Individual and household factors associated with tungiasis in a marginalized population in Karamoja, northeastern Uganda

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 heterogeneous, 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 cross-sectional study to identify factors associated with infection of individual children and adults, and a nested case–control study to identify factors for whole households (families). Infected children were identified through mass-screening of children aged 8–14 years between January and March 2022 in 25 villages. Of the 1619 children screened, 210 infected and 358 uninfected 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). To our knowledge, this is the first study to show an association of household infection (at least one case) 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.