Introduction

Tungiasis is an ectoparasitic infestation caused by tunga penetrans infestation. The disease is prevalent in the Caribbean, South America, Africa, and India, particularly during the hot, dry season [1, 2]. Tungiasis is also a zoonotic disease that raises the burden of human parasites, resulting in considerable disabling morbidity in endemic areas [3, 4]. The periungual region of the toes is the most preferred site for the flea, although infestation can also occur in hands, elbows, and genital and anal regions [5]. The infestation is more common in children, particularly those aged 5–10 years [6], living with reservoir domestic animals like cats, dogs, and pigs [7], poor personal hygiene, poor sanitation of the housing and residential environment, and a lack of foot wear are all risk factors for tungiasis infestation [8, 9].

There is a lack of information on the global occurrence of tungiasis. However, 88 countries are thought to be infested with jigger, according to global estimates. The ecto-parasite is present in the Sub-Saharan region of Africa, including Sierra Leone, Ivory Coast, Nigeria, and Ethiopia, as well as South Africa; it is also found in Zanzibar and Madagascar [10]. According to a study conducted in Logos state, Nigeria, the prevalence of Tunga penetrans is 22.5 to 45.2% [11, 12]. A similar study from Tanzania, shows the prevalence of Tungiasis is 39% while in Uganda the prevalence was at 47% in children between 3–8 years of age [13]. A study conducted in a rural district of Rwanda shows that the prevalence of Tungiasis infection among children was 23%.

According to a study conducted in a rural community in Nigeria, having a sand or clay floor inside the home, as well as a traditional resting place outside the building, are significant risk factors for getting jiggers [9]. Sleeping on a non-solid floor also increases the risk of penetration [14]. A study from Brazil shows walking barefoot and the presence of garbage littering in the area increase the risk of infection [12, 15]. Lack of education and information about the circumstances were frequently listed as risk factors for having jiggers in the literature [16, 17]. Animal ponds, inadequate sanitation, and a lack of infrastructure are also major contributors to the high prevalence. Poor neighborhoods are frequently clustered outside of major cities, where there is more wildlife [17]. The shortage of waste disposal among vulnerable residents is becoming more apparent. Inadequate or non-existent sanitation [15, 18], a lack of clean water and soap, and the resulting poor sanitation are all major contributors to jiggers infestation [11].

According to studies conducted in Ethiopia, the prevalence of tungiasis ranged from 15 to 59 percent. According, the prevalence of tungiasis among children aged 5 to 14 years is 15 percent in Jimma, and 24 percent in Wolayita Sodo [19], while it is 58 percent in the Wensho district [8]. Tungiasis prevalence is influenced by socio-demographic factors such as mothers’ education, cat-owning families, wearing footwear rarely or never [8], poverty wages, poor housing and living conditions, and poor health seeking behavior [12]. However, data on the prevalence of tungiasis in children and its risk factors were limited to tack action in this particular area. Therefore, this study is aimed at investigating the prevalence of tungiasis and its risk factors among children in Mettu rural woreda of Ilu Abba Bor Zone, southwest Ethiopia.

The study’s findings assist health-care administrators at all levels, especially those looking at the population in the woreda, in understanding the scope of the issue. It also increases the ability to search out new alternative healthcare options in view of the community’s prevalence of tungiasis and risk factors. Furthermore, it leads to a better understanding of the risk factors associated with the prevalence of tungiasis in children aged 5 to 14 in the area.

Methods and materials

Results

Socio-demographic characteristics

The socio-demographic characteristics of study participants were presented in table one below (Table 1). Accordingly, a total of 821 respondents participated in this study with a response rate of 100%. Of the 821 respondents, 520 (63.3%) were females. The majority of the study participants were 637 (77.6%) were school attending students. About 354 (43.5%) of mothers can read and write, 173 (21.1%) cannot read and write, 215 (26.5%) attended some primary education, and only 215 (9.6%) attended secondary and above education.

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Table 1. A socio-demographic characteristic of the respondent’s on the study of prevalence and risk factors of Tungiasis among children 5–14 years in Mettu rural woreda, 2020.

https://doi.org/10.1371/journal.pone.0262168.t001

In terms of father education, approximately 487 (60.5%) can read and write, 30 (3.7%) are unable to read and write, 188 (23.4%) have some primary education, and 100 (12.4%) have some secondary and higher education. Concerning family occupation, about 474 (57.7%) of mothers were engaged as home mothers as their main daily work, 565 (70.2%) of family heads were engaged in farming, and the rest were occupied with market work, daily labor and government employees. The main family size was five members, about half of 407 (49.6%) households had less than five family members, and 414 (50.4%) were with above five family size. The children’s ages ranged from 5 to 9 years for 429 (52.3%) and 10 to 14 years for the remaining 392 (47.2%) participants. The mean age was 10.18 years, and a standard deviation of 2.66 years.

Housing condition.

The housing condition and sanitation status of the households were presented in Table 2 below (Table 2). In this study, more than half of 553 (67.4%) had a separate kitchen for cooking in their home. The majority of the households 664 (80.9%) had access to improved water sources, about 194 (23.6%) had access to improved toilet facilities, only 50 (6.1%) had access to improved indoor floor (i.e cemented floor), 709 (86.4%) had roof cover of iron sheet, and 811 (98.8%) wood and mud wall type. Of the total participants, about 524 (63.8%) households own a plot of farm land, 487 (59.3%) had at least one life stock and 283 (34.5%) reported the presence of other domestic animals in their compounds. The majority of the children, 764 (93.1%) reported they had shoes, and 746 (90.9%) practiced bathing at least twice per week.

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Table 2. Housing condition of the respondents participated in study of prevalence and risk factors of tungiasis among children 5–14 years in Mettu rural woreda, 2020.

https://doi.org/10.1371/journal.pone.0262168.t002

Prevalence of tungiasis among children

Table 3 shows the prevalence of tungiasis among children aged 5 to 14 in Mettu rural woreda (Table 3). Accordingly, the prevalence of tungiasis among 5–14 years of children the study area was 52.3% (48.8%–55.7%). Of the total respondents only 69 (8.4%) agree that a tungiasis is as a public health disease, and 221 (26.9%) reported the community discriminate the person with tungiasis infestation. The majority of the respondents 746 (91.1%) argue parasite is the main cause the disease, and 59 (7.2%) reported it caused because of dirty environment. More than half 632 (77%) reported as the disease is not a public concern and not a point of discussion at family level. Skin infection is the major complication of the disease reported from 791 (96.3%). Of those reported at least one exposure the case 414 (96.1%) sagest the own removal of the flea larvae as solution for home remedy. The prevention methods were 614 (74.8%) personal hygiene, using chemicals 76 (9.3%), using shoes 6 (0.7%), and early removal of the larvae 125 (15.2%). Of the total respondents, 198 (24.1%) reported tungiasis is a seasonal in which winter season is a pick season 171 (86.4%) for the infestation in the study area.

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Table 3. Prevalence of Tungiasis among children 5–14 years in Mettu rural woreda, 2020.

https://doi.org/10.1371/journal.pone.0262168.t003

Risk factors of tungiasis among children

In this analysis, many variables were explored to test the association of adjustment of variables using logistic regression to predict variables that were associated with exposure of tungiasis during the crude analysis. In the final model, family size, school attendance, indoor house floor type, access to sleeping bed, family access to water supply, family access to toilet facility, family access to electric service, and farm land ownership were risk factors for tungiasis infestation in children aged 5 years to 14 years (Table 4). Accordingly, family size (AOR/ 95% CI:2.93/2.133–4.402), school attending (AOR/95% CI:1.49/1.017–2.186), indoor floor type (AOR/95% CI: 3.851/1.759–8.43), having sleeping bed(AOR/95% CI:0.16/0.03–0.82), access to protected water sources(AOR/95% CI: 0.245/0.15–0.39), access to improved toilet facilities (AOR/95% CI: 0.628/0.44–0.89), access to electric services (AOR/95% CI:0.305/0.15–0.62), and having own farmland (AOR/95% CI: 0.365/0.26–0.50).

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Table 4. Multivariable analysis of risk factors of tungiasis among children 5–14 years in Mettu rural woreda, southwest, Ethiopia.

https://doi.org/10.1371/journal.pone.0262168.t004

Discussion

This study demonstrated the prevalence of tungiasis and its risk factors among children aged 5 years to 14 years in Mettu rural woreda. The prevalence of tungiasis among children 5–14 years of age in Mettu rural woreda was 52.3%. This finding is higher than similar studies in Ethiopia in Wolayita Sodo 23.9% and Jimma 15.15% [25], Nigeria 45.2% [12], Uganda 22.5% [26], and lower than the study conducted in Densho district in Ethiopia 58% [8].

Of the total respondents, only 69 (8.4%) agree that tungiasis is a public health disease, and 221 (26.9%) reported the community discriminates against people with tungiasis infestation. More than half of 632 (77%) reported the disease is not a public concern and not a point of discussion at the family level. This demonstrates that the disease is widely discriminated against and ignored, even at the community level. The majority of the respondents 746 (91.1%) argue parasites are the main cause of the disease, and 59 (7.2%) reported it was caused because of the dirty environment.

Skin infection is the major complication of the disease reported by 791 (96.3%) respondents. The prevention methods were 614 (74.8%) personal hygiene, using chemicals 76 (9.3%), using shoes 6 (0.7%), and early removal of the larvae 125 (15.2%). Tungiasis is a seasonal disease, with the winter season being a pick season, according to 198 (24.1%) of the total respondents, and 171 (86.4%) for the infestation in the study area. Of those who reported exposure to the case, 414 (96.1%) suggest the own removal of the flea larvae as a solution for a home remedy. As a result of self-removal, which is more common in children, and the use of unsanitary tools, other fleas can embed in the skin, potentially leading to secondary infection as well as permanent disability.

The risk factors for tungiasis exposure among children aged 5 to 14 years were family size, school attendance, indoor house floor type, access to sleeping bed, family access to water supply, family access to toilet facilities, family access to electric service, and farmland ownership (Table 4). In this study, children from large families (those with five or more siblings) were 2.9 times more likely to contract tungiasis than children from small families (AOR/95% CI:2.93/2.133–4.402). Large family sizes in the study area may increase the exposure because each child may have a play station that the probability of getting the fleas increases. Similarly, child care in large families in rural Ethiopia is insufficient, resulting in high exposure to such neglected diseases. A study from northern Ethiopia suggests that less child care among rural Ethiopian communities increases the risk of stunting, with large family sizes being at a higher risk of less child care [27]. The stunted child is more vulnerable to many health risks, including tungiasis.

Children attending school were 1.49 times more likely risk than not attending children (AOR/95% CI:1.49/1.017–2.186). This discovery demonstrates that the school environment has a dusty floor, which increases the habitat of fleas. In Ethiopia, less school health intervention is in place, especially in rural areas where class rooms are full of dust where students attend learning. Children from households having mud and earth house floors were 3.8 times more likely risk than other types of indoor cemented floor (AOR/95% CI: 3.851/1.759–8.43). Similarly, floor types of mud and earth are more favorable for the growth of fleas. This finding is consistent with study results from Uganda [12].

Housing conditions and hygiene practice at family level are very important in the control of many communicable diseases. This study result shows children whose family had a sleeping bed were 84% less risk than those lacking a sleeping bed (AOR/95% CI:0.16/0.03–0.82). Having a sleeping bed reduces the risk of exposure because fleas grow in dust. Similarly, children with family access to protected water sources were 75.5% less risk than those lacking water improved water sources (AOR/95% CI: 0.245/0.15–0.39). This finding is similar to the result from Kenyan [22]. Availability of water supply facilitates hygiene practices, in which access to water initiates the children and family to wash their bodies, clothes, and clean their indoor environment.

In the current study, families with access to improved toilet facilities were 37% less likely risk than those lacking access to toilet facility access (AOR/95% CI: 0.628/0.44–0.89). The children from families with access to electric services were 69.5% less risk than those lacking electric service (AOR/95% CI:0.305/0.15–0.62). The children from families that own farm land were 63.5% less risk than those who own farm land (AOR/95% CI: 0.365/0.26–0.50). Access to toilet facilities, electricity, and one’s own farmland are indicators of a high-class economy in a rural community, and having such amenities improves one’s standard of living. In any community, having a good lifestyle is conventionally the way to reduce communicable disease. As a result, it has a similar effect on reducing tungiasis infestation in the study area. This finding is consistent with the study results from Densho district in Ethiopia [12]. However, this study did not address other age segments of the population that may have high or less prevalence even in the same family member. The risk among children may not be the same as the risk among the rest of the population in the same kebeles.

Conclusion

This study found a high prevalence of tungiasis infestation among children aged 5 to 14 in Mettu Woreda. Family size, school attendance, indoor house floor type, access to sleeping bed, family access to water supply, family access to toilet facilities, family access to electric utility, and farm land ownership were all statistically significant risk factors in the study area. Therefore, planning and implementing interventions for school health services to reduce the risk of infestation. Because this untreated disease poses a high risk to schoolchildren and is likely to increase absenteeism, school sanitation and hygiene promotion should be integrated and implemented. Community health workers must educate households and caregivers on the importance of not ignoring this common illness that causes disability. Finally, this study used a cross-sectional survey to assess risk and prevalence and was unable to establish a cause and effect relationship, a longitudinal study, particularly an interventional study, is recommended for future research.

Supporting information

Acknowledgments

The authors would like to thank all survey respondents, as well as the field supervisors, data collectors, Mettu woreda health office, and Mettu University, for their contributions to the success of our work.