Date Published: December 5, 2007
Publisher: Public Library of Science
Author(s): Uade Samuel Ugbomoiko, Liana Ariza, Ifeanyi Emmanuel Ofoezie, Jörg Heukelbach, Helton Santiago
Abstract: BackgroundThe parasitic skin disease tungiasis (caused by the flea Tunga penetrans) affects resource-poor communities in Latin America, the Caribbean and sub-Saharan Africa. Prevalences in endemic areas are high, and severe pathology occurs commonly. However, risk factors for infestation have never been assessed in Africa.Methods and FindingsA cross-sectional study was conducted in Erekiti, a rural community in Lagos State (Nigeria), where tungiasis is endemic. Individuals were examined clinically for the presence of tungiasis, and a questionnaire was applied. Data from 643 individuals (86.6% of the target population) were analyzed; 252 (42.5%) were infested with T. penetrans. In the multivariate logistic regression analysis, presence of pigs on the compounds (adjusted odds ratio = 17.98; 95% confidence interval: 5.55–58.23), sand or clay floor inside houses (9.33; 5.06–17.19), and having the common resting place outside the house (7.14; 4.0–14.29) were the most important risk factors identified. The regular use of closed footwear (0.34; 0.18–0.62) and the use of insecticides indoors (0.2; 0.05–0.83) were protective against infestation. The population attributable fractions associated with tungiasis were: sand or clay floor inside the house (73.7%), resting usually outside the house (65.5%), no regular use of closed footwear (51.1%), and pigs on the compound (37.9%).ConclusionThe presence of tungiasis in Erekiti is determined to an important extent by a limited number of modifiable variables. Effective and sustainable intervention measures addressing these factors need to be implemented in this and other West African communities with high disease burden.
Partial Text: The parasitic skin disease tungiasis is caused by the permanent penetration of the female sand flea Tunga penetrans into the epidermis of its host. After penetration, the female undergoes a hypertrophy and reaches the size of a pea. Tungiasis has many features of a neglected tropical disease and thus can be considered as a paradigm: it is endemic in poor communities and rural areas, it is associated with stigma, and there is no commercial market for products targeting the disease –. The disease only sporadically affects travelers to endemic areas in South America and Africa, whereas people living in local communities commonly suffer from severe infestation and associated pathology ,. Associated pathology includes bacterial superinfection, pain, fissures hindering individuals from walking normally, as well as deformation and loss of toenails and digits , –. Tungiasis lesions have also been described to be port of entry for tetanus infection ,,.
Of the 643 individuals of the target population, 557 (86.6%) were encountered and participated in the study. This represents 45.2% of the total population of the community. Of the participants, 299 (53.7%) were male and 258 (46.3%) female. Illiteracy rate was high (n = 445; 77.2%), and 100 individuals (56.5%) of the adult working population had a mean monthly income