Morbidity, Risk Factors, And Flea Species Responsible For Tungiasis In Selected Villages In Kisumu County, Kenya

ABSTRACT

Tungiasis is a neglected disease that afflicts four million Kenyans. To control its spread, there is a high demand for sustainable disease control strategies in rural endemic areas. The objective of this study was to determine the prevalence of tungiasis, associated risk factors, and the species of fleas causing it in rural western Kenya. A crossectional study was done in Otwenya Location, Maseno Division between August and September 2013. Seventy eight (78) randomly selected households were visited all household members (415) checked for tungiasis. Structured questionnaires were used to collect demographic and environmental data from household heads, neosomic and free-living fleas collected in houses and characterised using taxonomy and Polymerase Chain Reaction (PCR). Data analysis was done using the Statistical Package for Social Scientists (SPSS) version 17. Means and frequencies were calculated and the Fishers exact test and logistic regression with backward elimination used to identify risk factors for tungiasis. Tests for statistical significance were done at 95% confidence interval (CI). Participants were between 1 and 83 years old (females (52.8%) and males (47.2%)). In 39.7% of households, at least one case of tungiasis was found. The overall prevalence was 19.5%, peaking among 5-9 years olds (37.7%) and the elderly (60+ years) (43.8%). Tungiasis cases had between one and 53 lesions. The mean parasite load was 8.3 (males (9.6±1.6) and females (6.5±0.98), with pathological manifestations for tungiasis such as deformed toenails identified on 71.6% of cases. Approximately 19.8% had signs of bacterial infections. Living in houses with sandy flooring was a major risk factor for tungiasis (OR=11.1, p=0.01). Living in houses with animals such as dogs and cattle (OR=22.8, p=0.01) and Overcrowding in houses (OR=3.5, p=0.04) were other risk factors for the disease. Stigma and negligence played a major role in the establishment and proliferation of tungiasis in the study area. Diverse species of fleas were trapped in study houses. However, Tunga penetrans was the only species causing tungiasis. Otwenya Location is a tungiasis endemic area. Sensitisation of residents on its control, developing outreach programs that dispel negligence and stigma, and eliminating modifiable risk factors in homes can help to lower its burden in the area.