The authors have declared that no competing interests exist.
Background: Tungiasis is a parasitic tropical disease caused by female
Methods: A descriptive cross sectional design and utilizing quantitative data collection method. Simple random sampling technique was applied to select the participants. Quantitative data was collected through a pretested structured questionnaire. The data was keyed-into excel and analyzed using SPSS version 23.
Results: Study findings indicate that majority of the pupils infested with tungiasis were in classes 5 – 6 at 191(49%). Male participants were 200 (51%), while 185(49%) were female. Gender of pupils (χ2=4.383a, df=1, P<0.005) and household head occupation (χ2=44.729, df = 28, P<0.005) had a statistical significance with tungiasis infestation. Further significance was noted between participants who had ever heard of jiggers (χ2=6.361, df=1, P<0.005), Knowledge on important causes of jiggers (χ2=36.482, df = 9, P<0.005), mode of disease transmission (χ2=17.215, df = 5, P<0.005), signs and symptoms (χ2=4.088, df = 1, P<0.005), seriousness of jiggers in the area (χ2=13.175, df = 1, P<0.005) as well as pupil’s wearing of shoes (χ2=3.934, df = 1, P<0.005) and tungiasis infestation.
Conclusions: Study concludes that tungiasis is still a big problem in rural settings and knowledge on tungiasis infestation does not translate to prevention and control in the areas. More emphasis should be given to improving practices touching on personal hygiene and health education to increase awareness both at school and in the households.
Tungiasis is caused by the “jigger” flea
About 2.6 million Kenyans are infested with jiggers out of which 1.5 million are school going children who are physically and mentally disabled and unable to walk
Tungiasis has a focalized distribution with the disease occurring predominantly in impoverished populations. According to pilot investigations, tungiasis is highly prevalent in parts of Coast, Nyanza, Rift Valley, Western and Central regions of Kenya. However, sustainable control measures against tungiasis can only be developed if the epidemiological situation is well understood. Children are the hardest hit with a recent study estimating a point prevalence of 57% among children aged 5-12years in Murang’a South district, Kenya
The study was conducted in Ugenya Sub County in Nyanza region of Kenya. It is one of six constituencies of Siaya County. Population of 108,934
The study employed a descriptive cross- sectional design adapting both qualitative and quantitative data approaches. Studies by Ugbomoiko
Since the prevalence of tungiasis in Siaya County is not known. 50% prevalence will be used to determine the sample size. Minimum sample size will be determined using the following formula;
Where;
N = The minimum sample size
δ = The degree of precision (5%)
α = The level of significance (5%)
Z = The standard normal deviate that corresponds to 95% confidence interval
P = Estimated prevalence of Tungiasis (50%)
Therefore, N =(1.96)2× 0.50(1-0.50)/(0.05)2 = 384.16 Therefore 385 participants will be the minimum sample size.
The study adopted Multi-Stage sampling.
Pupils in the selected schools who assented to participate.
Pupils in the selected schools who did not assent to participate.
Before the onset of the study, information meetings were held with County officials in the line ministries, School committees and the Communities gatekeepers so as to sensitize on disease prevention and control, and for ownership of the process before the study commenced. Community Health Workers (CHWs) were involved from the onset of diagnosis and a pre examination on how to identify classification of jiggers was done for them and the field officers. A pretested semi structured questionnaire was conducted among 385 participants and administered in English, or the local language to the participants.
For the school based survey; interviewer administered semi-structured questionnaires were developed and used as one of the data collection tools to elicit information on the demographic data that is age, gender and class levels, behavioral that is, personal hygiene such as bathing and wearing shoes. Before administration, approximately 10% of the 385 questionnaires (38 questionnaires) were pretested by administering them to schools from an area neighboring the survey site. Revisions after pretesting were done before implementation.
Data was entered into the computer using Excel and Access. Statistical analysis was done after data validation. Data was then exported into the Statistical Package for Social Scientists (SPSS) version 23 and was analysed. Summary/descriptive statistics was used to describe the data and generate summary tables for each level-factor. Chi square tests used to test associations between variables where applicable. Results were presented in frequency distribution tables and charts. Differences between the parameters of estimate was deemed statistically significant at
The 385 respondents class distribution had 5 – 6 classes were the majority at 191(49%) while those in class 7 – 8 were 189 (48%) and respondents who were in class 3 – 4 (3%) was the least category. The clients who had ever been infested with jiggers were at 333 (85.4%). The 385 respondent’s gender distribution had 200 (51%) male and 185(49%) female. There was significant association between sex and tungiasis infestation at (χ2=4.383a, df=1, p=0.036). The age distribution of 10 - 15 category were the majority at 303 (78.3%) with 15 – 18 category at 81 (21.0%). The family size distribution of 4 -7 category had the highest respondents at 60.2%, 9 – 11 category at 121(31.3%. The household head occupation distribution the majority were farmers at 177 (47.7%) and businessmen were 44 (11.9%).Chi – Square test indicated relationship between the household head occupation and tungiasis infestation at (χ2=44.729a, df=28, p=0.023). Christians were the majority of respondent’s parents at 383(99.2%).
The 385 respondent’s gender distribution had 200 (51%) male and 185 (49%) female. There was significant association between There was significant association between gender and ever infested with jiggers at (Pearson value=4.383a, df=1, p=0.036).The clients who had ever hear of jiggers and knew breeding place a majority indicated dusty soils at 231 (62.1%), under body skin at 71 (19.1%) and the least indicated on trees at 2 (0.5%). The respondents who heard ever had of jiggers a majority indicated family at 143 (36.9%), from friends and peers at 70 (18.0%), teachers at 68 (17.5%) and the least were respondents who had from media, health worker, family friends religious leader, teachers and campaigns at 2 (0.5%). The most important cause of jiggers according to the majority of the respondents was soil at 156 (39.9%), pigs 133 (34.0%) and the least was poverty at 4 (1.0%). There is dependency between the stated important causes of jiggers and who had ever been infested with jiggers at (Pearson value=36.482a, df=9, p<0.0001). Soil was indicated by respondents as the main media for disease transmission at 113 (29.5%), Contact with infected person 109 (28.5%), through domestic animals at 74 (19.3%) and the least was Contact with infected water at 5 (1.3%). Disease transmission had a relationship with respondents who had ever been infested with jiggers at (Pearson value=17.215a, df=5, p=0.004). Itchiness was the major Signs and symptoms of disease that was indicated at 381 (99.0%) with a significant chi-square association at (Pearson value=4.088a, df=1, p=0.043). Jigger prevention method that was rated highest was washing regularly at 140 (40%), followed by wearing shoes 130 (37%) those who felt that a combination of washing regularly and wearing shoes is also a prevention strategy were 50 (14%). Jigger infestation season that had the highest proportion was dry season at 359 (92%) while those who do not know were 8 (2%). The respondents who felt that jigger was a serious problem in the area were 265 (69%) and the chi – square test indicated association between the jiggers being a serious problem and respondents who had ever been infested with jiggers at (Pearson value=13.175a, df=1, p<0.0001).
313 (80%) of the respondents indicated that they normally wear shoes to school and 261 (83.4%) among those who wore shoes to school had ever been infested with jiggers. There was a statistically significant association between wearing shoes to school and tungiasis infestation at (χ2=3.934a, df=1, P =0.047). The respondent who wore shoes to school on daily basis were 201 (56%) and those who occasionally wore were 79 (22%). 176(49%) indicated that they wear closed shoes and open shoes at 125(35%), The respondent who wash themselves on daily basis at 359 (92%), occasionally were 23 (6%).187(48%) were the respondents who often washed uniforms biweekly and 102 (26%) washed weekly and only 63 (16%) washed on daily basis. Majority of the respondents indicated that they sleep in the main house at 165 (43%) and in stand-alone kitchen were 141 (36%).
Summary of the key findings of the study indicate a positive relationship between; gender of pupils, occupation of household head, participants who had ever heard of jiggers, signs and symptoms, Seriousness of jiggers in the area, disease transmission and causes of jiggers, pupils practices like wearing of shoes significantly predict tungiasis infestation.
Study findings indicate a significant association between gender of pupils and them being infested with tungiasis. These data differences were attributed to exposure and environmental factors, rather than difference in susceptibility, thus, we speculate that gender differences are, similar to age, related to different exposure and disease-related behavior. These findings have been consistent across studies and seem to differ from community to community. Research in Cameroon and Trinidad found statistically significant differences between the sexes with which males carried higher disease burden compared to females
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Respondents class | 03-Apr | 3(30.0) | 7(70.0) | 10 | 4.177 | 2 | 0.124 |
05-Jun | 22(11.5) | 169(88.5) | 191 | ||||
07-Aug | 32(16.9) | 157(83.1) | 189 | ||||
Sex | Male | 22(10.9) | 179(89.1) | 201 | 4.383 | 1 | 0.036 |
Female | 35(18.4) | 155(81.6) | 190 | ||||
Age | 05-Sep | 0(0.0) | 2(100.0) | 2 | 1.036 | 3 | 0.793 |
Oct-15 | 47(15.4) | 259(84.6) | 306 | ||||
15 - 18 | 10(12.2) | 72(87.8) | 82 | ||||
19 and Above | 0(0.0) | 1(100.0) | 1 | ||||
Family size | 01-Mar | 4(17.4) | 19(82.6) | 23 | 2.55 | 3 | 0.466 |
04-Jul | 36(15.5) | 197 (84.5) | 233 | ||||
09-Nov | 15(12.4) | 106(87.6) | 121 | ||||
12 and Above | 3(30.0) | 7(70.0) | 10 | ||||
Household head occupation | Business | 10(20.5) | 40(79.5) | 50 | 44.729 | 28 | 0.023 |
Farmer | 22(12.4) | 155(87.6) | 177 | ||||
Formal Employment | 5(5.3) | 50(94.7) | 55 | ||||
Not working | 2(20.0) | 8(80.0) | 10 | ||||
Informal employment | 9(15.4) | 70(84.6) | 79 | ||||
Religion of the parent | Christian | 58(15.1) | 325(84.9) | 383 | 0.535 | 1 | 0.465 |
Muslim |
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Ever heard of jiggers | No | 2(66.7) | 1(33.3) | 3 | 6.361. | 1 | 0.012 | ||||||||
Yes | 56(14.5) | 329(85.5) | 385 | ||||||||||||
Jiggers breeding place | Trees | 0(0.0) | 2(100.0) | 2 | 10.827 | 5 | 0.055 | ||||||||
Water | 3(60.0) | 2(40.0) | 5 | ||||||||||||
Dusty soils | 41(13.4) | 233(86.6) | 274 | ||||||||||||
Under body skin | 11(15.5) | 60(84.5) | 71 | ||||||||||||
Other | 5(25.0) | 15(75.0) | 20 | ||||||||||||
Mode of finding information about the disease | Media | 5(36.4) | 8(63.6) | 13 | 19.222 | 12 | 0.083 | ||||||||
Health workers | 1(4.5) | 28(95.5) | 29 | ||||||||||||
Family | 18(9.1) | 142(90.9 | 160 | ||||||||||||
Friends and peers | 13(15.7) | 68(84.3) | 81 | ||||||||||||
Religious leaders | 0(0.0) | 5(100.0) | 5 | ||||||||||||
Teachers | 14(20.6) | 54(79.4) | 68 | ||||||||||||
Community baraza | 1(10.0) | 9(90.0) | 10 | ||||||||||||
Campaigns | 1(20.0) | 4(80.0) | 5 | ||||||||||||
Others | 3(17.6) | 14(82.4) | 17 | ||||||||||||
Most important cause of jiggers | Soil | 15(7.7) | 183(92.3) | 198 | 36.482 | 9 | <0.0001 | ||||||||
Chicken | 0(0.0) | 2(100.0) | 2 | ||||||||||||
Dogs | 6(20.0) | 24(80.0) | 30 | ||||||||||||
Pigs | 25(18.8%) | 108(81.2) | 133 | ||||||||||||
Other | 12(34.8%) | 16(65.2) | 28 | ||||||||||||
Disease transmission | Contact with infected water | 0(0.0) | 5(100.0) | 5 | 17.215a | 5 | 0.004 | ||||||||
From soil | 15(6.2) | 149(93.8) | 161 | ||||||||||||
Through domestic animals | 20(27.0) | 54(73.0) | 74 | ||||||||||||
Contact with infected person | 14(12.8) | 9(87.2) | 109 | ||||||||||||
Other | 5(16.1) | 26(83.9) | 31 | ||||||||||||
Seriousness of jiggers in the area | No | 28(23.1) | 93(76.9) | 121 | 13.175 | 1 | <0.0001 | ||||||||
Yes | 25(9.4) | 240(90.6) | 265 | ||||||||||||
Prevention of jiggers | Wearing shoes | 24(18.5%) | 106(81.5%) | 130 | 7.802a | 5 | 0.167 | ||||||||
Washing regularly | 13(9.3%) | 127(90.7%) | 140 | ||||||||||||
Wearing school uniform | 2(33.3%) | 4(66.7%) | 6 | ||||||||||||
Using the toilet | 1(12.5%) | 7(87.5%) | 8 | ||||||||||||
Others | 2(10.5%) | 17(89.5%) | 19 | ||||||||||||
Wearing shoes and washing regularly | 10(20.0%) | 40(80.0%) | 50 | ||||||||||||
High season of jiggers infestation | Wet | 4(19.0%) | 17(81.0%) | 21 | 2.317a | 3 | 0.509 | ||||||||
Dry | 52(14.5%) | 307(85.5%) | 359 | ||||||||||||
Don’t know | 1(12.5%) | 7(87.5%) | 8 | ||||||||||||
Wet, dry | 1(50.0%) | 1(50.0%) | 2 |
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Wearing of shoes to school | No | 6(7.7) | 72(92.3) | 78 | 3.934 | 1 | 0.047 |
Yes | 52(16.6) | 261(83.4) | 313 | ||||
58(14.8) | 333(85.2) | 391 | |||||
Frequency of wearing shoes to school | Daily basis | 31(15.4) | 170(84.6) | 201 | 3.092 | 3 | 0.378 |
Occasionally | 12(15.2) | 67(84.8) | 79 | ||||
Rarely | 10(18.5) | 44(81.5) | 54 | ||||
Other | 1(3.8) | 25(96.2) | 26 | ||||
Type of shoes worn to school | Open shoes | 19(15.2) | 106(84.8) | 125 | 4.027 | 3 | 0.259 |
Closed shoes | 29(16.5) | 147(83.5) | 176 | ||||
Sandals | 6(15.0) | 34(85.0) | 40 | ||||
Other | 0(0.0) | 21(100.0) | 21 | ||||
Frequency of washing self | Daily basis | 54(15.0) | 305(85.0) | 359 | 1.699 | 3 | 0.637 |
Occasionally | 4(17.4) | 19(82.6) | 23 | ||||
Rarely | 0(0.0) | 4(100.0) | 4 | ||||
Other | 0(0.0) | 5(100.0) | 5 | ||||
Frequency of washing uniforms | Daily basis | 16(25.4) | 47(74.6) | 63 | 6.587 | 3 | 0.086 |
Weekly | 12(11.8) | 90(88.2) | 102 | ||||
Bi weekly | 25(13.4) | 162(86.6) | 187 | ||||
Other | 5(14.3) | 30(85.7) | 35 | ||||
Part of house pupils sleep | Main house | 30(18.2) | 135(81.8) | 165 | 3.519 | 3 | 0.318 |
Stand-alone Kitchen | 17(12.1) | 124(87.9) | 141 | ||||
Extension | 11(14.7) | 64(85.3) | 75 | ||||
Other | 0(0.0) | 7(100.0) | 7 |
Current study findings reported a significance dependency between participants who had ever heard of jiggers and tungiasis infestation. This finding emphasizes the importance of education and raising awareness in the prevention and control of tungiasis
The findings indicated a positive significance with regard to knowledge, specifically on signs and symptoms and tungiasis infestation. The knowledge on early signs and symptoms should act as a trigger mechanism for the household members to take appropriate action to prevent and control infestation. Further findings revealed that Itching is the commonest symptoms. Studies by Muehlen (2005) posted that the first evidence of infestation by the sand flea is a tiny black dot on the skin at the point of penetration and then a small inflammatory papule with a central black dot forms within the next few weeks
Positive level of significance was also noted on the seriousness of jiggers as a disease in the study area. These findings are in tandem with a study by Winter
Findings revealed a positive influence on disease transmission and causes of jiggers with disease occurrence. Soil was noted as the main cause of tungiasis. A study by Heukelbach
Study findings reported level of significance between pupil’s wearing of shoes and tungiasis infestation. Pupils behaviour and practices towards a certain disease normally affects occurrence. These findings are in tandem with a study on tungiasis conducted in Brazil, which revealed that there was remarkable reduction in tungiasis when people started using shoes as opposed to sandals
Study concludes that tungiasis is still a big problem in rural settings and Knowledge on tungiasis infestation does not translate to prevention and control in the areas. More emphasis should be given to improving practices touching on personal hygiene and health education to increase awareness both at school and in the households.
Since it was a Cross-Sectional study, it was therefore difficult to infer causality.
This study was approved by the KEMRI Ethical Review Committee (SSC/ERC protocol No. (KEMRI/SERU/ESACIPAC/P003/353). The study used questionnaires uniquely coded with results of each questionnaire being kept in strict confidence. Participating in the study was voluntary and one could withdraw at any point. The purpose of the study and its objectives were explained to local authorities, opinion leaders, head teachers, and community members. Informed consent and assent was obtained from the participating respondents in writing. Parental consent was obtained for participants under 16. Subjects were assured about confidentiality of information obtained from them and personal identifiers were removed from the data set before analysis.
Not applicable
That all data used in the manuscript is available for sharing; including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes, without breaching participant confidentiality.
JM- conceived of the study, participated in its design coordination, and helped to draft the manuscript.
The authors would like to acknowledge Director KEMRI for time given to conduct the study. Vote of thanks goes to the study participants and the study team as a whole. We wish to express our sincere thanks to Ganze Sub County Administrators, Ministries of Health, Education and Agriculture and the community members for facilitating the smooth running of the project in Ganze. We are also grateful to Geoffrey Monari for his statistical inputs. This paper is published with the permission of the Director KEMRI.