Getting rid of the plague? A qualitative study of community responses and health workers’ experiences with tungiasis in a high prevalence area in Western Kenya.

Project summary

Abstract

Background: Tungiasis is a painful and itchy skin affection caused by a flea, Tunga Penetrans/ jiggers, which enters the epidermis of humans/ animals. If untreated it may result into bacterial infection, sepsis, necrosis and disability. Jiggers are common in urban slums and rural and fishing communities in Africa and South America. Millions of poor people are at risk in more than 80 nations. In Kenya, about 4% of the population may suffer “funza” infestation. Yet, fighting jiggers mainly remains NGOs’ task. There is a need for qualitative research to explore coping experiences and challenges with fighting the vermin at the grassroots, to inform effective health promotion measures.                               

Methods: Qualitative participatory research was carried out in Bungoma County during a two-month fieldwork in 2012 and 2015. Data collection methods included; participant observation and informal talks, interviews and group discussions. In total, 32 interviews were conducted, involving all together 55 persons, whereof 19 were met at health facilities, including Public Health Officers and NGO- and community health volunteers, while 36 were seen in the community; including persons affected by jiggers and other key informants. Data were also collected through observation using checklists.                           

Results: Those infected feel “tortured” by multiple penetrations on hands and feet which are painful and physically disabling, resulting in work-incapacity and school drop-out. People feel stigmatized, neglected, and serious infestation affects people’s mental well-being. People not infected thought that those infected did not care about personal hygiene or living conditions. Pupils not affected preferred not to play with those infected. Children and elders are particularly vulnerable, because they depend on assistance to remove the jiggers. Different “traditional” and “modern” methods are used for removing and eradicating the flea. Yet, there is confusion about effective approaches at all levels, and consistent guidelines are lacking at the time of study. Where the attack-rate were high, informants saw reoccurrence after treatment is perceived as “inevitable”. Those infected feel that they are looked down at and left alone with an irremediable plague, and the government is perceived to pay little attention to this vermin affecting the poor.

Conclusion: Tungiasis is a debilitating and neglected ailment affecting households, schools and communities, while viciously increasing the circle of poverty. To fight fatalism, high-prevalence communities need coordinated public health measures to combat re-occurrence and environmental infestation, such as early and effective treatment, health education and sanitation procedures including the role of animals as reservoirs. Prevalence needs to be documented and early prevention and treatment promoted in vulnerable groups and communitiess.

Method

Article to be  submitted