Assessing the impact of tungiasis on children's quality of life in Kenya.

Tungiasis is a neglected tropical skin disease caused by the sand flea, Tunga penetrans which penetrates the skin causing considerable pain and itching. In this cross-sectional study we aimed to assess its impact on the quality of life of school children in Kenya. School pupils (198) aged 8-14 years with tungiasis were randomly selected and interviewed using a tungiasis-specific quality of life instrument (TLQI). The caregivers of each infected pupil and 199 randomly selected caregivers of uninfected pupils were interviewed using the proxy KIDscreen52 to assess their child's general health-related quality of life (HR-QoL). Generalized linear models were used to assess associations between quality-of-life variables, children's tungiasis status and other covariables. Among infected children, 62.4% had TLQI scores reflecting a moderate to very high impact, with no significant difference between mild and severe cases. Severe cases had a lower proxy-HR-QoL than uninfected pupils (β -21.15, 95% CI -39.63 - -2.68, p = 0.025), but this was not significant in multivariable models. For the first time, this study demonstrated for children whose caregivers were depressed, tungiasis had a higher impact on their quality of life (TLQI adjusted β 0.28, 95% CI 0.08 - 0.49, p = 0.006) and had a lower general HR-QoL (adjusted β -40.34, 95%CI -55.91 - -24.76, p < 0.001). Conversely, if their caregiver showed them affection, tungiasis had a lower impact on their quality of life (TLQI, adjusted β -0.45, 95% CI -0.70 - -0.20, p < 0.001). Further studies are needed to investigate the interaction of tungiasis with parenting styles, the mental health of children and their caregivers and their effect on children's well-being. However, this evidence indicates programs aiming to control tungiasis should include activities targeting the mental health and parenting style of caregivers.