Risk factors associated with jigger infestation in Kitany location, Keiyo Marakwet county, Kenya

Abstract

Background: The jigger menace in Kenya has of late gained Public Health importance in rural and urban-slum settings and 10 million people are vulnerable. The regions affected include Central, Western, Coast, Rift Valley, and Nyanza. In 2011/12 Keiyo Marakwet County reported 2,222 households with jiggers and 4,612 cases of jigger infestation among the villagers. Virulence; known as tungiasis, results from infestation by the fertilized female flea, which embeds into the epidermis usually of the feet, feeds on lymph and swells as the eggs grow. The mature eggs are extruded onto the ground, where the larvae feed, pupate and metamorphose into the adult flea. Knowledge on risk factors, personal hygiene and environmental sanitation has the potential for reducing jigger infestation in Kitany location. General objective: To determine the prevalence and risk factors associated with tungiasis in Kitany Location, Keiyo Marakwet County, Kenya. Specific objectives: To determine the prevalence of tungiasis among different age groups in Kitany Location and factors associated with tungiasis: knowledge, attitudes and practices towards jigger infestation. Methods: This cross-sectional study involved 300 randomly selected households and 1,439 individuals. A semi-structured interviewer administered questionnaire and an interview schedule was used to collect data on socio-demographic factors, housing, ownership and presence of domestic animals, knowledge, attitude and practice. Analysis was carried out using Chi square, the Mann-Whitney U-test and multiple logistic regression model to determine the factors significantly associated with the prevalence of tungiasis. SPSS V.16.0 was used to analyze data. All results were considered significant at 95% confidence level. Results: The median age of the respondents was 18 years (interquartile range 10-36 years). Most of the respondents were female (750/52.12%) and majority (887/61.64%) had primary level of education. A total of 260 individuals (18%) were infested with Tunga penetrans. There was little difference in prevalence between children 5 to 9 years (16.0%) and adults (15%). Infestation was highest in the elderly (40.1%). Itching (85.7%) and pain (85.7%) were the most common associated symptoms, followed by walking difficulties (76.7%), and ulceration (72.3%). Surgical extraction of embedded sand fleas using unsterile sewing needles (67%) and thorns (65%) was the most commonly used treatments. A variety of topical products such as insecticides (31.7%), washing detergent (31.3%) and potassium permanganate (28.7%) were used. Family members were mostly responsible for treatment of jigger (80.7%). Multiple logistic regression analysis showed that tungiasis was associated with age (p<0.001), level of education (p<0.005), status of the compound (p<0.018), type of housing (0.009), state of walls (p<0.001), state of beddings (p<0.008), and lighting (p<0.018) in the household. Conclusions and Recommendations: The presence of tungiasis in the Kitany community was associated with a set of modifiable variables. Effective and sustainable intervention measures addressing these factors need to be implemented in the study area, to reduce the burden of this neglected tropical disease. An integrated approach combining the control of, housing and environmental factors, and health education is needed.