Neurocognitive and mental health outcomes in children with tungiasis: a cross-sectional study in rural Kenya and Uganda.

BACKGROUND: Tungiasis, a neglected tropical parasitosis, disproportionately affects children. Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis. Pathophysiology of tungiasis suggests it could detrimentally affect cognition and behaviour. This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis. METHODS: This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda. The participants were stratified into infected and uninfected based on the presence of tungiasis. The infected were further classified into mild and severe infection groups based on the intensity of the infection. Adapted, validated, and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data. Statistical tests including a multilevel, generalized mixed-effects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes. RESULTS: When adjusted for covariates, mild infection was associated with lower scores in literacy [adjusted ß(aß) = - 8.9; 95% confidence interval (CI) - 17.2, - 0.6], language (aß = - 1.7; 95% CI - 3.2, - 0.3), cognitive flexibility (aß = - 6.1; 95% CI - 10.4, - 1.7) and working memory (aß = - 0.3; 95% CI - 0.6, - 0.1). Severe infection was associated with lower scores in literacy (aß = - 11.0; 95% CI - 19.3, - 2.8), response inhibition, (aß = - 2.2; 95% CI - 4.2, - 0.2), fine motor control (aß = - 0.7; 95% CI - 1.1, - 0.4) and numeracy (aß = - 3; 95% CI - 5.5, - 0.4). CONCLUSIONS: This study provides first evidence that tungiasis is associated with poor neurocognitive functioning in children. Since tungiasis is a chronic disease with frequent reinfections, such negative effects may potentially impair their development and life achievements.

Control of Tungiasis in Absence of a Roadmap: Grassroots and Global Approaches.

Tungiasis is a tropical skin disease caused by the sand flea Tunga penetrans. It inflicts misery upon tens of millions of people, mostly children, across Central and South America and sub-Saharan Africa, and yet there is no globally accepted roadmap for its control. Here we review how research in the last 15 years has developed control methods and report on new grassroots and digital mapping approaches. Treatment is now possible with a two-component dimethicone, used for the treatment of headlice in Europe, Asia and Canada, but not yet available in most tungiasis-endemic areas. Prevention is possible through the daily use of repellents based on coconut oil. A Kenyan coastal community has successfully controlled tungiasis using a neem and coconut oil mix produced locally to treat cases, combined with spraying floors with neem solution and distributing closed shoes. Development of affordable hard floor technology is underway, although not yet widely available, but is a priority to control off-host stages in the floors of homes. A new web-based digital mapping application will enable researchers and health officials to collaborate, share data and map the prevalence of tungiasis. We conclude that tungiasis can be controlled through a multi-disciplinary, One Health approach.