National prevalence and risk factors for tungiasis in Kenya

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. Graphical Abstract

Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life

“…All of these factors are interconnected in a vicious cycle as illustrated in Fig 3 , possibly trapping children into a life of poverty [ 34 ] which puts them at greater risk of tungiasis. The association of tungiasis with low weight-for-age even when adjusted for SES, i.e.…”

“…This impact study was a comparison of outcomes among children with and without tungiasis nested in a cross-sectional survey aiming to determine the national level prevalence as reported previously [ 2 ]. The survey was conducted in nine counties of Kenya, purposively selected to represent the five major climatic zones, cultures and geography of the country: Turkana, Samburu, Kericho, Nakuru, Muranga, Kajiado, Makueni, Taita Taveta and Kilifi.…”

“…Those found infected were assessed for infection intensity (number of live and dead fleas, manipulated lesions and cluster of fleas). Infected pupils were also examined for associated morbidity as described previously [ 2 ] recording the presence of symptoms that are easily identified by non-clinical field officers; desquamation, fissures, ulcers and abscess for acute symptoms and hyperkeratosis, deformed nails and lost nails for chronic symptoms. Symptoms normally recorded by previous studies [ 18 ] but omitted here since they are difficult for non-clinicians to identify, were oedema, erythema, warmness and peri-ungual hyperkeratosis.…”

“…Other explanatory variables were county, school location (urban/ rural), school type (public/ private), pupil age, gender, disability, other skin abnormality, socioeconomic status (SES; as described previously [ 2 ]), adults the pupil lives with (both parents/ others), who the main caregiver is (mother/ other), mother’s school level attained (none/ primary/ secondary/ don’t know), father away a lot, mother away a lot, parents attend school meetings (never/sometimes/always), parents make sure pupils completes homework (never/sometimes/always), chronically ill family member, family member disabled, pupil missed school to help at home, pupil sleeps in parents’ house, number of people sleep in room with pupil.…”

The Burden of Tungiasis (Jiggers’ Infestation) and Its Impact on Rural Vulnerable Populations in Kenya: A Comprehensive Health Assessment on Muranga County, Kenya

“…Another crucial aspect of eradicating tungiasis in Muranga County is ensuring access to treatment and healthcare services. This includes providing affected individuals with medical care to remove the embedded sand fleas safely and treat any resulting infections [15]. Health facilities in the region should be equipped with the necessary supplies and trained personnel to manage tungiasis cases effectively [16].…”