Prevalence and associated risk factors of tungiasis in Chipata and Vubwi districts of eastern Zambia

Abstract

Tungiasis, also commonly known as jiggers, is a zoonotic ectoparasitosis caused by the permanent penetration of the epidermis by a gravid female sand flea Tunga penetrans in the skin of a host. The skin disease is known to occur throughout Latin America, the Caribbean and sub Saharan Africa especially among resource poor communities. There is no or little epidemiologic data on the skin disease in Zambia. A cross-section study was conducted in rural communities in Chipata and Vubwi districts of Zambia to determine the prevalence, risk factors and levels of awareness of tungiasis. A total of 384 households were visited from where at least one member was interviewed and examined. A household was considered infested if at least one individual had tungiasis. Collected data included among others social demographic characteristics, household living conditions, localization of the lesions, nature of lesions (avital or vital), number of embedded female T. penetrans and tungiasis specific disease related information including knowledge. The overall prevalence of active tungiasis in the study area was 13.5% (95% CI= 10.1 – 16.9) with Chipata recording 12.6% (95% CI= 8.5 – 16.7) and Vubwi 15.3% (95% CI= 9.3 – 21.3). On assessment of risk factors, individuals in age categories ≤ 15years and those ≥ 60 years showed higher prevalence 68.8% (95% CI= 46.1 – 91.5) and 18.2% (95% CI=2.1 – 34.3), respectively, compared to those in the intermediary age groups (p=0.001). The type of sanitary facilities and marital status as it related to age were found to be significant predictors of tungiasis (p<0.05). Living in a households with a pit latrines reduced the risk of tungiasis by 25.4% (95% CI= 0.071 – 0.913), when compared to those that practiced open defecation (p=0.036). Those that were of marriageable age and single (>20 years old and single) were 19.7 (95% CI= 5.152 – 75.469) more likely to have tungiasis than those that were married and ≥20 years old (p=0.001). All other variables were not significantly associated with T. penetrans (p>0.05). The levels of awareness of the disease in the study area were very good, ranging from 80% to 83% on the basis of having experienced tungiasis and 3.3% to 71% on disease specific knowledge. Tungiasis is prevalent among the studied rural communities in Chipata and Vubwi districts. Although the awareness of the disease was high in the studied communities, people were not able to link tungiasis with risk factors. More research work needs to be done in order to rank the risk factors and to determine the burden tungiasis exerts in economic terms.