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

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.

Tungiasis Stigma and Control Practices in a Hyperendemic Region in Northeastern Uganda

“…The high prevalence of tungiasis infection (61.0%) among the interviewed household caretakers corresponds with the prevalence of 62.8% among the overall population in our study area in Napak district, northeastern Uganda [15]. Tungiasis is known to be endemic in Uganda, especially in rural communities in Eastern regions, where a study found that in 22.5% of households, tungiasis infection was present in at least one household member [46].…”

“…Population-based studies have shown high prevalence of tungiasis, for example, 25% in rural Kenya [4], 45% in rural Nigeria [11], and 43% in Brazilian fishing villages [12], and very severe cases with hundreds of sand fleas have been described in Tanzania, Colombia, and Madagascar [2,13,14]. In Napak District, rural northeastern Uganda, our study team recently found extremely high tungiasis prevalence of 62.8% [15]. Despite its endemic presence in many countries, tungiasis has been neglected by healthcare professionals and researchers alike [1,16].…”

“…In a fact-finding pilot study in November 2020, our team confirmed that tungiasis was highly prevalent in the three parishes, using rapid assessment for tungiasis [34] in 11 villages. The pilot study showed a tungiasis prevalence of 68.5% (n = 456) among 666 examined individuals [15].…”

“…This study took place during the initial phase of a two-year long tungiasis control intervention project (2021/2022), the results of which are published elsewhere in this issue [15]. The larger intervention aimed at eliminating tungiasis as a public health problem in the area and included regular screening of the population for tungiasis; treatment of cases with a mixture of two dimeticone oils (NYDA ® ); and tungiasis-related health education and community engagement in Napak District, Uganda.…”

“…The total population of the 17 villages in our study area was 5482 individuals during the project's baseline evaluation in February/March 2021 [15]. They belong to the semi-nomadic Karamojong ethnic group living in small villages which were further compartmentalized into manyatas, groups of houses surrounded by stick fences as protection against wild animals and animal raiders.…”