Risk Factors for Tungiasis in Nigeria: Identification of Targets for Effective Intervention

Tungiasis is a parasitic skin disease caused by the sand flea Tunga penetrans. After penetration into the skin, the flea grows and reaches the size of a pea. The disease is a neglected public health problem in endemic areas in Latin America, the Caribbean and Africa, and causes considerable morbidity in the affected communities. We performed a study in a rural community in Nigeria to detect factors associated with tungiasis. People were examined for the presence of sand flea lesions, and a questionnaire was applied. Of the 643 individuals examined, 252 (42.5%) had tungiasis. The most important factors independently associated with the disease were: presence of pigs on the compound (adjusted odds ratio [OR] = 17.98), sand or clay floor inside house (OR = 9.33), and having the common resting place outside the house (OR = 7.14). The regular use of closed footwear (OR = 0.34) and the use of insecticides indoors (OR = 0.2) were protective factors. Our data show that tungiasis in this community is determined to an important extent by some variables that may be a target for interventions

Knowledge, attitudes and practices regarding head lice infestations in rural Nigeria

Introduction: Head lice infestations are common in sub-Saharan Africa, but knowledge, attitudes and practices have never been studied in this region.\ud \ud Methodology: This population-based study was conducted in a small rural community (population = 590) in Kwara State, Central Nigeria. Inhabitants of the community were interviewed regarding head lice infestations, using a pre-tested structured questionnaire, and examined regarding the presence of active pediculosis.\ud \ud Results: Of the 496 participants included, 367 (74.0%) had experienced head lice infestations, but only 26 (11.1%) of the individuals older than 15 years knew the correct mode of transmission. Of 142 individuals with active pediculosis, only 1 (0.7%) felt ashamed. Treatment was most commonly done by grooming (46.3%), followed by combing (27.2%). Only 4.6% used pediculicides, and 21.8% did not apply any treatment. Opinions about difficulties in controlling head lice were asked in three groups: biological, technical and social. In the first group, the most common difficulty noted was detecting head lice (52.1%), followed by possible resistance that would lengthen the time of infestation (38.9%). Technical constraints included concerns on the safety and effectiveness of products (48.7%) and difficulties in obtaining treatment (46.2%). Social contraints included difficulty in treating children (24.4%), lack of knowledge (23.5%), and the social behavior of children (22.2%).\ud \ud Conclusions: Head lice were not perceived as an important disease in a rural Nigerian community, and feelings about the infestation were mostly indifferent. Despite its common occurrence, knowledge on head lice was limited

Pigs are the most important animal reservoir for Tunga penetrans (jigger flea) in rural Nigeria

We examined the domestic animals and rodents in a community in rural Nigeria. Of the 133 animals examined, 29 (21.8%) were infested, the highest prevalence of infestation and highest parasite load was found in the pigs (prevalence 54.8%, median = nine embedded parasites), followed by dogs (45.5%; median = 4), Rattus rattus (29.4%; median = 2) and Mus minutoides (15.4%; median = 1.5). Of all the tungiasis lesions identified 83% were found in pigs. Our data confirm that tungiasis is a zoonotic disease, and that pigs are its most important animal reservoir in this endemic community

Self-diagnosis of head lice infestation in rural Nigeria as a reliable rapid assessment tool for pediculosis

Pediculosis capitis is a common disease in industrialized countries, but there are also areas in sub-Saharan Africa where head lice infestations are highly endemic. However, there are no data available from the African continent on the accuracy of head lice diagnosis made by affected individuals.\ud \ud We performed a door-to-door survey in Skanko village (Kwara State, Central Nigeria). Individuals were asked to answer a question regarding their head lice status, and then wet combing with conditioner was performed to diagnose an active infestation.\ud \ud Active head lice infestation was observed in 144 (29.0%) of the 496 participants. Less than 1% of those without pediculosis stated being infested; and more than 90% of individuals with heavy infections did so. In contrast, only 47% of individuals with 5 lice were aware of their infestation. Overall sensitivity (73.6%), specificity (99.1%), positive predictive value (97.2%) and negative predictive value (90.2%) of self-diagnosis, as compared to wet combing were high.\ud \ud Our data show that interviewing individuals about their infestation status can be used as a simple rapid assessment method for diagnosing head lice in a typical rural setting in Nigeria

Impact of scabies in resource-poor communities

Purpose of review: Features of endemic scabies are specific in resource-poor and underprivileged communities, with implications for control measures on the community level. In this review, these special aspects are addressed.\ud \ud Recent findings: Scabies is endemic in many resource-poor communities, with a prevalence of 20% and higher. Transmission is influenced by social attitudes, migration, access to healthcare services, housing conditions, hygiene conditions, and crowding. Endemic scabies occurs with severe infestations, complications, and sequels, mainly in children. Sleep loss as a result of scabies-related itching is common. Complications include secondary infections by group A streptococci and acute poststreptococcal glomerulonephritis. Shame, restriction of leisure activities, and stigmatization are common. Treatment of scabies includes a variety of topical compounds, but control on the community level is not an easy task. As ivermectin kills a variety of other parasites, this oral drug is increasingly used for mass treatment. Intervention should address socioemotional aspects using an integrated approach with professionals from different areas, and the community.\ud \ud Summary: Scabies is a neglected disease and needs to be perceived as an important public health problem causing morbidity in many resource-poor communities. Future work on epidemiology, clinical aspects, transmission dynamics, socioeconomic aspects, and sustainable control in resource-poor communities is needed

High prevalence of Plasmodium falciparum and soil-transmitted helminth co-infections in a periurban community in Kwara State, Nigeria

Prevalence of malaria and soil-transmitted helminth infections, and the burden of disease are enormous in sub-Saharan Africa. Co-infections aggravate the clinical outcome, but are common due to an overlap of endemic areas. A cross-sectional survey was conducted to assess prevalence, intensity of infection and association between malaria and soil-transmitted helminth infections in a typical periurban community in Kwara State. Fresh blood and faecal samples were examined using thick blood film and Kato-Katz smear techniques.A total of 383/471 study participants (81.3%) were infected with at least one parasite species, with the following prevalences and mean infection intensities: Plasmodium falciparum 63.7% (2313.6 parasites/μl); Ascaris lumbricoides 63.1% (3152.1 epg); Trichuris trichiura 53.3% (1043.5 epg); and hookworms 30.1% (981.7 epg). Sixty-three percent of the study population were co-infected with two or more parasite species. The prevalence of ascariasis was significantly higher in individuals infected with P. falciparum (adjusted OR: 5.87; 95% CI: 3.30–10.42). Heavy A. lumbricoides and T. trichiura infections were associated with high P. falciparum parasitaemia. Co-endemicity of malaria and soil transmitted helminth infections is an important public health problem in the study area. Multi-target integrated approaches focusing on disease intervention are essential to mitigate morbidity caused by multiple infections. Keywords: Malaria, Soil-transmitted helminths, Interaction, Prevalence, Nigeri

Prevalence and clinical aspects of tungiasis in south-west Nigerian schoolchildren

Tungiasis is highly prevalent in resource-poor communities in sub-Saharan Africa, but studies among schoolchildren are scanty. We assessed prevalence, parasite load and clinical aspects of tungiasis in schoolchildren in south-western Nigeria. A total of 545 schoolchildren was examined. Of these, 133 (24.4%; 95% CI, 20.9-28.2%) were infested with Tunga penetrans. Boys showed a higher prevalence than girls (31% versus 18%, P<0.0001); in those infested, the median number of lesions was two, with no gender difference (2 boys, interquartile range, 1-4; 2 girls; interquartile range, 1-4; P=0.34). The maximum number of 44 lesions was found in a 14-year-old boy. Desquamation was present in 90.2%, followed by erythema (54.9%) and oedema (43.6%); 54.9% showed any chronic pathology and more one-third nail deformations. Our study indicates that tungiasis is an important health problem in rural Nigerian schoolchildren. Sustainable interventions are required to control the disease in this and similar communities

Characterization of freshwater snail intermediate hosts of schistosomes in four communities from Osun State, Southwest Nigeria

Aim: Freshwater snails of the genus Bulinus act as essential intermediate hosts of Schistosoma haematobium, a trematode parasite that causes urogenital schistosomiasis. The snails are widely distributed throughout Nigerian waters. Since species identification of the Bulinus snails is important for appropriate control strategies of urogenital schistosomiasis, this study therefore aimed at identifying the Bulinus species responsible for transmission of the infection in four communities located in an endemic Local Government Area of Nigeria. It also aimed at using restriction fragment length polymorphism (RFLP) as a more affordable method than sequencing to characterize Bulinus snails from schistosomiasis endemic regions in Nigeria.Methods: In this study, 100 freshwater snails morphologically identified as Bulinus species were collected from four communities located in a previously reported schistosomiasis endemic Local Government Area (LGA), namely Olorunda LGA in Oshun State, Southwest Nigeria. All snails were screened for schistosome infection using polymerase chain reaction (PCR) targeting the DraI gene. Molecular identification of the snails was done by PCR amplification of their entire internal transcribed spacer region including the 5.8S ribosomal RNA gene and RFLP. Results: Five of the 100 snails were positive for schistosome infection. PCR-RFLP profiles showed bands of different sizes for 26 other snails including the schistosome-infected ones. RFLP analysis showed that 11 of the snails belonged to the freshwater snails of the genus Physa while 13 belonged to the freshwater snails of the genus Bulinus, including Bulinus globosus (8) and B. truncatus (5). The species of the remaining two snails could not be resolved using the reference profiles from our previous studies.Conclusion: This study confirmed previous observations that limited morphological uniqueness within the Bulinus groups hinders their identification, and RFLP is a cheaper alternative method to sequencing that can be used by laboratories with limited resources for Bulinus species identification