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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. |
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