title: Risk factors for tungiasis in Nigeria: identification of targets for effective intervention.
abstract: BACKGROUND
  The parasitic skin disease tungiasis (caused by the flea Tunga penetrans) affects resource-poor communities in Latin America, the Caribbean and sub-Saharan Africa. Prevalences in endemic areas are high, and severe pathology occurs commonly. However, risk factors for infestation have never been assessed in Africa.
  
  
  RESULTS
  A cross-sectional study was conducted in Erekiti, a rural community in Lagos State (Nigeria), where tungiasis is endemic. Individuals were examined clinically for the presence of tungiasis, and a questionnaire was applied. Data from 643 individuals (86.6% of the target population) were analyzed; 252 (42.5%) were infested with T. penetrans. In the multivariate logistic regression analysis, presence of pigs on the compounds (adjusted odds ratio = 17.98; 95% confidence interval: 5.55-58.23), sand or clay floor inside houses (9.33; 5.06-17.19), and having the common resting place outside the house (7.14; 4.0-14.29) were the most important risk factors identified. The regular use of closed footwear (0.34; 0.18-0.62) and the use of insecticides indoors (0.2; 0.05-0.83) were protective against infestation. The population attributable fractions associated with tungiasis were: sand or clay floor inside the house (73.7%), resting usually outside the house (65.5%), no regular use of closed footwear (51.1%), and pigs on the compound (37.9%).
  
  
  CONCLUSIONS
  The presence of tungiasis in Erekiti is determined to an important extent by a limited number of modifiable variables. Effective and sustainable intervention measures addressing these factors need to be implemented in this and other West African communities with high disease burden.
authors.affiliation: Department of Zoology, University of Ilorin, Ilorin, Nigeria.
authors.forename: Uade Samuel
authors.initials: US
authors.lastname: Ugbomoiko
authors.forename: Liana
authors.initials: L
authors.lastname: Ariza
authors.forename: Ifeanyi Emmanuel
authors.initials: IE
authors.lastname: Ofoezie
authors.forename: Jörg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D007300:Insect Control / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population; D005423:Siphonaptera / Q000472:pathogenicity*; D012876:Skin Diseases, Parasitic / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D011795:Surveys and Questionnaires