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Teixeira JBDC, dos Santos KC, Guedes PEB, Vitor RC, Bitar TV, Harvey TV, Sevá ADP, Carlos RSA. Tungiasis: Participation of Cats and Chickens in the Dispersion and Maintenance of the Disease in an Endemic Tourist Area in Brazil. Trop Med Infect Dis 2023; 8:456. [PMID: 37888584 PMCID: PMC10611092 DOI: 10.3390/tropicalmed8100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/18/2023] [Accepted: 09/02/2023] [Indexed: 10/28/2023] Open
Abstract
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.
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Affiliation(s)
- Jamille Bispo de Carvalho Teixeira
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Katharine Costa dos Santos
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Paula Elisa Brandão Guedes
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Rebeca Costa Vitor
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Thammy Vieira Bitar
- Departamento de Ciências Agrárias e Ambientais (DCAA), Curso de Medicina Veterinária, Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil;
| | | | - Anaiá da Paixão Sevá
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Renata Santiago Alberto Carlos
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
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Elson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, Chondo E, Mburu E, Wakio M, Lore J, Maia M, Adetifa I, Orindi B, Bejon P, Fillinger U. National prevalence and risk factors for tungiasis in Kenya. Infect Dis Poverty 2023; 12:85. [PMID: 37723532 PMCID: PMC10506256 DOI: 10.1186/s40249-023-01131-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans, the female of which burrows into the skin, causing pain and itching. The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens. The tungiasis research community is keen to develop survey methods to fill this gap. Here we used a school-based, thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya. METHODS We conducted the first nationally representative survey of tungiasis, including nine counties covering the major ecological zones of Kenya. A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school. Pupils were examined thoroughly for tungiasis. Two surveys were conducted, the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors. Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect. RESULTS The overall prevalence of tungiasis in the first survey was 1.35% [95% confidence interval (CI): 1.15-1.59%], and 0.89% in the second survey. The prevalence ranged from 0.08% (95% CI: 0.01-0.59%) in Taita Taveta county to 3.24% (95% CI: 2.35-4.44%) in Kajiado county. Tungiasis infection was associated with county of residence, male sex [adjusted odds ratio (aOR) = 2.01, 95% CI: 1.52-2.67], and lower age (aOR = 0.81, 95% CI: 0.75-0.88). For the first time we demonstrate an association with attending public schools rather than private schools (aOR = 5.62, 95% CI: 1.20-26.22) and lower socioeconomic status (aOR = 0.10, 95% CI: 0.03-0.33). Using a rapid screening method of the top of feet only, would have missed 62.9% of all cases, 78.9% of mild cases and 20.0% of severe cases. CONCLUSIONS Tungiasis is widely but heterogeneously distributed across Kenya. School-based surveys offer an efficient strategy for mapping tungiasis distribution.
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Affiliation(s)
- Lynne Elson
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | | | | | | | | - Marta Maia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ifedayo Adetifa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Phillip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ulrike Fillinger
- International Centre for Insect Physiology and Ecology (Icipe), Nairobi, Kenya
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Elson L, Matharu AK, Riithi N, Ouma P, Mutebi F, Feldmeier H, Krücken J, Fillinger U. Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures. Infect Dis Poverty 2023; 12:24. [PMID: 36941724 PMCID: PMC10027580 DOI: 10.1186/s40249-023-01080-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
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.
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Affiliation(s)
- Lynne Elson
- KEMRI-Wellcome Trust Research Programme, Hospital Road, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Abneel K Matharu
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Naomi Riithi
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Paul Ouma
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Francis Mutebi
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité University Medicine, Berlin, Germany
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
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Mutebi F, McNeilly H, Thielecke M, Reichert F, Wiese S, Mukone G, Feldmeier H. Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda. Trop Med Infect Dis 2023; 8:tropicalmed8020111. [PMID: 36828527 PMCID: PMC9963877 DOI: 10.3390/tropicalmed8020111] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
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.
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Affiliation(s)
- Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala P.O. Box 7062, Uganda
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
- Correspondence: or
| | - Hannah McNeilly
- Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Edinburgh EH8 9XD, UK
| | - Marlene Thielecke
- Charité Center for Global Health, Institute of International Health, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - Susanne Wiese
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - George Mukone
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
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Rasoamialy-Soa Razanakolona L, Raharisoa A, Soankasina AH, De La Croix Jaonasoa J, Nicolas P, Antilahy JA, Chebbah D, Akhoundi M, Izri A. Clinical and epidemiological survey of tungiasis in Madagascar. Travel Med Infect Dis 2022; 50:102449. [PMID: 36113754 DOI: 10.1016/j.tmaid.2022.102449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
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.
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Affiliation(s)
| | - Annie Raharisoa
- Laboratoire de Biologie Médicale, Centre Hospitalier Régional de Référence Itasy, Miarinarivo, Madagascar
| | - Abel Hermann Soankasina
- Département de Biologie Médicale, Hôpital Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Jean De La Croix Jaonasoa
- Laboratoire de Biologie Médicale, Centre Hospitalier Régional de Référence Sambava, Sambava, Madagascar
| | - Patrick Nicolas
- Biochemistry Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Jimmy Anders Antilahy
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Dahlia Chebbah
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France.
| | - Arezki Izri
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France; Unité des Virus Émergents (UVEAix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France
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Hyuga A, Larson PS, Ndemwa M, Muuo SW, Changoma M, Karama M, Goto K, Kaneko S. Environmental and Household-Based Spatial Risks for Tungiasis in an Endemic Area of Coastal Kenya. Trop Med Infect Dis 2021; 7:2. [PMID: 35051118 PMCID: PMC8778305 DOI: 10.3390/tropicalmed7010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Ayako Hyuga
- Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi 852-8523, Nagasaki, Japan;
- Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi 852-8523, Nagasaki, Japan;
| | - Peter S. Larson
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, C/O Centre for Microbiology Research, KEMRI, Nairobi P.O. Box 19993-00202, Kenya; (P.S.L.); (S.W.M.); (M.C.)
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Morris Ndemwa
- Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi 852-8523, Nagasaki, Japan;
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, C/O Centre for Microbiology Research, KEMRI, Nairobi P.O. Box 19993-00202, Kenya; (P.S.L.); (S.W.M.); (M.C.)
| | - Sheru W. Muuo
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, C/O Centre for Microbiology Research, KEMRI, Nairobi P.O. Box 19993-00202, Kenya; (P.S.L.); (S.W.M.); (M.C.)
| | - Mwatasa Changoma
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, C/O Centre for Microbiology Research, KEMRI, Nairobi P.O. Box 19993-00202, Kenya; (P.S.L.); (S.W.M.); (M.C.)
| | - Mohamed Karama
- Centre of Public Health Research, Kenya Medical Research Institute (KEMRI), Off Mbagathi Road, Nairobi P.O. Box 54840-00200, Kenya;
| | - Kensuke Goto
- Division of Health and Safety Sciences Education, Department of Educational Collaboration, Osaka Kyoiku University, 4-698-1 Asahigaoka, Kashiwara-shi 582-8582, Osaka, Japan;
| | - Satoshi Kaneko
- Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi 852-8523, Nagasaki, Japan;
- Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi 852-8523, Nagasaki, Japan;
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, C/O Centre for Microbiology Research, KEMRI, Nairobi P.O. Box 19993-00202, Kenya; (P.S.L.); (S.W.M.); (M.C.)
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Deka MA, Heukelbach J. Distribution of tungiasis in latin America: Identification of areas for potential disease transmission using an ecological niche model. LANCET REGIONAL HEALTH. AMERICAS 2021; 5:100080. [PMID: 36776459 PMCID: PMC9903635 DOI: 10.1016/j.lana.2021.100080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Background Tungiasis is a neglected tropical disease (NTD) found in Sub-Saharan Africa and Latin America. Despite the high frequency in marginalized populations, little information is available on the geography and estimates of the population at risk in endemic regions. Here we used a geostatistical model to map the potential geographic distribution of areas suitable for tungiasis transmission in Latin America and estimated the at-risk population. Methods We developed an ecological niche model (ENM) using tungiasis occurrence records and remotely sensed environmental and socioeconomic data. The potential geographic distribution was then compared to the current population distribution of the region to derive the total population living in urban and rural areas. Findings We identified a total of 138 records of occurrences of tungiasis in Latin America, ranging from Mexico to Argentina; 27 reports were not included in the modeling, due to missing detailed geographic information. The occurrences with detailed geographic information (n = 112) included 17 countries in Latin America and the Caribbean. The locations were in environments that primarily consisted of forests (29%), croplands (16•5%), and shrublands (10•9%). We predicted environmentally suitable areas for tungiasis transmission in 45 countries. The estimated human population living in these areas is 450,546,547 with urban centers accounting for 347,007,103 and rural areas 103,539,444. Countries with significant ecological suitability and documented occurrences include Brazil, Colombia, Mexico, Argentina, Bolivia, Ecuador, French Guyana, Guatemala, Haiti, Paraguay, Peru, Trinidad and Tobago, and Venezuela. Interpretation This is the first study mapping the potential distribution of tungiasis in Latin America, evidencing the need for population-based studies and elaboration of integrated control measures. Funding This project was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the Centers for Disease Control and Prevention.
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Affiliation(s)
- Mark A. Deka
- ORISE Fellow, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Corresponding author:
| | - Jorg Heukelbach
- Postgraduate Program of Public Health, School of Medicine, Federal University of Ceará, Fortaleza - CE, Brazil
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Alemayehu T. Prevalence of multidrug-resistant bacteria in Ethiopia: a systematic review and meta-analysis. J Glob Antimicrob Resist 2021; 26:133-139. [PMID: 34129993 DOI: 10.1016/j.jgar.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Multidrug-resistant (MDR) bacteria are a significant public-health threat worldwide, especially in low- and middle-income countries. Comprehensive data are important to understand the magnitude of multidrug resistance (MDR), however these are not available in Ethiopia. METHODS Five electronic databases and grey literature of Addis Ababa University Repository were searched for data regarding the prevalence of MDR bacteria in Ethiopia. OpenMetaAnalyst R1.3 was used for analysis using a random-effects model to determine the effect size. Heterogeneity among articles was checked using the inconsistency index (I2). Funnel plot was used to check for publication bias. The quality of each article was checked using the Newcastle-Ottawa checklist adapted for cross-sectional studies. RESULTS Through database searching, 2094 articles were identified, of which 37 fulfilled the study inclusion criteria. This review comprises 6856 bacteria, of which 4949 isolates were MDR. The overall pooled prevalence of MDR was 70.5% (95% CI 64.9-76.1%), with considerable heterogeneity (I2 = 97.48%, P < 0.001). Funnel plot revealed no publication bias. Sidama (81.7%) had the highest MDR and Tigray (51.1%) the lowest. The greatest source of MDR was from multiple sites of infection (MSI) (76.8%); the least was from bloodstream infections (62.9%). MDR was higher in studies conducted on hospital-acquired infections (72.1%) compared with both hospital- and community-acquired infections (69.8%). CONCLUSION Our study indicates a high prevalence of MDR in Ethiopia. Sidama region, MSI and hospital-acquired infections showed the highest MDR in subgroup analysis. Regional hospitals should implement infection prevention and proper use of antibiotics in the community.
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Affiliation(s)
- Tsegaye Alemayehu
- Hawassa University College of Medicine and Health Science, School of Medical Laboratory, P.O. Box. 1560, Hawassa, Ethiopia.
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Obebe OO, Aluko OO. Epidemiology of tungiasis in sub-saharan Africa: a systematic review and meta-analysis. Pathog Glob Health 2020; 114:360-369. [PMID: 32909926 DOI: 10.1080/20477724.2020.1813489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
- Oluwasola O Obebe
- Department of Veterinary Parasitology & Entomology, University of Ibadan , Ibadan, Nigeria
| | - Olufemi O Aluko
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
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Deka MA. Mapping the Geographic Distribution of Tungiasis in Sub-Saharan Africa. Trop Med Infect Dis 2020; 5:E122. [PMID: 32722011 PMCID: PMC7558156 DOI: 10.3390/tropicalmed5030122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/30/2022] Open
Abstract
The geographic distribution of tungiasis is poorly understood, despite the frequent occurrence of the disease in marginalized populations of low socioeconomic status. To date, little work is available to define the geography of this neglected tropical disease (NTD). This exploratory study incorporated geostatistical modeling to map the suitability for tungiasis transmission in sub-Saharan Africa (SSA). In SSA, environmental suitability is predicted in 44 countries, including Angola, Nigeria, Ghana, Cameroon, Cote de Ivoire, Mali, Ethiopia, the Democratic Republic of the Congo, Kenya, Gabon, Uganda, Rwanda, Tanzania, Zambia, Zimbabwe, Madagascar, and South Africa. In total, an estimated 668 million people live in suitable areas, 46% (304 million) of which reside in East Africa. These evidence-based maps provide vital evidence of the potential geographic extent of SSA. They will help to guide disease control programs, inform policymakers, and raise awareness at the global level. Likewise, these results will hopefully provide decisionmakers with the pertinent information necessary to lessen morbidity and mortality in communities located in environmentally suitable areas.
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Affiliation(s)
- Mark A Deka
- Department of Geography, Texas State University; 601 University Drive, San Marcos, TX 78666, USA
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