Background: Tungiasis is a skin infestation caused by the female sand flea called Tunga penetrans. Associated with a significant morbidity, this ectoparasite is present in all tropical regions, such as Gabon. Unfortun...Background: Tungiasis is a skin infestation caused by the female sand flea called Tunga penetrans. Associated with a significant morbidity, this ectoparasite is present in all tropical regions, such as Gabon. Unfortunately, in this country, no study has ever been undertaken on this disease. However, in both urban and rural areas of this country, it causes disfigurement and mutilation of the feet or hands in infested persons, and is sometimes responsible for the school dropout of many children. It is in this context that this timely and relevant research was conducted to assess the prevalence and risk factors associated with Tungiasis in school-aged children in the city of Port Gentil, Ogooué-Maritime province, Gabon in Central Africa. Materials and Methods: This prospective and cross-sectional study took place from May 22 to August 18, 2022, in two popular and underprivileged neighborhoods of the city of Port Gentil. It consisted of a physical diagnosis of the participants, and with the help of a questionnaire submitted to their parents/guardians, numerous data were collected. Entered into an Excel 2016 spreadsheet, the data were exported to the R software in its R Commander interface, for two types of analyses. A univariate and a multivariate analysis, using logistic regression, first on socio-demographic characteristics and then on habitual and environmental behavioral characteristics, was performed and the variables in this analysis reported odds ratios and their 95% confidence intervals. The results were statistically significant at p Results: A total of 637 school-aged children with a mean age of 12.73 years and a standard deviation of 5.44, were registered and examined for this study. Among them, Tunga penetrans infestation was found in 242 children, indicating an overall prevalence of 37.99% (95% CI [0.34 - 0.41]). Univariate and multivariate analyses, using logistic regression, first according to socio-demographic characteristics and then according to risk factors indicated that, the age groups of 5 to 9 years (Adjusted Odds Ratio = 9.27;95% CI: [6.66 - 12. 91]) and 10 - 14 years (Adjusted Odds Ratio = 0.16;95% CI: [0.10 - 0.25]), Eshira ethnicity (Adjusted Odds Ratio = 7.46;95% CI: [2.97 - 18.76]), child’s primary education level (Adjusted Odds Ratio = 0.008;95% CI: [0.006 - 0.011]), Father’s/Guardian’s education level (Adjusted Odds Ratio = 0.22;95% CI: [0.13 - 0.35]), homemaker status (Adjusted Odds Ratio = 4.89;95% CI: [3.51 - 6. 79]) and risk factors such as: promiscuity with dogs, cats or other animals around the house (Adjusted Odds Ratio = 38.30;95% CI: [22.13 - 66.26]), wearing shoes a few times (Adjusted Odds Ratio = 0.02;95% CI [0.01 - 0.03]), walking sometimes barefoot, on land or sand (Adjusted Odds Ratio = 0.28;95% CI: [0.18 - 0.42]), having other sources of water consumed than the tap (Adjusted Odds Ratio = 0.25;95% CI: [0.16 - 037]), living in a dwelling with soil or sand (Adjusted Odds Ratio = 6.8;95% CI: [4.58 - 10.09]), having average housing conditions (Adjusted Odds Ratio = 46.8;95% CI [24.29 - 90.16]), and the number of people living in the family that was greater than or equal to 6 (Adjusted Odds Ratio = 0.1;95% CI [0.07 - 0.13]), were significantly associated with the prevalence of Tungiasis. Conclusion: The results of this study will inform control programs and water and sanitation interventions for the Tunga penetrans epidemic in Port Gentil, Gabon.展开更多
Background Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans.Female fleas penetrate the skin,particularly at the feet,and cause severe inflammation.This study aimed to characterize...Background Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans.Female fleas penetrate the skin,particularly at the feet,and cause severe inflammation.This study aimed to characterize disease burden in two highly affected regions in Kenya,to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping,targeting,and monitoring interventions.Methods From February 2020 to April 2021,3532 pupils age 8–14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms.Of the infected pupils,266 were quasi-randomly selected and their households visited,where an additional 1138 family members were examined.Inflammation was assessed using infra-red thermography.A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots.Results The overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3%[95%confidence interval(CI):8.4–10.3].Based on mixed effects logistic models,the odds of infection with tungiasis among school pupils was three times higher in Kwale(coastal Kenya)than in Siaya[western Kenya;adjusted odds ratio(aOR)=0.36,95%CI:0.18–0.74];three times higher in males than in females(aOR=3.0,95%CI:2.32–3.91)and three times lower among pupils sleeping in a house with a concrete floor(aOR=0.32,95%CI:0.24–0.44).The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third(aOR=0.32,95%CI:0.19–0.53)of that when schools were closed due to COVID-19 restrictions and approximately half(aOR=0.44,95%CI:0.29–0.68)in surveys done after school re-opening(round 3).Infection intensity was positively correlated with inflammation as measured by thermography(Spearman’s rho=0.68,P<0.001)and with the clinical score(rho=0.86,P<0.001).Based on the two-level classification,severe cases were associated with a threefold higher level of pain(OR=2.99,95%CI:2.02–4.43)and itching(OR=3.31,95%CI:2.24–4.89)than mild cases.Conclusions Thermography was a valuable addition for assessing morbidity and the proposed two-level classification of disease severity clearly separated patients with mild and severe impacts.The burden of tungiasis was considerably higher in households surveyed during COVID-19 restrictions suggesting underlying risks are found in the home environment more than in school.展开更多
Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like ...Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis.Pathophysiology of tungiasis suggests it could detrimentally afect cognition and behaviour.This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis.Methods This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda.The participants were stratifed into infected and uninfected based on the presence of tungiasis.The infected were further classifed into mild and severe infection groups based on the intensity of the infection.Adapted,validated,and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data.Statistical tests including a multilevel,generalized mixed-efects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes.Results When adjusted for covariates,mild infection was associated with lower scores in literacy[adjustedβ(aβ)=−8.9;95%confdence interval(CI)−17.2,−0.6],language(aβ=−1.7;95%CI−3.2,−0.3),cognitive fexibility(aβ=−6.1;95%CI−10.4,−1.7)and working memory(aβ=−0.3;95%CI−0.6,−0.1).Severe infection was associated with lower scores in literacy(aβ=−11.0;95%CI−19.3,−2.8),response inhibition,(aβ=−2.2;95%CI−4.2,−0.2),fne motor control(aβ=−0.7;95%CI−1.1,−0.4)and numeracy(aβ=−3;95%CI−5.5,−0.4).Conclusions This study provides frst evidence that tungiasis is associated with poor neurocognitive functioning in children.Since tungiasis is a chronic disease with frequent reinfections,such negative efects may potentially impair their development and life achievements.展开更多
Background Tungiasis is a highly neglected tropical skin disease caused by the sand flea,Tunga penetrans,the female of which burrows into the skin,causing pain and itching.The disease occurs throughout South America a...Background Tungiasis is a highly neglected tropical skin disease caused by the sand flea,Tunga penetrans,the female of which burrows into the skin,causing pain and itching.The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens.The tungiasis research community is keen to develop survey methods to fill this gap.Here we used a school-based,thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya.Methods We conducted the first nationally representative survey of tungiasis,including nine counties covering the major ecological zones of Kenya.A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school.Pupils were examined thoroughly for tungiasis.Two surveys were conducted,the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors.Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect.Results The overall prevalence of tungiasis in the first survey was 1.35%[95%confidence interval(CI):1.15-1.59%],and 0.89%in the second survey.The prevalence ranged from 0.08%(95%CI:0.01-0.59%)in Taita Taveta county to 3.24%(95%CI:2.35-4.44%)in Kajiado county.Tungiasis infection was associated with county of residence,male sex[adjusted odds ratio(aOR)=2.01,95%CI:1.52-2.67],and lower age(aOR=0.81,95%CI:0.75-0.88).For the first time we demonstrate an association with attending public schools rather than private schools(aOR=5.62,95%CI:1.20-26.22)and lower socioeconomic status(aOR=0.10,95%CI:0.03-0.33).Using a rapid screening method of the top of feet only,would have missed 62.9%of all cases,78.9%of mild cases and 20.0%of severe cases.Conclusions Tungiasis is widely but heterogeneously distributed across Kenya.School-based surveys offer an efficient strategy for mapping tungiasis distribution.展开更多
文摘Background: Tungiasis is a skin infestation caused by the female sand flea called Tunga penetrans. Associated with a significant morbidity, this ectoparasite is present in all tropical regions, such as Gabon. Unfortunately, in this country, no study has ever been undertaken on this disease. However, in both urban and rural areas of this country, it causes disfigurement and mutilation of the feet or hands in infested persons, and is sometimes responsible for the school dropout of many children. It is in this context that this timely and relevant research was conducted to assess the prevalence and risk factors associated with Tungiasis in school-aged children in the city of Port Gentil, Ogooué-Maritime province, Gabon in Central Africa. Materials and Methods: This prospective and cross-sectional study took place from May 22 to August 18, 2022, in two popular and underprivileged neighborhoods of the city of Port Gentil. It consisted of a physical diagnosis of the participants, and with the help of a questionnaire submitted to their parents/guardians, numerous data were collected. Entered into an Excel 2016 spreadsheet, the data were exported to the R software in its R Commander interface, for two types of analyses. A univariate and a multivariate analysis, using logistic regression, first on socio-demographic characteristics and then on habitual and environmental behavioral characteristics, was performed and the variables in this analysis reported odds ratios and their 95% confidence intervals. The results were statistically significant at p Results: A total of 637 school-aged children with a mean age of 12.73 years and a standard deviation of 5.44, were registered and examined for this study. Among them, Tunga penetrans infestation was found in 242 children, indicating an overall prevalence of 37.99% (95% CI [0.34 - 0.41]). Univariate and multivariate analyses, using logistic regression, first according to socio-demographic characteristics and then according to risk factors indicated that, the age groups of 5 to 9 years (Adjusted Odds Ratio = 9.27;95% CI: [6.66 - 12. 91]) and 10 - 14 years (Adjusted Odds Ratio = 0.16;95% CI: [0.10 - 0.25]), Eshira ethnicity (Adjusted Odds Ratio = 7.46;95% CI: [2.97 - 18.76]), child’s primary education level (Adjusted Odds Ratio = 0.008;95% CI: [0.006 - 0.011]), Father’s/Guardian’s education level (Adjusted Odds Ratio = 0.22;95% CI: [0.13 - 0.35]), homemaker status (Adjusted Odds Ratio = 4.89;95% CI: [3.51 - 6. 79]) and risk factors such as: promiscuity with dogs, cats or other animals around the house (Adjusted Odds Ratio = 38.30;95% CI: [22.13 - 66.26]), wearing shoes a few times (Adjusted Odds Ratio = 0.02;95% CI [0.01 - 0.03]), walking sometimes barefoot, on land or sand (Adjusted Odds Ratio = 0.28;95% CI: [0.18 - 0.42]), having other sources of water consumed than the tap (Adjusted Odds Ratio = 0.25;95% CI: [0.16 - 037]), living in a dwelling with soil or sand (Adjusted Odds Ratio = 6.8;95% CI: [4.58 - 10.09]), having average housing conditions (Adjusted Odds Ratio = 46.8;95% CI [24.29 - 90.16]), and the number of people living in the family that was greater than or equal to 6 (Adjusted Odds Ratio = 0.1;95% CI [0.07 - 0.13]), were significantly associated with the prevalence of Tungiasis. Conclusion: The results of this study will inform control programs and water and sanitation interventions for the Tunga penetrans epidemic in Port Gentil, Gabon.
文摘Background Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans.Female fleas penetrate the skin,particularly at the feet,and cause severe inflammation.This study aimed to characterize disease burden in two highly affected regions in Kenya,to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping,targeting,and monitoring interventions.Methods From February 2020 to April 2021,3532 pupils age 8–14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms.Of the infected pupils,266 were quasi-randomly selected and their households visited,where an additional 1138 family members were examined.Inflammation was assessed using infra-red thermography.A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots.Results The overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3%[95%confidence interval(CI):8.4–10.3].Based on mixed effects logistic models,the odds of infection with tungiasis among school pupils was three times higher in Kwale(coastal Kenya)than in Siaya[western Kenya;adjusted odds ratio(aOR)=0.36,95%CI:0.18–0.74];three times higher in males than in females(aOR=3.0,95%CI:2.32–3.91)and three times lower among pupils sleeping in a house with a concrete floor(aOR=0.32,95%CI:0.24–0.44).The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third(aOR=0.32,95%CI:0.19–0.53)of that when schools were closed due to COVID-19 restrictions and approximately half(aOR=0.44,95%CI:0.29–0.68)in surveys done after school re-opening(round 3).Infection intensity was positively correlated with inflammation as measured by thermography(Spearman’s rho=0.68,P<0.001)and with the clinical score(rho=0.86,P<0.001).Based on the two-level classification,severe cases were associated with a threefold higher level of pain(OR=2.99,95%CI:2.02–4.43)and itching(OR=3.31,95%CI:2.24–4.89)than mild cases.Conclusions Thermography was a valuable addition for assessing morbidity and the proposed two-level classification of disease severity clearly separated patients with mild and severe impacts.The burden of tungiasis was considerably higher in households surveyed during COVID-19 restrictions suggesting underlying risks are found in the home environment more than in school.
基金funded by the German Research Foundation(DFG)through the project"Tungiasis in East-Africa-an interdisciplinary approach to understanding the interactions between parasite and host"(project number 405027164KR 2245/7-1)to Jürgen Krücken,Amina Abubakar,Ulrike Fillinger,and Charles Waiswa.
文摘Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis.Pathophysiology of tungiasis suggests it could detrimentally afect cognition and behaviour.This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis.Methods This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda.The participants were stratifed into infected and uninfected based on the presence of tungiasis.The infected were further classifed into mild and severe infection groups based on the intensity of the infection.Adapted,validated,and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data.Statistical tests including a multilevel,generalized mixed-efects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes.Results When adjusted for covariates,mild infection was associated with lower scores in literacy[adjustedβ(aβ)=−8.9;95%confdence interval(CI)−17.2,−0.6],language(aβ=−1.7;95%CI−3.2,−0.3),cognitive fexibility(aβ=−6.1;95%CI−10.4,−1.7)and working memory(aβ=−0.3;95%CI−0.6,−0.1).Severe infection was associated with lower scores in literacy(aβ=−11.0;95%CI−19.3,−2.8),response inhibition,(aβ=−2.2;95%CI−4.2,−0.2),fne motor control(aβ=−0.7;95%CI−1.1,−0.4)and numeracy(aβ=−3;95%CI−5.5,−0.4).Conclusions This study provides frst evidence that tungiasis is associated with poor neurocognitive functioning in children.Since tungiasis is a chronic disease with frequent reinfections,such negative efects may potentially impair their development and life achievements.
文摘Background Tungiasis is a highly neglected tropical skin disease caused by the sand flea,Tunga penetrans,the female of which burrows into the skin,causing pain and itching.The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens.The tungiasis research community is keen to develop survey methods to fill this gap.Here we used a school-based,thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya.Methods We conducted the first nationally representative survey of tungiasis,including nine counties covering the major ecological zones of Kenya.A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school.Pupils were examined thoroughly for tungiasis.Two surveys were conducted,the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors.Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect.Results The overall prevalence of tungiasis in the first survey was 1.35%[95%confidence interval(CI):1.15-1.59%],and 0.89%in the second survey.The prevalence ranged from 0.08%(95%CI:0.01-0.59%)in Taita Taveta county to 3.24%(95%CI:2.35-4.44%)in Kajiado county.Tungiasis infection was associated with county of residence,male sex[adjusted odds ratio(aOR)=2.01,95%CI:1.52-2.67],and lower age(aOR=0.81,95%CI:0.75-0.88).For the first time we demonstrate an association with attending public schools rather than private schools(aOR=5.62,95%CI:1.20-26.22)and lower socioeconomic status(aOR=0.10,95%CI:0.03-0.33).Using a rapid screening method of the top of feet only,would have missed 62.9%of all cases,78.9%of mild cases and 20.0%of severe cases.Conclusions Tungiasis is widely but heterogeneously distributed across Kenya.School-based surveys offer an efficient strategy for mapping tungiasis distribution.
