Dataset Information

Controlling tungiasis in an impoverished community: an intervention study.

ABSTRACT:

Background

In Brazil, tungiasis is endemic in some resource-poor communities where various domestic and sylvatic animals act as reservoirs for this zoonosis. To determine the effect of control measures on the prevalence and intensity of infestation of human and animal tungiasis, a repeated cross-sectional survey with intervention was carried out.

Methodology/principal findings

In a traditional fishing community in Northeast Brazil, humans and reservoir animals were treated, and premise-spraying using an insecticide was done, while a second fishing community served as a control. Both communities were followed up 10 times during a 12-month period. At baseline, prevalence of tungiasis was 43% (95% confidence interval [CI]: 35%-51%) and 37% (95% CI: 31%-43%) in control and intervention villages, respectively. During the study, prevalence of tungiasis dropped to 10% (95% CI: 8%-13%; p<0.001) in the intervention village, while the prevalence remained at a high level in the control village. However, after one year, at the end of the study, in both communities the prevalence of the infestation had reached pre-intervention levels. Whereas the intensity of infestation was significantly reduced in the intervention community (p<0.001), and remained low at the end of the study (p<0.001), it did not change in the control village.

Conclusion/significance

Our study shows that a reduction of prevalence and intensity of infestation is possible, but in impoverished communities a long-lasting reduction of disease occurrence can only be achieved by the regular treatment of infested humans, the elimination of animal reservoirs, and, likely, through environmental changes.

Trial registration

Controlled-Trials.com ISRCTN27670575.

SUBMITTER: Pilger D

PROVIDER: S-EPMC2565488 | biostudies-literature | 2008

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Controlling tungiasis in an impoverished community: an intervention study.

Pilger Daniel D Schwalfenberg Stefan S Heukelbach Jörg J Witt Lars L Mencke Norbert N Khakban Adak A Feldmeier Hermann H

PLoS neglected tropical diseases 20081022 10

<h4>Background</h4>In Brazil, tungiasis is endemic in some resource-poor communities where various domestic and sylvatic animals act as reservoirs for this zoonosis. To determine the effect of control measures on the prevalence and intensity of infestation of human and animal tungiasis, a repeated cross-sectional survey with intervention was carried out.<h4>Methodology/principal findings</h4>In a traditional fishing community in Northeast Brazil, humans and reservoir animals were treated, and pr ...[more]

PMID: 18941513

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Project description:BackgroundTungiasis is a neglected tropical disease caused by female sand fleas (Tunga penetrans) embedded in the skin. The disease is associated with important morbidity. Tungiasis is endemic along the Coast of Kenya with a prevalence ranging from 11% to 50% in school-age children. Hitherto, studies on epidemiological characteristics of tungiasis in Africa are scanty.MethodsIn a cross-sectional study 1,086 individuals from 233 households in eight villages located in Kakuyuni and Malanga Sub-locations, Kilifi County, on the Kenyan Coast, were investigated. Study participants were examined systematically and the presence and severity of tungiasis were determined using standard methods. Demographic, socio-economic, environmental and behavioral risk factors of tungiasis were assessed using a structured questionnaire. Data were analyzed using bivariate and multivariate regression analysis.ResultsThe overall prevalence of tungiasis was 25.0% (95% CI 22.4-27.5%). Age-specific prevalence followed an S-shaped curve, peaking in the under-15 year old group. In 42.5% of the households at least one individual had tungiasis. 15.1% of patients were severely infected (≥ 30 lesions). In the bivariate analysis no specific animal species was identified as a risk factor for tungiasis. Multivariate analysis showed that the occurrence of tungiasis was related to living in a house with poor construction characteristics, such as mud walls (OR 3.35; 95% CI 1.71-6.58), sleeping directly on the floor (OR 1.68; 95% CI 1.03-2.74), the number of people per sleeping room (OR = 1.77; 95% CI 1.07-2.93) and washing the body without soap (OR = 7.36; 95% CI 3.08-17.62). The odds of having severe tungiasis were high in males (OR 2.29; 95% CI 1.18-44.6) and were very high when only mud puddles were available as a water source and lack of water permitted washing only once a day (OR 25.48 (95% CI 3.50-185.67) and OR 2.23 (95% CI 1.11-4.51), respectively).ConclusionsThe results of this study show that in rural Kenya characteristics of poverty determine the occurrence and the severity of tungiasis. Intra-domiciliary transmission seems to occur regularly.

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Project description:BackgroundTungiasis, a parasitic skin disease caused by the female sand flea Tunga penetrans, is a prevalent condition in impoverished communities in the tropics. In this setting, the ectoparasitosis is associated with important morbidity. It causes disfigurement and mutilation of the feet. Feasible and effective treatment is not available. So far prevention is the only means to control tungiasis-associated morbidity.MethodologyIn two villages in Central Madagascar, we assessed the efficacy of the availability of closed shoes and the twice-daily application of a plant-based repellent active against sand fleas (Zanzarin) in comparison to a control group without intervention. The study population was randomized into three groups: shoe group, repellent group and control group and monitored for ten weeks. The intensity of infestation, the attack rate and the severity of tungiasis-associated morbidity were assessed every two weeks.FindingsIn the repellent group, the median attack rate became zero already after two weeks. The intensity of the infestation decreased constantly during the observation period and tungiasis-associated morbidity was lowered to an insignificant level. In the shoe group, only a marginal decrease in the intensity of infestation and in the attack rate was observed. At week 10, the intensity of infestation, the attack rate and the severity score for acute tungiasis remained significantly higher in the shoe group than in the repellent group. Per protocol analysis showed that the protective effect of shoes was closely related to the regularity with which shoes were worn.ConclusionsAlthough shoes were requested by the villagers and wearing shoes was encouraged by the investigators at the beginning of the study, the availability of shoes only marginally influenced the attack rate of female sand fleas. The twice-daily application of a plant-based repellent active against sand fleas reduced the attack to zero and lowered tungiasis-associated morbidity to an insignificant level.

Dataset Information

Controlling tungiasis in an impoverished community: an intervention study.

Background

Methodology/principal findings

Conclusion/significance

Trial registration

Publications

Controlling tungiasis in an impoverished community: an intervention study.

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