Research Article: Risk Factors for Tungiasis in Nigeria: Identification of Targets for Effective Intervention

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 [1]–[3]. 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 [4],[5]. Associated pathology includes bacterial superinfection, pain, fissures hindering individuals from walking normally, as well as deformation and loss of toenails and digits [1], [6]–[8]. Tungiasis lesions have also been described to be port of entry for tetanus infection [7],[9],[10].

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


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