Abstract
Tungiasis is a cutaneous parasitosis caused by an embedded female sand flea. The distribution of cases can be spatially heterogeneous even in areas with similar risk profiles. This study assesses household and remotely sensed environmental factors that contribute to the geographic distribution of tungiasis cases in a rural area along the Southern Kenyan Coast. Data on household tungiasis case status, demographic and socioeconomic information, and geographic locations were recorded during regular survey activities of the Health and Demographic Surveillance System, mainly during 2011. Data were joined with other spatial data sources using latitude/longitude coordinates. Generalized additive models were used to predict and visualize spatial risks for tungiasis. The household-level prevalence of tungiasis was 3.4% (272/7925). There was a 1.1% (461/41,135) prevalence of infection among all participants. A significant spatial variability was observed in the unadjusted model (p-value < 0.001). The number of children per household, earthen floor, organic roof, elevation, aluminum content in the soil, and distance to the nearest animal reserve attenuated the odds ratios and partially explained the spatial variation of tungiasis. Spatial heterogeneity in tungiasis risk remained even after a factor adjustment. This suggests that there are possible unmeasured factors associated with the complex ecology of sand fleas that may contribute to the disease’s uneven distribution.
Highlights
Tungiasis is a zoonotic, cutaneous parasitosis caused by the embedding of female sand fleas (Tunga spp.) into the upper strata of the skin [1]
Few studies have reported on affected populations globally, though over 20 million in the Americas and 668 million people in sub-Saharan Africa are estimated to be at risk of tungiasis [5,6]
This study aims to address spatial risks that cause a spatially heterogeneous distribution of tungiasis by considering risk factors related to demographics and socio-economy, as well as spatial ecological factors, in a tungiasis endemic area using a comprehensive, household-level tungiasis survey in a resource-poor, rural area of East Africa
Summary
Cutaneous parasitosis caused by the embedding of female sand fleas (Tunga spp.) into the upper strata of the skin [1]. Tungiasis is common to poor communities in sub-Saharan Africa, South America, and the Caribbean [2]. The female flea burrows headfirst into the upper strata of the skin. The female produces eggs, which cause the flea to expand to several times its original size, compressing and causing stress to the surrounding skin tissues. Few studies have reported on affected populations globally, though over 20 million in the Americas and 668 million people in sub-Saharan Africa are estimated to be at risk of tungiasis [5,6]
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