title: Tungiasis-related knowledge and treatment practices in two endemic communities in northeast Brazil.
abstract: BACKGROUND
  Tungiasis, caused by the sand flea Tunga penetrans, is highly prevalent in many resource-poor communities in sub-Saharan Africa, Latin America and the Caribbean. Studies on knowledge and treatment practices related to tungiasis in affected populations are virtually nonexistent. To fill this gap, we performed a study in two resource-poor communities in northeast Brazil where this parasitic skin disease is highly prevalent.
  
  
  METHODS
  Structured interviews were realized in a representative sample of household leaders in an urban slum in Fortaleza, capital of Ceará State (northeast Brazil), and in a traditional fishing village 60 km southeast of the city.
  
  
  RESULTS
  Two hundred ninety household leaders were interviewed in the urban slum and 136 in the fishing village. Knowledge about the etiological agent of tungiasis and its transmission was high in both communities: 90% knew the flea as the etiological agent of tungiasis. Transmission of tungiasis was thought to be related to sandy soil (72% and 84% in the urban slum and in the fishing village, respectively), presence of animals (52% and 59%), walking barefoot (5% and 23%), and with the presence of garbage littering the area (23% and 21%). Surgical extraction of embedded sand fleas using unsterile sewing needles was the most commonly treatment applied (97% and 96%). In addition, a variety of topical products and medical ointments was used. Mothers were almost exclusively responsible for treatment and knowledge transfer to the next generation. The health sector neither provided health education nor treatment.
  
  
  CONCLUSIONS
  In communities of low socio-economic status in northeast Brazil, knowledge on tungiasis was high, but individuals did not follow appropriate treatment. A reduction of intensity of infestation, bacterial superinfection and associated morbidity is feasible with minimum support from the health sector, such as supplying hypodermic needles and disinfectants to mothers, and targeted health education.
authors.affiliation: Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Winter
authors.forename: Fabíola A
authors.initials: FA
authors.lastname: Oliveira
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilcke
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
authors.forename: Hermann
authors.initials: H
authors.lastname: Feldmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004478:Ectoparasitic Infestations / Q000453:epidemiology* / Q000469:parasitology / Q000601:surgery; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012646:Self Administration / Q000379:methods; D005423:Siphonaptera; D055815:Young Adult