Tungiasis is a neglected tropical disease (NTD), meaning it does not receive adequate attention.  It is most prevalent among those living in poverty in the Caribbean, South America and the sub-Saharan region of Africa. Despite this fact, Tungiasis continues to go unaddressed in global public health agendas. Tungiasis does not get much coverage in academic circles, by community health care practitioners, public health experts, decision makers, funding organizations and pharmaceutical companies. No country, particularly in the sub-Saharan region, knows its disease burden regarding Tungiasis, which is a challenge in addressing the problem.

The What

Tungiasis is a skin disease caused by female sand fleas (Tunga penetrans), commonly called jiggers. It is a zoonosis, meaning it can be transmitted between humans and animals, particularly domestic animals such as dogs, cats and pigs. The disease occurs when the female flea burrows into the skin. The most affected areas of the human body are the feet, but the elbows, hands, knees, genitals, buttocks and periungal areas (fingers or toes) are also sites of infection.

At the acute stage, victims suffer from severe pain, itching, sleep problems, inflammation, swelling, deep fissures, ulcers and abscess development due to bacterial superinfection.  Those who suffer chronically experience protracted pain, deformity, damage to the feet, disability and eventually long-term cognitive impairment. In addition to the physical manifestations of the disease, those with Tungiasis also endure social stigma and isolation.

Tungiasis Prevalence: The Where

The prevalence of Tungiasis in Sub-Saharan Africa varies by location.  The disease primarily affects children and elderly people in every country within the Sub-Saharan region of Africa.  The prevalent rates of infection in each country are as follows: 

• Ethiopia: 46.5%
• Cameroon: 44.9%
• Tanzania: 42.0%
• Kenya: 37.2%
• Nigeria: 28.1%
• Rwanda: 22.7%
• Uganda: 20.1% 

These rates are averages, but some areas within these countries show higher prevalence. For example, northeastern Uganda recorded a prevalence rate of 62.8%.

Ongoing Efforts: The How

Risk factors for contracting Tungiasis include poverty, poor hygiene, lack of sealed flooring, mud/earthen housing, rearing of domestic animals, and walking barefoot. Home remedies attempted include manual extractions with non-sterile sharp instruments, which cause inflammation, significant pain, bleeding, open wounds and a high risk of bacterial and viral infections. Other methods include the use of motor oil, tobacco, naphthalene, kerosene and hydrogen peroxide. None of these methods is effective, and all are dangerous.

The most recommended treatment for Tungiasis is the use of low-viscosity Dimeticone. It is the most effective and works in mild and severe cases. Another effective treatment is the combination of coconut and neem oil. However, it is not as effective as Dimeticone and requires more application to the affected area.

Innovations for Tropical Disease Elimination (IFOTRODE), a humanitarian organization based in Uganda, carried out a two-year study in the country’s northeast. The study included quarterly detection and treatment efforts. People and animals received treatment with Dimeticone oil, and the team also organized community health promotions through local dialogues. During the study, health workers diagnosed and treated 12,540 cases. As a result, the prevalence of tungiasis in the area dropped from 62.8% to 5.7%. It appears researchers have discovered the formula required to reduce and even possibly eradicate Tungiasis.

Looking Ahead

The success of community-based efforts in Uganda shows that the right tools and attention can dramatically reduce tungiasis. Expanding access to effective treatments like dimeticone, investing in public health education, and strengthening global awareness will help eliminate the disease. With continued innovation and support, communities can achieve the goal of ending the suffering caused by tungiasis in Sub-Saharan Africa.

– Danielle Milano

Danielle is based in Pineville, LA, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr