Risk factors for tungiasis in Nigeria: Identification of targets for effective intervention

Abstract

Background: The 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 Findings: A 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 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 day 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 used of closed footwear (0.34; 0.18-0.62) and the use of insecticides indoor (0.2; 0.05-0.83) were protective against infestation. The population attributable fractions associated with tungiasis were: sand or day 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%). Conclusion: The presence of tungiasis in Erekiti is determined to an important extent by a limited number of variables. Effective and sustainable intervention measures addressing these factors need to be implemented in this and other West African communities with high disease burden. © 2007 Ugbomoiko et al.