

Skin problems cause significant sickness in communities with poor living conditions, but they have received less attention in national or global health studies because of their low mortality rates. In many developing regions, the prevalence of parasitic skin diseases among schoolchildren is not reported. Previous studies thus have attempted to identify risk factors for these conditions using the frequentist approach. This study aimed to assess the occurrence and risk factors of skin infections among rural schoolchildren in southern Ethiopia by combining a frequentist and a Bayesian approach.

Methodology/Principal findings

Using three-stage random sampling, we assessed 864 schoolchildren aged 7–14 years from the Wonago district in southern Ethiopia. We detected potential risk factors for scabies, tungiasis, and tinea infections and recorded their hygienic practices and socio-demographic information. The frequentist model revealed a clustering effect of 8.8% at the classroom level and an insignificant effect at the school level. The Bayesian model revealed a clustering effect of 16% at the classroom level and 5.3% at the school level. Almost three-fourths of the sample had at least one type of skin problem, and boys were at higher overall risk than girls (adjusted odds ratio [aOR] 1.55 [95% Bayesian credible interval [BCI] 1.01, 2.28). Risk factors included unclean fingernails (aOR 1.85 [95% BCI 1.08, 2.97]); not washing the body (aOR 1.90 [95% BCI 1.21, 2.85]) and hair (aOR 3.07 [95% BCI 1.98, 4.57]) with soap every week; sharing a bed (aOR 1.97 [95% BCI 1.27, 2.89]), clothes (aOR 5.65 [95% BCI 3.31, 9.21]), or combs (aOR 3.65 [95% BCI 2.28, 5.53]); and living in a poor household (aOR 1.76 [95% BCI 1.03, 2.83]). Washing legs and feet with soap daily was identified as a protective factor for each of the three skin diseases (aOR 0.23 [95% BCI 0.15, 0.33]).

Conclusions/Significance

We observed high variation in skin problems at the classroom level, indicating the presence of shared risk factors in these locations. The findings suggest the need to improve children’s personal hygiene via health education by schoolteachers and health workers.

Skin problems are common disorders in resource poor settings. Scabies and tungiasis are neglected tropical diseases causing significant sickness in communities with poor living conditions. Scabies is dermatosis caused by a burrowing mite, Sarcoptes scabiei var. hominis. Tungiasis is caused by a flea, Tunga penetrans, infesting the skin, usually on the feet or hands. Tinea infection is a fungal dermatophyte infection of the skin and the most common dermatological problem among schoolchildren in Ethiopia, especially tinea capitis. Application of a Bayesian approach to identify possible risk factors for these problems has seldom been used. We found that compared to the frequentist model, the Bayesian model better explained school- and classroom-level variations in skin problems among schoolchildren. Our findings also suggest that transmission of skin infections, especially fungal and scabies infections, frequently occurs in schools and classrooms. We identified several risk factors for these conditions, including low socioeconomic status; unclean fingernails; not washing with soap at least every week; and sharing beds, clothes, and combs. Thus, it is important to improve the personal hygiene of schoolchildren through education. Regular checkups by teachers also can improve skin health and related morbidity in rural schoolchildren in southern Ethiopia.

Clinical implications and treatment options of tungiasis in domestic animals

Tunga penetrans, Tunga trimamillata and Tunga hexalobulata are the three species of sand fleas which cause tungiasis in domestic animals. Tunga penetrans and T. trimamillata are zoonotic in the tropical and sub-tropical endemic communities of Latin America and Africa. Tungiasis in animals frequently occurs alongside human tungiasis. Currently, most of the attention given to tungiasis is focusing on the human disease, and animal tungiasis is extremely neglected despite its public health and animal health significance. This review highlights recent findings concerning the clinical implications and treatment options but also summarises the occurrence, major features, public health and economic significance of tungiasis in domestic animals. Pigs, dogs, cats and domestic ruminants have been reported to harbour high intensities of sand fleas in endemic communities. High infection intensities cause significant animal morbidity which is often exacerbated by excoriations and secondary bacterial infections which are potentially fatal. In addition to the potential economic losses accruing from tungiasis-related morbidity, infected domestic animals contribute to transmission and persistence of sand fleas and eventually also to severe human disease. Although control of animal tungiasis is possible by adoption of proper husbandry practices, affected communities may not afford the resources required to implement them. Also, there are no widely acceptable and affordable insecticides for treatment of tungiasis in animals. Extension services aiming at increasing awareness on tungiasis and its control should be intensified. Also, available commercial insecticides should be evaluated for therapeutic and prophylactic properties against animal tungiasis.

Repellent Effects of Selected Organic Leaf Extracts of Tithonia diversifolia (Hemsl.) A. Gray and Vernonia lasiopus (O. Hoffman) against Sitophilus zeamais Motschulsky (Coleoptera: Curculionidae)

Introduction

Sitophilus zeamais infestation is among the major setbacks to sustainable maize farming and availability. It causes an estimated annual loss of 5-10% and 20-30% of the total maize grains loss in the temperate and tropical zones, respectively. Although synthetic pesticides are quick and effective in managing crop pests, their overuse and misuse is discouraged due to their detrimental effects on human and environment. Natural pesticidal products that are extracted from plants are particularly gaining importance as an alternative to synthetic pesticides. They are available, easily biodegraded and have low toxicity to nontarget organisms. Most botanical pesticides act on insects by repelling them away from the crops in the field or in the stores. Therefore, this study aimed to determine repellency potential of organic leaf extracts of Tithonia diversifolia and Vernonia lasiopus on S. zeamais. Materials and methods. The phytochemical profile of T. diversifolia and V. lasiopus was determined using GC-MS. Laboratory-based experiments were carried out using area preference method to assess the efficacy of the extracts against weevils for a test period of 5 h. Six groups of experiments were set up with ten S. zeamais in each test: positive control (Actellic), negative control (solvent only), and four different experimental extract concentrations (25, 50, 75, and 100%).

Results

The results indicated that T. diversifolia and V. lasiopus leaf extracts possess potent repellency effect on weevils. All the extracts simply discouraged S. zeamais from the treated areas recording significantly good levels of repellent activities between 26 and 96%. Furthermore, the GC-MS analysis manifested the presence of bioactive compound in the extracts which are associated with the repellency effects.

Conclusion

The study scientifically confirms the traditional use of the T. diversifolia and V. lasiopus and provides important platform for further study on the extracts as bioresource of botanical repellent.

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

Tungiasis is a public health disease in many rural and urban slums in sub-Saharan Africa (SSA), primarily affecting children and the elderly. Yet, this disease has received little attention in many sub-Saharan African countries. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of tungiasis and associated risk factors in SSA. We searched AJOL, Google Scholar, Web of Science, and PubMed for population-based studies that reported the prevalence of tungiasis and risk factors in SSA between January 1980 and July 2020. The study employed a random-effects model and heterogeneity to estimate the pooled prevalence and evaluate the Cochran's Q-test respectively across studies that met the inclusion criteria. We screened 104 articles and retrieved 42 full-text articles to evaluate for inclusion in the review. Twenty-seven studies involving 16,303 individuals in seven SSA countries were analyzed. The pooled prevalence of tungiasis in SSA was 33.4% (95% CI: 27.6-39.8), while tungiasis prevalence was 46.5%, 44.9%, 42.0%, 37.2%, 28.1%, 22.7% and 20.1% for Ethiopia, Cameroon, Tanzania, Kenya, Nigeria, Rwanda, and Uganda, respectively. The risk of tungiasis was associated with gender, participants' age groups (4-15 years and ≥60 years), earthen floor, non-regular use of footwear, contact with animals, and residence in rural areas. An integrated approach addressing significant factors in tungiasis prevalence in SSA needs to be designed and implemented by a trans-disciplinary composition of community leaders, health professionals, non-governmental institutions, and policymakers.

Factors associated with tungiasis among primary school children: a cross-sectional study in a rural district in Rwanda

BACKGROUND

Tungiasis is a relatively frequent ectoparasitosis in low-income settings, yet its morbidity and social impact are still not well understood due to the scarcity of information. In Rwanda, data on the magnitude and conditions leading to the tungiasis is rare. This study sought to determine the prevalence and factors associated with tungiasis among primary school children in Rwandan setting.

METHOD

A descriptive cross-sectional study utilising systematic random sampling method was adopted to select 384 children from three primary schools. From July to October 2018, data were collected on socio-demographic characteristics of children, parents, and households. Logistic regression was applied to analyse socio-demographic factors associated with tungiasis with a level of significance set at P-value< 0.05.

RESULTS

Prevalence of tungiasis among three primary schools was 23%. Factors associated with tungiasis included walking barefoot (AOR: 78.41; 95% CI: 17.91-343.10), irregular wearing of shoes (AOR: 24.73; 95% CI: 6.27-97.41), having dirty feet (AOR: 12.69; 95% CI: 4.93-32.64), wearing dirty clothes (AOR: 12.69; 95% CI: 4.18-38.50), and living in a house with earthen plastered floor (AOR: 28.79; 95% CI: 7.11-116.57). Children infected with tungiasis attended class less frequently (AOR: 19.16, 95%CI: 7.20-50.97) and scored lower (AOR: 110.85, 95%CI: 43.08-285.20) than those non-infected. The low school attendance and poor performance could be partly explained by difficulty of walking, lack of concentration during school activities, and isolation or discrimination from classmates.

CONCLUSION

Tungiasis was a public health challenge among school going children in a rural Rwandan setting. This study revealed that children affected with tungiasis had poor hygiene, inadequate housing environments and consequently poor school attendance and performance. Improving socio-economic conditions of households with special emphasis on hygiene of family members and housing conditions, would contribute to preventing tungiasis.

Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya II: Results from a school-based observational study

Introduction

Awareness of the public health importance of tungiasis has been growing in East Africa in recent years, but data on epidemiological characteristics necessary for the planning and implementation of control measures do not exist. The work presented here was part of a larger cross-sectional study on the epidemiology of tungiasis in coastal Kenya and aims at identifying risk factors of tungiasis and severe disease in school children.

Methods

A total of 1,829 students of all age groups from five schools and 56 classes were clinically examined for tungiasis on their feet based on standardized procedures and observations made about the school infrastructure. To investigate the impact of school holidays, observations were repeated after school holidays in a subset of children in one school. In an embedded case-control study, structured interviews were conducted with 707 students in the five schools to investigate associations between tungiasis and household infrastructure, behaviour and socio-economic status.

Results

The overall prevalence of tungiasis was 48%; children below the age of 15 years were the most affected, and boys were twice as likely as girls to be infected. The highest risk of disease was associated with the socio-economic circumstances of the individual student at home. The study indicated that mild to moderate tungiasis could be reduced by a third, and severe tungiasis by over half, if sleeping places of children had hardened floors, whilst approximately a seventh of the cases could be prevented by sealing classroom floors in schools, and another fifth by using soap for daily feet washing.

Conclusion

There is a clear role for public health workers to expand the WASH policy to include washing of feet with soap in school-aged children to fight tungiasis and to raise awareness of the importance of sealed floors.

Tungiasis is a neglected tropical skin disease caused by penetrated sand fleas, the adult female of which burrows into the skin of the feet. The parasite rapidly expands its body size by a factor of 2000. The growth causes immense itching, inflammation, pain and debilitation. The current lack of good treatment methods means people attempt to remove the fleas themselves with non-sterile instruments causing more damage. Control efforts focus on prevention but there is little data to guide this in East Africa. The current study reinforces our previously published results on the household level from the same communities, indicating that prevention needs to focus on hardening the floors of resource-poor families and integrating daily foot washing with soap into water, hygiene and sanitation programs.

Seasonal variation and persistence of tungiasis infestation in dogs in an endemic community, Bahia State (Brazil): longitudinal study

Tungiasis is a zoonosis neglected by authorities, health professionals, and affected populations. Domestic, synanthropic, and sylvatic animals serve as reservoirs for human infestation, and dogs are usually considered a main reservoir in endemic communities. To describe the seasonal variation and the persistence of tungiasis in dogs, we performed quarterly surveys during a period of 2 years in a tourist village in the municipality of Ilhéus, Bahia State, known to be endemic for tungiasis. Prevalence in dogs ranged from 62.1% (43/66) in August 2013 to 82.2% (37/45) in November 2014, with no significant difference (p = 0.06). The prevalence of infestation remained high, regardless of rainfall patterns. Of the 31 dogs inspected at all surveys, period prevalence was 94% (29/31; 95% CI 79.3-98.2%) and persistence of infestation indicator [PII] was high (median PII = 6 surveys, q1 = 5, q3 = 7). Dogs < 1 year of age had a higher mean prevalence of 84.5%, as compared with 69.3% in the older dogs. No significant difference was found between the risk of infestation and age or sex (p = 0.61). Our data indicate that canine tungiasis persisted in the area during all periods of the year. The seasonal variation described in human studies from other endemic areas was not observed, most probably due to different rainfall patterns throughout the year. The study has important implications for the planning of integrated control measures in both humans and animal reservoirs, considering a One Health approach.

Spatial distribution, prevalence and potential risk factors of Tungiasis in Vihiga County, Kenya

Background

Tungiasis is a parasitic disease caused by the sand flea Tunga penetrans also known as jigger flea. Communities living in precarious conditions in tropical and sub tropical countries bear the brunt of the infection. The main objective of this study was to determine the burden of Tungiasis in Vihiga County in Kenya.

Methods

This was a cross-sectional study conducted in 21 villages in 3 Sub-locations in Vihiga County, western Kenya. A total of 437 participants, 5 years old and above were clinically examined for the presence of tungiasis after consenting to take part in the study. Diagnosis was made following standard methods. A semi- structured questionnaire was administered to assess socio-demographic factors, housing, presence and ownership of animals, knowledge and practice related to tungiasis. Data were analyzed using bivariate and multivariate regression analysis. GIS was used to map the geographic distribution of tungiasis in the area.

Results

The overall prevalence was found to be (21.5%; 95% CI: 17.7–25.3%). The cases were analysed and visualized in a map form. Multivariate analysis suggested that the occurrence of tungiasis was associated with variables that indicated low economic status (like a monthly income of Ksh ≤ 1000 (adjusted odds ratio 27.85; 95% CI: 4.13–187.59), earthen floor (0.36; 0.13–1.024) and lack of toilet facilities (4.27; 0.82–22.34), age of participant ≤14 (27.414; 10.02–74.99), no regular use of closed footwear (1.98; 0.987–3.97) and common resting place inside the house (1.93; 0.96–3.89).

Conclusions

Tungiasis is an important health problem in Vihiga County occasioned by the low economic status of the people affected. Factors that point to poverty contribute to the occurrence of tungiasis. These findings suggest a need to design control strategies for tungiasis that are cost effective and easily accessible.

Tungiasis even though curable, continues to cause a lot of morbidity and in some cases death to millions of people living in tropical and subtropical countries. The global burden of tungiaisis is not known unlike for most diseases which attract a lot of attention and funding. There are also gaps on the exact geographical distribution of this disease and the communities affected, hence it is largely ignored and neglected by the scientific community, the health sector, pharmaceutical industries and policy makers. As a consequence, there are no universally accepted methods to treat and control tungiasis. The study attempted to close this gap by combining geographic information system and questionnaire data to visualize the burden and risk factors of tungiasis in Vihiga County, Kenya. The researchers found that tungiasis is an important health burden in Vihiga County, Kenya and that its occurrence was associated with factors that point to poverty. These findings suggest a need to design control strategies for tungiasis that are cost effective and easily accessible by the communities affected.

Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia

Background

Tungiasis is an ectoparasitic infestation, which still has public health importance in deprived populations of developing countries. Data on the prevalence and risk factors of tungiasis is rare in Ethiopia. Hence, this study was designed to determine the prevalence and risk factors of tungiasis among children in Wensho district, southern Ethiopia.

Methods

From February to May 2016, we conducted a community-based cross-sectional study on 366 children 5–14 years old. Data about the presence and severity of tungiasis were obtained through inspection and data on risk factors were collected through interviews of parents/guardians of the children using structured questionnaire and through observation of the housing environment using structured checklist.

Results

Two hundred fifteen (58.7%, 95% confidence interval [CI]: 53.7%, 63.8%) of the 366 children were infested with Tunga penetrans. Most lesions were localized in the feet and the distribution of the disease by sex was similar (57.4% among males and 60.3% among females). Children of illiterate mothers (adjusted odds ratio [AOR]: 3.62, 95% CI: 1.35, 9.73) and children whose mothers have attended only primary education (AOR: 2.72, 95% CI: 1.06, 6.97), children from cat owning households (AOR: 4.95, 95% CI: 1.19, 20.60) and children who occasionally use footwear (AOR: 7.42, 95% CI: 4.29, 12.83) and those who never use footwear (AOR: 12.55, 95% CI: 3.38, 46.58) had a significantly higher odds of tungiasis infestation.

Conclusion

Tungiasis is an important public health problem with considerable morbidity among children in Wensho. Hence, implementation of tungiasis prevention strategies such as promoting shoes wearing, provision of health education, fumigating the residential houses and applying insecticides on pets are recommended.

Animal and human tungiasis-related knowledge and treatment practices among animal keeping households in Bugiri District, South-Eastern Uganda

BACKGROUND

Zoonotic tungiasis caused by Tunga penetrans remains a serious public and animal health problem among endemic villages in Uganda and many sub Saharan African countries. Studies on human and animal tungiasis-related knowledge and treatment practices in endemic communities have never been undertaken, a limitation to development of sustainable control measures.

METHODS

A cross sectional study using semi-structured questionnaires (Supplementary file S1) was conducted among 236 animal rearing households in 10 endemic villages in Bugiri District, South-Eastern Uganda. Focus group discussions and observation checklists were used to validate and clarify the findings.

RESULTS

Most respondents knew the aetiology (89.4%), clinical signs (98%) and the ecology of T. penetrans as well as the major risk factors of human tungiasis (65.2%). In contrast, very few respondents were aware of animal tungiasis. Only 4.8% of those with infected animals on the compound knew that some of their animals were infected and 13.6% of the respondents had ever seen tungiasis-affected animals. Pigs (13.1%, n=31) and dogs (0.85%, n=2) were the only T. penetrans animal hosts known to animal owners. Affected humans were treated by extraction of embedded sand fleas using non-sterile sharp instruments in all households that reported occurrence of human tungiasis at least once (n=227). Also, affected animals were mainly treated by mechanical removal of embedded sand fleas in households that have ever experienced animal tungiasis (four out of 12; 33.3%). In a few instances, plant and animal pesticides (n=3) and other chemicals such as grease, paraffin and wood preservative (n=3) were also used to treat animal tungiasis.

CONCLUSION

The study revealed a high level of knowledge on human tungiasis but inadequate knowledge on the zoonotic nature of tungiasis. Commonly applied methods for treatment of human and animal tungiasis are a health hazard by themselves. Concerted i.e. One Health-based efforts aiming at promoting appropriate treatment of tungiasis, adequate living conditions and increased awareness on tungiasis in the communities are indicated in order to eliminate tungiasis-associated disease.

The prevalence and association with health-related quality of life of tungiasis and scabies in schoolchildren in southern Ethiopia

Background

The prevalence of skin disease in low and middle income countries is high and communicable skin diseases are a significant public health problem. Tungiasis is an ectoparasite infestation caused by the flea Tunga penetrans, which has a widespread geographical distribution. Tungiasis causes painful skin lesions and may affect activities of daily living.

Objective

We wished to determine the prevalence and impact of tungiasis and scabies in schoolchildren in southern Ethiopia.

Methods

A cross-sectional study was performed in which students were examined by dermatologists and the skin disorders recorded. Individuals with pyogenic skin infections, scabies and tungiasis were also invited to complete the Children’s Dermatology Life Quality Index.

Results

There was a high burden of skin disease amongst this cohort with more than 40% having an ectodermal parasitic skin disease. The majority of these were due to tungiasis. Tungiasis was evident in more than a third of children and was associated with onychodystophy. There was a significant association between wearing “closed” footwear and a greater number of tungiasis lesions but not tungiasis per se. Dermatophyte infections, acne and plantar maceration secondary to occlusive footwear were also common.

Scabies and tungiasis appeared to have a significant negative effect on quality of life.

Conclusion

Tungiasis is highly prevalent in schoolchildren in the part of Ethiopia where the study was conducted and is associated with a deleterious effect on quality of life. The role of footwear in both preventing and possibly exacerbating cutaneous ailments in this setting requires further study.

Skin disorders are very common in all geographical locations and especially so in low and middle income countries. In these settings many of the commonest skin disorders are communicable.

Human ectoparasites such as lice and scabies mites live on the skin and Tunga penetrans fleas enter the skin to shed their eggs and complete their lifecycle. All of these ectoparasites cause significant morbidity particularly in poorer communities.

We have shown that the infestations of scabies and tungiasis were the commonest skin disorders in the Ethiopian schoolchildren examined in this study. These conditions are associated with a significant impact on the quality of life of these children as measured by the Children’s Dermatology Life Quality Index.

Footwear protects individuals from many conditions both infectious and non-infectious however in this cohort footwear was associated with maceration of the skin and this requires further investigation.

Prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda

Introduction

Tungiasis is an endemic but neglected health problem in Uganda especially in resource poor communities. It is largely affecting rural communities in the Eastern, West Nile and Central regions. This study assessed prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda.

Methods

This was a cross sectional study that used a semi-structured questionnaire and observational checklist to collect quantitative data from 422 households in 12 villages. Prevalence of tungiasis was defined as presence of Tunga penetrans in the skin of any household member at the time of data collection.

Results

The prevalence of tungiasis was 22.5%. However, a big percentage 41.5% of households were reported to have had T. penetrans in the previous month while 49.5% had T. penetrans for more than one month. Majority (90.5%)of the participants used a pin, needle, or thorn to remove sand flea from infected body parts. Having dirty feet (AOR 3.86, CI (1.76-8.34)), dirty clothes (AOR 3.46, CI (2.00-5.97)), cracked house floor (AOR =6.28, CI (3.28-12.03)), dirty floor (AOR 3.21, CI (1.38-7.46)), littered compounds (AOR= 2.95, CI (1.66-5.26)) and rearing cattle (AOR 2.38, CI (1.28-4.45)) were associated with tungiasis. However, practicing preventive measures (AOR 0.51, CI (0.29-0.90)) was found protective for disease.

Conclusion

Tungiasis is still a prevalent health problem in rural communities in Eastern Uganda due to a number of individual (host) and environmental factors. There is need to increase awareness regarding improvement in sanitation and hygiene to enable communities’ implements interventions for prevention of T. penetrans.