High density rural settlements, parenting behavior and child disability are significant factors associated with tungiasis in Karamoja, northeastern Uganda: a case control study

Background Tungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogenous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies. Methods We conducted a case: control study to identify factors associated with infection of individual children, adults and with the whole household. Infected children were identified through mass-screening of 1619 children aged 8 to 14 years between January and March 2022 in 25 villages. Infected (210) and uninfected (358) children were randomly selected, and their households were enrolled into the study. Observations were made of the homesteads, and structured interviews were conducted with the caregivers. All adults and children in the households were examined. Mixed effect logistic regression analysis was used to identify factors associated with infection of individuals or households. Results We found children who lived in high-density settlements (manyattas) had more than three times the odds of being infected than those in more open, low-density settlements (adjusted odds ratio aOR 3.51, 95% CI 1.57−7.83, p = 0.002). For the first time we demonstrate the association of household infection with having a child with a disability (aOR 5.38, 95% CI 1.92−15.03, p = 0.001) and a caregiver who did not show affection to their child (aOR 1.79, 95% CI 1.02−3.13, p = 0.041). For individual adults, those who reported drinking alcohol had four times the odds of infection than those who did not (aOR 4.74, 95% CI 1.93−11.68, p = 0.001). Frequency of washing feet, soap use and house cleanliness were also associated with household infection. Conclusion Control programs should be developed together with the caregivers to enable them to reduce alcohol use, improve their childcare, hygiene and sanitation practices. Trial registration: not applicable