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Delie AM, Melese M, Limenh LW, Esubalew D, Worku NK, Fenta ET, Hailu M, Abie A, Mehari MG, Dagnaw TE. Prevalence and associated factors of head lice infestation among primary school children in low- and middle-income countries: systematic review and meta-analysis. BMC Public Health 2024; 24:2181. [PMID: 39135177 PMCID: PMC11318336 DOI: 10.1186/s12889-024-19712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Head lice infestation remains a persistent public health concern among primary school children in resource-limited settings, affecting their well-being and academic performance. Despite previous studies, there is no consistent evidence on the prevalence and factors associated with head lice infestation. This study aimed to determine the prevalence and factors related to head lice infestation among primary school children in low and middle-income countries. METHODS This review was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Relevant electronic databases, including PubMed, Cochrane Library, Web of Science, Science Direct, AJOL, and Google Scholar, were used to retrieve articles. The study included only published articles written in English languages between December 01, 2014 to January 31, 2024 for studies reporting the prevalence of head lice infestation or associated factors among primary school children in low- and middle-income countries. This review has been registered on PROSPERO with Prospero registration number CRD42024506959. The heterogeneity of the data was evaluated using the I2 statistic. A meta-analysis was conducted using STATA 17 software, with a 95% confidence interval. Publication bias was evaluated using funnel plots and statistical tests, such as Egger's and Beggs's tests, to identify publication biases in the included studies. Meta-regression was also carried out to assess the source of publication of publication bias. RESULTS The review included 39 studies involving 105,383 primary school children. The pooled prevalence of head lice infestation among primary school children in low- and middle-income countries was 19.96% (95% CI; 13.97, 25.95). This review also found out that being a girl was 3.71 times (AOR = 3.71; 95% CI: 1.22-11.26) more likely to have head lice infestation as compared to boys, while children with a previous history of infestation were 4.51 times (AOR = 4.51; 95% CI: 2.31-8.83) more likely to have head lice infestation as compared to their counterparts. CONCLUSION The overall prevalence of head lice infestation among primary school children in low- and middle-income countries was found to be high. Female gender, children who had a previous history of infestation, and family size were significant predictors of head lice infestation. As a result, policymakers and program administrators should focus on the identified determinants.
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Affiliation(s)
- Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, P.O. Box: 40, Injibara, Ethiopia.
| | - Mihret Melese
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Liknaw Workie Limenh
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Nigus Kassie Worku
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, P.O. Box: 40, Injibara, Ethiopia
| | - Mickiale Hailu
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Bahir Dar, Ethiopia
| | - Alemwork Abie
- Department of Midwifery, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Molla Getie Mehari
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tenagnework Eseyneh Dagnaw
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, P.O. Box: 40, Injibara, Ethiopia
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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. Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life. PLoS Negl Trop Dis 2024; 18:e0011800. [PMID: 38776337 PMCID: PMC11149845 DOI: 10.1371/journal.pntd.0011800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/04/2024] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans. The flea burrows into the skin inducing a strong inflammatory response, leading to pain and mobility restrictions with potential impacts on quality of life. Few countries implement control efforts and there are few data on the impact of the disease to support policy decisions. We conducted a survey to determine the impact of tungiasis among primary school children across nine counties of Kenya. A total of 10,600 pupils aged 8 to 14 years were randomly selected from 97 primary schools and examined for tungiasis. For 81 cases and 578 randomly selected controls, anthropometric measurements were made, and school attendance and exam scores were collected from school records. Of those with tungiasis, 73 were interviewed regarding their quality of life using a tungiasis-specific instrument. Mixed effect ordered logistic and linear models were used to assess associations between disease status and impact variables. Compared to uninfected pupils, those with tungiasis had lower weight-for-age z-scores (adjusted β -0.41, 95% CI: -0.75-0.06, p = 0.020), missed more days of school the previous term (adjusted Incidence Rate Ratio: 1.49, 95% CI: 1.01-2.21, p = 0.046) and were less likely to receive a high score in mathematics (aOR 0.18, 95% CI: 0.08-0.40, p<0.001) and other subjects. Pupils with severe disease (clinical score >10) were four times more likely to experience severe pain than those with mild disease (OR 3.96, 95% CI: 1.35-11.64, p = 0.012) and a higher impact on their quality of life than those with mild disease (aOR 3.57, 95% CI: 1.17-10.8, p = 0.025) when adjusted for covariates. This study has demonstrated tungiasis has a considerable impact on children's lives and academic achievement. This indicates the need for integrated disease management for school-aged children to protect their physical and cognitive development and their future prospects.
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Affiliation(s)
- Lynne Elson
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Marta Maia
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ifedayo Adetifa
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benedict Orindi
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
| | - Phillip Bejon
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ulrike Fillinger
- International Centre for Insect Physiology and Ecology (icipe), Nairobi, Kenya
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Matharu AK, Ouma P, Njoroge MM, Amugune BL, Hyuga A, Mutebi F, Krücken J, Feldmeier H, Elson L, Fillinger U. Identification of tungiasis infection hotspots with a low-cost, high-throughput method for extracting Tunga penetrans (Siphonaptera) off-host stages from soil samples-An observational study. PLoS Negl Trop Dis 2024; 18:e0011601. [PMID: 38377105 PMCID: PMC10906885 DOI: 10.1371/journal.pntd.0011601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/01/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The sand flea, Tunga penetrans, is the cause of a severely neglected parasitic skin disease (tungiasis) in the tropics and has received little attention from entomologists to understand its transmission ecology. Like all fleas, T. penetrans has environmental off-host stages presenting a constant source of reinfection. We adapted the Berlese-Tullgren funnel method using heat from light bulbs to extract off-host stages from soil samples to identify the major development sites within rural households in Kenya and Uganda. METHODS AND FINDINGS Simple, low-cost units of multiple funnels were designed to allow the extraction of >60 soil samples in parallel. We calibrated the method by investigating the impact of different bulb wattage and extraction time on resulting abundance and quality of off-host stages. A cross-sectional field survey was conducted in 49 tungiasis affected households. A total of 238 soil samples from indoor and outdoor living spaces were collected and extracted. Associations between environmental factors, household member infection status and the presence and abundance of off-host stages in the soil samples were explored using generalized models. The impact of heat (bulb wattage) and time (hours) on the efficiency of extraction was demonstrated and, through a stepwise approach, standard operating conditions defined that consistently resulted in the recovery of 75% (95% CI 63-85%) of all present off-host stages from any given soil sample. To extract off-host stages alive, potentially for consecutive laboratory bioassays, a low wattage (15-25 W) and short extraction time (4 h) will be required. The odds of finding off-host stages in indoor samples were 3.7-fold higher than in outdoor samples (95% CI 1.8-7.7). For every one larva outdoors, four (95% CI 1.3-12.7) larvae were found indoors. We collected 67% of all off-host specimen from indoor sleeping locations and the presence of off-host stages in these locations was strongly associated with an infected person sleeping in the room (OR 10.5 95% CI 3.6-28.4). CONCLUSION The indoor sleeping areas are the transmission hotspots for tungiasis in rural homes in Kenya and Uganda and can be targeted for disease control and prevention measures. The soil extraction methods can be used as a simple tool for monitoring direct impact of such interventions.
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Affiliation(s)
- Abneel K. Matharu
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Berlin, Germany
- 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
| | - Margaret M. Njoroge
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Billy L. Amugune
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Ayako Hyuga
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Francis Mutebi
- Makerere University, College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Jürgen Krücken
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Berlin, Germany
| | - Hermann Feldmeier
- Charité–Universitätsmedizin Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Lynne Elson
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- University of Oxford, Centre for Tropical Medicine and Global Health, Oxford, United Kingdom
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
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Elson L, Nyawa SM, Matharu A, Fillinger U. Developing low-cost house floors to control tungiasis in Kenya - a feasibility study. BMC Public Health 2023; 23:2483. [PMID: 38087242 PMCID: PMC10714545 DOI: 10.1186/s12889-023-17427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
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).
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Affiliation(s)
- Lynne Elson
- KEMRI-Wellcome Trust, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Dabaso Tujengane CBO, Watamu, Kenya
| | | | - Abneel Matharu
- Human Health Theme, International Centre for Insect Physiology and Ecology, Nairobi, Kenya
| | - Ulrike Fillinger
- Human Health Theme, International Centre for Insect Physiology and Ecology, Nairobi, Kenya.
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Ahirirwe SR, Migisha R, Mwine P, Bulage L, Kwesiga B, Kadobera D, Ario AR. Investigation of human tungiasis cases, Sheema District, Uganda, November 2021-February 2022. Pan Afr Med J 2023; 46:71. [PMID: 38282773 PMCID: PMC10819847 DOI: 10.11604/pamj.2023.46.71.41277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 01/30/2024] Open
Abstract
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.
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Affiliation(s)
- Sherry Rita Ahirirwe
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Patience Mwine
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
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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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10
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Mwai J, Nyole D, Abdi MH, Omogi J. Factors associated with tungiasis among school-age children in Kwale County, rural Kenya. Int Health 2022; 15:85-92. [PMID: 35390149 PMCID: PMC9808516 DOI: 10.1093/inthealth/ihac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 03/14/2022] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Judy Mwai
- Kenya Medical Research Institute-CPHR
| | - Diana Nyole
- ITROMID-Jomo Kenyatta University of Agriculture and Technology
| | | | - Jarim Omogi
- Corresponding author: Tel: +254720573449; E-mail:
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dos Santos KC, Chiummo RM, Heckeroth AR, Zschiesche E, Brandão Guedes PE, Harvey TV, de Jesus AV, da Paixão Sevá A, de Oliveira JTS, dos Santos Freire Z, Krücken J, de Almeida Borges F, von Samson-Himmelstjerna G, Alberto Carlos RS. Efficacy of oral fluralaner (Bravecto) against Tunga penetrans in dogs: A negative control, randomized field study in an endemic community in Brazil. PLoS Negl Trop Dis 2022; 16:e0010251. [PMID: 35286319 PMCID: PMC8947607 DOI: 10.1371/journal.pntd.0010251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/24/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2022] Open
Abstract
The sand flea Tunga penetrans is one of the zoonotic agents of tungiasis, a parasitic skin disease of humans and animals. The dog is one of its main reservoirs. This negatively controlled, randomized, double-masked clinical trial evaluated the therapeutic and residual efficacy of fluralaner for treatment of dogs naturally infested with T. penetrans. Sixty-two dogs from an endemically affected community in Brazil were randomly assigned to either receive oral fluralaner (Bravecto chewable tablets) at a dose of 25 to 56 mg fluralaner/kg body weight, or no treatment (31 dogs per group). Dogs were clinically examined using a severity score for acute canine tungiasis (SCADT), parasitological examinations as defined by the Fortaleza classification, and pictures of lesions on days 0 (inclusion and treatment), 7 ± 2, 14 ± 2, 21 ± 2, 28 ± 2, 60 ± 7, 90 ± 7, 120 ± 7 and 150 ± 7. The percentage of parasite-free dogs after treatment was >90% between days 14 and 90 post-treatment with 100% efficacy on study days 21, 28 and 60. Sand flea counts on fluralaner treated dogs were significantly lower (p<0.025) than control dogs on all counts from day 7 to 120. The number of live sand fleas on treated dogs was reduced by > 90% on day 7, > 95% on days 14 and 90, and 100% from day 21 to 60, and with a significant difference between groups from day 7 to 120. From day 7 to day 120, mean SCADT scores were significantly reduced in treated dogs with a mean of 0.10 compared to 1.54 on day 120 in untreated dogs. Therefore, a single oral fluralaner administration is effective for treating and achieving long lasting (> 12 weeks) prevention for tungiasis in dogs. Tungiasis is a dermatological disease that affects humans and animals infested with sand fleas (Tunga spp.), especially in communities exposed to contaminated sandy and dry soil, where living conditions are precarious and access to basic health is limited. These sand fleas penetrate host skin and cause severe acute and chronic injuries that can dramatically compromise the host’s health. Dogs are a primary reservoir and disseminator of these fleas in South America. In this clinical field trial, the efficacy of a single oral dose of fluralaner (Bravecto chewable tablets) was evaluated for treatment and prevention of tungiasis in dogs in an endemic area of Brazil. The treatment was assessed through absence of live sand fleas and resolution of characteristic tungiasis skin lesions. Fluralaner was 100% effective from the third to the eighth week post-treatment, eliminated live sand fleas and protected against new infestations during the study. Therefore, fluralaner proved to be an excellent therapeutic option for treatment and a highly effective control option for canine tungiasis.
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Affiliation(s)
- Katharine Costa dos Santos
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | | | | | - Eva Zschiesche
- MSD, Animal Health Innovation GmbH, Schwabenheim, Germany
| | - Paula Elisa Brandão Guedes
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Tatiani Vitor Harvey
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Anderson Vieira de Jesus
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Anaiá da Paixão Sevá
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Joana Thaisa Santos de Oliveira
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Zelina dos Santos Freire
- UFMS, Federal University of Mato Grosso do Sul, Faculty of Veterinary Medicine and Animal Science, Campo Grande, Mato Grosso do Sul, Brazil
| | - Jürgen Krücken
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Berlin, Germany
| | - Fernando de Almeida Borges
- UFMS, Federal University of Mato Grosso do Sul, Faculty of Veterinary Medicine and Animal Science, Campo Grande, Mato Grosso do Sul, Brazil
| | - Georg von Samson-Himmelstjerna
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Berlin, Germany
- * E-mail: (GvSH); (RSAC)
| | - Renata Santiago Alberto Carlos
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil. CNPq Reseracher - PQ2
- * E-mail: (GvSH); (RSAC)
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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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Prevalence and associated factors of Tunga penetrans infestation among 5-14-year-olds in rural Ethiopia. PLoS One 2021; 16:e0259411. [PMID: 34714881 PMCID: PMC8555830 DOI: 10.1371/journal.pone.0259411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Tunga penetrans, also known as sand flea, causes Tungiasis in humans and animals. Despite its notoriety as an entomological problem, however, the ectoparasite receives little consideration from public health professionals. It is against this background that this article aims to assess the prevalence of and factors associated with Tunga penetrans infestation among 5-14-year-olds in rural Western Ethiopia. Methods From November to December 2020, 487 children aged 5 to 14 were selected from four primary schools in a cross-sectional study using systematic random sampling. Clinical exams, Interviews with parents/guardians and observations of the housing and classroom environments were used to collect data. Descriptive statistics and multivariable regression were used to characterize the data and identify factors associated with Tunga penetrans infestation. Result Tunga penetrans infestation (Tungiasis) was diagnosed in 138 of the 487 children examined, placing the prevalence at 28.3% (95% CI: 24.2%, 32.2%). Mud plastered walls [AOR: 5.83, % CI (3.44–9.88)], having cats in the house [AOR: 5.91, 95% CI (3.51–10.11)], not having separated sleeping quarters for animals [AOR: 4.60, 95% CI (2.69–7.86)], using self-supplied water [AOR: 6.30, 95% CI (3.33–11.93)], walking>30 minutes to school [AOR: 2.37, 95% CI (1.48–3.80)] were associated with Tungiasis. Conclusion In one way or another, several of the identified factors were linked to poverty. Improved house wall materials, fumigation of mud-plastered houses, dusting or spraying insecticides on domestic animals (such as cats), improved access to water, community education about keeping animals separated from living spaces, and hygiene promotion are all needed, with a focus on locally available, low-cost technologies that the poorest families can afford.
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Amare HH, Lindtjorn B. Risk factors for scabies, tungiasis, and tinea infections among schoolchildren in southern Ethiopia: A cross-sectional Bayesian multilevel model. PLoS Negl Trop Dis 2021; 15:e0009816. [PMID: 34613968 PMCID: PMC8494366 DOI: 10.1371/journal.pntd.0009816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Hiwot Hailu Amare
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | - Bernt Lindtjorn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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Elson L, Thielecke M, Fillinger U, Feldmeier H. Infection with tungiasis through interhost movement of adult female sand fleas, Tunga penetrans. Trans R Soc Trop Med Hyg 2021; 116:85-86. [PMID: 34352892 PMCID: PMC7613320 DOI: 10.1093/trstmh/trab117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lynne Elson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK and KEMRI-Wellcome Trust, Kilifi 80108, Kenya
| | - Marlene Thielecke
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin 10117, Germany
| | - Ulrike Fillinger
- Human Health Theme, International Centre of Insect Physiology and Ecology, Nairobi 00100, Kenya
| | - Hermann Feldmeier
- Institute of Microbiology and Infectious Diseases Immunology, Charité University Medicine, Berlin, Germany
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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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