Wiese Susanne, Elson Lynne, Reichert Felix, Mambo Barbara, Feldmeier Hermann
Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany.
WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Watamu, Kenya.
PLoS Negl Trop Dis. 2017 Oct 9;11(10):e0005925. doi: 10.1371/journal.pntd.0005925. eCollection 2017 Oct.
Tungiasis is a neglected tropical disease caused by female sand fleas (Tunga penetrans) embedded in the skin. The disease is associated with important morbidity. Tungiasis is endemic along the Coast of Kenya with a prevalence ranging from 11% to 50% in school-age children. Hitherto, studies on epidemiological characteristics of tungiasis in Africa are scanty.
In a cross-sectional study 1,086 individuals from 233 households in eight villages located in Kakuyuni and Malanga Sub-locations, Kilifi County, on the Kenyan Coast, were investigated. Study participants were examined systematically and the presence and severity of tungiasis were determined using standard methods. Demographic, socio-economic, environmental and behavioral risk factors of tungiasis were assessed using a structured questionnaire. Data were analyzed using bivariate and multivariate regression analysis.
The overall prevalence of tungiasis was 25.0% (95% CI 22.4-27.5%). Age-specific prevalence followed an S-shaped curve, peaking in the under-15 year old group. In 42.5% of the households at least one individual had tungiasis. 15.1% of patients were severely infected (≥ 30 lesions). In the bivariate analysis no specific animal species was identified as a risk factor for tungiasis. Multivariate analysis showed that the occurrence of tungiasis was related to living in a house with poor construction characteristics, such as mud walls (OR 3.35; 95% CI 1.71-6.58), sleeping directly on the floor (OR 1.68; 95% CI 1.03-2.74), the number of people per sleeping room (OR = 1.77; 95% CI 1.07-2.93) and washing the body without soap (OR = 7.36; 95% CI 3.08-17.62). The odds of having severe tungiasis were high in males (OR 2.29; 95% CI 1.18-44.6) and were very high when only mud puddles were available as a water source and lack of water permitted washing only once a day (OR 25.48 (95% CI 3.50-185.67) and OR 2.23 (95% CI 1.11-4.51), respectively).
The results of this study show that in rural Kenya characteristics of poverty determine the occurrence and the severity of tungiasis. Intra-domiciliary transmission seems to occur regularly.
潜蚤病是一种由雌性沙蚤（穿皮潜蚤）侵入皮肤引起的被忽视的热带病。该疾病与严重的发病率相关。潜蚤病在肯尼亚沿海地区为地方病，学龄儿童中的患病率在11%至50%之间。迄今为止，关于非洲潜蚤病流行病学特征的研究很少。
在一项横断面研究中，对肯尼亚沿海基利菲县卡库尤尼和马兰加分区八个村庄233户家庭的1086人进行了调查。对研究参与者进行系统检查，并使用标准方法确定潜蚤病的存在和严重程度。使用结构化问卷评估潜蚤病的人口统计学、社会经济、环境和行为风险因素。数据采用双变量和多变量回归分析。
潜蚤病的总体患病率为25.0%（95%置信区间22.4 - 27.5%）。特定年龄患病率呈S形曲线，在15岁以下年龄组达到峰值。42.5%的家庭中至少有一人患有潜蚤病。15.1%的患者感染严重（≥30个病灶）。在双变量分析中，未确定特定动物物种为潜蚤病的风险因素。多变量分析表明，潜蚤病的发生与居住在建筑特征较差的房屋有关，如土墙（比值比3.35；95%置信区间1.71 - 6.58）、直接睡在地板上（比值比1.68；95%置信区间1.03 - 2.74）、每个睡眠房间的人数（比值比 = 1.77；95%置信区间1.07 - 2.93）以及不用肥皂洗澡（比值比 = 7.36；95%置信区间3.08 - 17.62）。男性患严重潜蚤病的几率较高（比值比2.29；95%置信区间1.18 - 44.6），当只有泥坑作为水源且缺水导致每天只能洗一次澡时，几率非常高（分别为比值比25.48（95%置信区间3.50 - 185.67）和比值比2.23（95%置信区间1.11 - 4.51））。
本研究结果表明，在肯尼亚农村，贫困特征决定了潜蚤病的发生和严重程度。家庭内传播似乎经常发生。
