title: Identifying risk factors for tungiasis and heavy infestation in a resource-poor community in northeast Brazil.
abstract: Tungiasis is a neglected parasitic skin disease caused by penetration of female sand fleas into the epidermis. The ectoparasitosis is widespread in resource-poor communities in South America, the Caribbean and sub-Saharan Africa. To identify risk factors for the presence of sand fleas and severe infestation in an endemic community, we examined the entire population of a traditional fishing village for the presence of embedded sand fleas and determined the number and type of lesions. Demographic, behavioural and environmental characteristics of the population were assessed using a structured questionnaire. Multivariable analysis showed that both occurrence of tungiasis and heavy infestation were significantly related to poor housing conditions (odds ratio [OR]=4.7, 95% CI 1.4-15.8), lack of health education (OR=4.1, 95% CI 2.0-8.6) and presence of animals on the compound (OR=1.9, 95% CI 1.1-3.4). Contrary to common belief, a protective effect of frequent use of closed footwear could not be demonstrated. Based on the population attributable fractions calculated for the major risk factors identified, we conclude that several low-cost interventions would have a considerable impact on the occurrence of tungiasis and heavy infestation.
authors.affiliation: Department of Medical Microbiology, Institute of Infectious Medicine, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany. muehlenm@rki.de
authors.forename: Marion
authors.initials: M
authors.lastname: Muehlen
authors.forename: Hermann
authors.initials: H
authors.lastname: Feldmeier
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilcke
authors.forename: Benedikt
authors.initials: B
authors.lastname: Winter
authors.forename: Jörg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004478:Ectoparasitic Infestations / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012307:Risk Factors; D005423:Siphonaptera