Kilifi, Muranga, Kajiado, Nakuru and Samburu counties leads in high prevalence of Tungiasis (jiggers) in Kenya, A new study in nine counties has revealed. The national country prevalence of Tungiasis is 1.1 percent with Taita Taveta county having the lowest prevalence.
The study selected counties to cover major climate zones and cultures of Kenya, with a total of 17,432 children between the age of 8-14 years estimated to be infected by jiggers in the 9 counties, with Muranga having 3,920 and 3,712 in Nakuru county.
The study was conducted between May 2021 and June 2022.
According to Lynne Elson, a research fellow with Oxford University and KEMRI -Wellcome Trust in Kenya who presented the study, children under 15 years carry the highest burden, with prevalence in schools in this study ranging between 0 percent to 25 percent.
“Previously little was known of the actual disease burden and its distribution in Kenya nor the ecology of off-host stages or the physical, social or economic environment linking the human, domestic animal and sylvatic animal cycle.”
The study revealed that Jiggers infection is associated with male sex, public schools and having another skin disease. Among 605 pupils interviewed, jiggers were negatively associated with socio-economic status, with never using soap to wash their feet, and not sleeping under a bed net.
A study presented by Berrick Otieno also of KEMRI -Wellcome Trust demonstrated infection in children was associated with several caregiver characteristics including their mental health status.
The researchers recommended economic support to those affected and with daily use of soap for foot washing among boys and possibly use of bed nets in an integrated approach to control multiple diseases.
The study and the one presented by Berrick Otieno confirmed that jiggers has a considerable impact on children’s lives, their cognitive development, academic achievement and likely future earning potential.
“Children with severe jigger infestation had a higher impact on their quality of life than those with mild disease,” the researchers said adding that “they expressed higher levels of shame, anger, difficulty concentrating in school, sleeping and walking.”
There has been little research conducted on Tungiasis globally compared to other parasitic diseases hampering development of effective disease prevention and control measures. It affects mostly children of school age, the elderly and disabled people.
The studies were presented at the Frontiers in Tungiasis research symposium presented at the just concluded 13 KEMRI Annual Scientific and Health Conference (13th KASH). This symposium was jointly organized by scientists from the KEMRI-Wellcome Trust and the International Centre of Insect Physiology and Ecology (icipe).
Tungiasis which is a neglected tropical skin disease caused by a sand flea which is known scientifically as Tunga penetrans. The adult female burrows into the skin, mostly of people’s feet but also their hands. The larvae develop in the soil, mostly inside houses with an unsealed earthen floor. It is found very widely throughout Sub-Saharan Africa as well as Central and South America. Tungiasis results in significant morbidity, manifesting itself in a number of symptoms such as severe local inflammation, auto-amputation of digits, deformation and loss of nails, formation of fissures and ulcers, gangrene and walking difficulties. Many people have been suffering from jigger infestation in silence because of stigma and discrimination they face because of lack of information.
According to another study presented by Nelson Ouma titled ‘prevalence and spatial distribution of Tungiasis in Kilifi health demographic surveillance system, ‘most common factors that are seen to aggravate Tungiasis include poor housing conditions with household with earthen floors positively associated with Tungiasis. The study points out that prevalence is highest in Banda ra salama, Ziani, Junju and Chasimba sub-locations in Kilifi county.
While Kana Suzuki of Nagasaki University found that severe cases (more than 20 fleas per person), was high in elderly persons, however, there were many cases in children.
Her study titled ‘mid-term report from JICA grassroot project: sustainable Tungiasis control in Homabay county’ revealed that lack of reporting tools is a big challenge to sustain reporting of new cases.
Jurgen Krucken, parasitologist from the University Berlin, presented his study on Animal tungiasis and Tunga penetrans-associated bacteria in Uganda and Kenya and revealed that jiggers can cause severe diseases in domestic animals possibly impacting their economic value and these can also be reservoir for the parasites. “Tungiasis (jiggers) in domestic animals is clinically similar to human disease but this is poorly known in endemic areas”.
Abneel Matharu a PhD student at icipe found the insect growth regulator, pyripoxifen, was able to interrupt the life cycle of the fleas when applied to the earthen floors and reduced the number of people infected, potentially providing a novel tool for disease control.
Among policy makers, health officials and the wider population the jigger flea is not regarded as a serious threat to health and yet the studies demonstrated they have a high impact on the lives of children and the elderly. Currently, there is no well-known or effective treatment available.