National prevalence and risk factors for tungiasis in Kenya

Abstract Background Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans , the female of which burrows into the skin, causing pain and discomfort. The disease occurs throughout South America and Sub-Saharan Africa but there are few systematic data on national disease burdens. Methods We conducted the first nationally representative survey of tungiasis, including nine counties covering the major ecological zones of Kenya. A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school. Pupils were examined thoroughly for tungiasis. Two surveys were conducted, the first between May and July 2021 and the second between October 2021 and April 2023. Results The overall prevalence of tungiasis in the first survey was 1.3% (95% CI 1.1–1.5%), and 0.89% in the second survey. The prevalence ranged from 0.08% (95% CI 0.01–0.6%) in Taita Taveta county to 3.2% (95% CI 2.4–4.4%) in Kajiado county. Tungiasis infection was associated with county of residence, male sex (adjusted Odds ratio (aOR) 2.01 95% CI 1.52–2.67), and lower age (aOR 0.81 95% CI 0.75–0.88). For the first time we demonstrate an association with attending public schools (aOR 5.62 95% CI 1.20–26.22) and lower socioeconomic status (aOR 0.10 95% CI 0.03–0.33). Conclusion Tungiasis is widely but heterogeneously distributed across Kenya. School-based surveys offer an efficient strategy for mapping tungiasis distribution.