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JIGGERS CONTROL & JIGGER FLEA MANAGEMENT
JIGGER AND JIGGER FLEA INFESTATION IN KENYAN COMMUNITIES
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JIGGERS AND JIGGER FLEA INFECTION MANAGEMENT IN KENYA
Tungiasis is a neglected public health problem in Kenya. The disease is caused by the Jigger flea, also known as sand flea, Funza, Chigoe or Tunga penetrans. According to the Ministry of Health National Policy Guidelines on Prevention and Control of Jigger Infestations an estimated 1.4 million Kenyans suffer from jigger infestation in the country.
Tungiasis is a disease of the poor and poor hygiene is one of the major causes of infestation. Children from impoverished communities and families in the country who are affected are not able to walk properly and thus miss out on school.
In adults, the inability to use the limbs affected due to pain in the affected areas hampers normal economically productive activities. The stigma associated with the disease has a debilitating psychological effect on the affected. Secondary infection due to the wounds caused by the jiggers may cause life-threatening complications such as tetanus or gangrene.
The Jigger Mite
The jigger mite, also known as “Sand Flea” is the smallest flea known to humans. It reaches a size of no more than 1mm. It is a parasitic insect and it infests mammals. In rare cases even humans. However, the target of those fleas is mostly cattle and rodents.
Where the Jigger Lives
The jigger lives in sandy areas, around 2 cm deep in the sand (rarely deeper than 5 cm). This is a preferred depth for the flea because of the high temperature above that level, which prevents the development, and the lack of oxygen any deeper. The population of sand fleas drop drastically in rainy weather. The water drags the undeveloped jiggers deep into the soil, drowning them.
Life Span and Eating Habits of Jiggers
The eggs of the flea will turn into fully grown adults in around 27 days. It will need roughly 6 days for an egg to hatch. After that, it will go through two instar stages, and pupate in another 6 days if the environment is pleasant. This will be the beginning of the “cocoon” stage for the jigger and after roughly 15 days it will pop out a developed adult sand flea.
What is the Jigger Flea Feeding On
Adult fleas are feeding on blood. The preferred targets are cattle and rodents, there are many different species of jiggers in the world and each one is targeting different animals to feed on. Some are pickier and suck the blood only of rats or cows. There are only one species of sand flea that takes on humans as a host.
Why do we use the term host?
Well, the male sand flea feeds and moves along with its life. The female jigger has something else in mind.
The Jigger Mite and Tungiasis
The female sand flea digs itself into the flesh of its meal and sets in there for good. A female flea once infested a host, will live there the rest of its life. The female jigger leaves a hole in the epidermis, through which it can breathe and even mate. It will continuously feed on its host and give birth without detaching.
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.
Jiggers Infestation & Management
Tropical parasitic skin diseases are experienced by millions of the poorest populations of the world. However, many of them are not listed by the World Health Organization as Neglected Tropical Diseases (NTDs). As a consequence they are ignored by governments and health care workers alike and they do not receive the scientific interest they merit. Tungiasis or sand flea disease is one of them, caused by a parasitic insect, the female sand flea the Tunga penetrans. In spite of the lack of funding, a fair amount is known about the parasite’s ecology, epidemiology and the morbidity caused by the disease. There is no universally accepted method for treatment or prevention in endemic communities and a ‘roadmap’ for its control has never been developed.
Jigger Life Cycle
Tunga penetrans belongs to the family Siphonaptera. Only the adult female sand flea burrows into the epidermis of its host, usually on the feet, with the final segments of her abdomen protruding. The female is fertilised by a male while she is already embedded in the skin. The female undergoes a remarkable hypertrophy called neosomy as the eggs develop inside her abdomen. One week after penetration, eggs will be expelled and fall on the soil or floor. Under favorable conditions, they develop in dry soil into larvae and pupae, before emerging as infective adults themselves. Hence, the off-host cycle is identical to all other flea species.
Around the world tungiasis has various local names including jiggers, chigoe, pique or nigua, mineme, indicating that the disease has been prevalent in many populations for a long time. Tungiasis has reached endemic proportions among marginalized, resource-poor urban and rural communities in sub-Saharan Africa, South America and several islands in the Caribbean. Prevalence may be up to 60% in children and 30% in the general populations. However, there is no data in any country of the accurate geographic distribution and age-specific prevalence. In most endemic areas transmission is seasonal, with the highest incidence during the dry season. When transmission occurs indoors, incident cases appear the whole year round.
Children, disabled persons and the elderly bear the highest disease burden. While most cases have few embedded fleas, some individuals may present with hundreds. A persistent high parasite load leads to complete immobilization, anaemia and cachexia. Studies on the risk factors of tungiasis have consistently shown that demographic, behavioral and environmental factors associated with poverty predispose to a high disease burden.
Tungiasis is a zoonosis with domestic animals such as dogs, cats, goats, pigs, and sylvatic animals such as rats and monkeys being infected and serving as reservoirs, with different species being the main reservoir in different areas. There is convincing evidence that the whole life cycle can be completed indoors without involvement of a reservoir.
The severity of the disease is directly related to the number of embedded fleas infection. Acute morbidity is triggered by an intense inflammatory response around embedded sand fleas. Bacterial superinfection is almost constant and re-enforces the inflammation. In non-immunized individuals, fatal tetanus is a known complication. Over time, with constant re-infection, chronic pathology develops characterized by desquamation of the skin, oedema around the nail rim, fissures, ulcers, deformation and loss of nails.
Due to pain and itching, children are unable to concentrate on their lessons at school and have difficulty in sleeping and walking. Tungiasis has recently been demonstrated to significantly impair the quality of life of children. Infection is often associated with stigma, with victims being ridiculed, and they consequently isolate themselves. Since tungiasis impairs mobility and concentration, it impacts children’s ability to learn and to get jobs. Similarly, tungiasis affects adults’ ability to conduct their work, whether it be a paid job or on their own farm.
Tungiasis in livestock is associated with severe morbidity and by consequence reduces the merchantability of affected animals, an additional negative impact on household economics. Thus, there is a vicious cycle between poverty exposing people to tungiasis and tungiasis causing more poverty and ultimately impacting the socioeconomic development of whole community.
Prevention Measures for Tungiasis Infections
The following strategies have been identified for elimination of fleas and reduction of jigger infestations;
Smearing the floor and walls of Manyattas with cow dung. This has been demonstrated to repel fleas from the Manyattas
Separation of human inhabited areas from those of animals which host fleas, such as dogs, chicken e.t.c
Use of shoes when and wherever possible.
Treatment of Jiggers
Use of potassium permanganate (antiseptic) and petroleum jelly is the most effective non-invasive way of treating jigger infestations. This treatment has been demonstrated to eradicate the jiggers, enabling affected children and adults to return to work or school. The treatment is quick, effective, and painless. It is important not to use sharp objects to remove jiggers since this results to open wounds.
Treatment procedure includes:
Clean the area by soaking in a basin filled with soap and water
Add potassium permanganate to the basin and soak for 10-15 minutes
Dry the feet and hands
Generously apply Vaseline to the area
Remove gloves and wash hands
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