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By Annonciata Byukusenge
Jiggers, not to be confused with chiggers, is a dermatologic infiltration by a flea called Tunga penetrants. The name jiggers comes from the synonym for the causative flea, the jigger flea, and is one of many synonyms. Today, many health professionals refer to jiggers by their more formal name Tungiasis. Tungiasis is a painful, itchy skin condition that occurs when female sand fleas burrow into your skin to feed as they lay their eggs. You develop white circles with black dots in the centers. These lesions most commonly affect your feet but they can develop anywhere on your body.10 Sept 2022.
Mukanyandwi wakes up at five in the morning every day. Her main activity consists of farming crops on a small 3-ar farm at Nyange, a remote rural village in the Musanze district in the Northern province, of Rwanda.
The people who live in the Nyange sector, Musanze district say that to suffer from Jigger disease known as Tungiasis, caused by poverty because they can’t buy cement for locking their house themselves, bath soap or clean their clothes and body lotion or baby jerry because even getting food and sustenance for their families is a problem. The people who say this are from vulnerable families. However, the government of Rwanda has the goal of eliminating Neglected Tropical Diseases (NTDs) as a public health problem by 2030. The people affected by Tungiasis are mostly from the Nyange, Muko, and Nkotsi sectors. The majority of those people are from indigenous communities.
Some of those people are suffering from Tungiasis themselves and others have kids suffering from Tungiasis, but the science direct says that Tungiasis is a poverty-associated disease with a limited spatial distribution.
The adult female sand flea, Tunga penetrants, causes Tungiasis. The larvae and pupae develop in dry shaded soils, mostly inside the sleeping rooms of houses with an unsealed earthen floor where most transmission occurs. The embedded flea causes inflammation, pain and itching, and difficulty walking, sleeping, and concentrating on school or work. Tungiasis is a zoonosis that affects humans and animals alike.
How common is Tungiasis?
More than 20 million people worldwide are at risk of Tungiasis. Impoverished people who go barefoot and live in rural areas, remote villages, and shantytowns in large cities are more likely to get Tungiasis. The condition is more problematic for some boys between the ages of 5 and 14 and the elderly. It is estimated that 8 in 10 disadvantaged children living in areas that have sand fleas develop Tungiasis. https://my.clevelandclinic.org/health/diseases/24162-tungiasis
According to the World Health Organization (WHO), T. penetrants are found in tropical and subtropical regions of the Caribbean, South America, and sub-Saharan Africa. Over 1 billion people live in areas suitable for transmitting Tungiasis, but no country conducts routine surveillance, so the actual disease burden is unknown. However, within endemic communities, surveys have reported prevalence from 7% to 63%, i.e., distribution is heterogeneous.
Who is at risk?
Elderly people and children aged 5–14 years, particularly boys, are at highest risk. People with disabilities are also highly vulnerable to infection.
Tungiasis thrives where living conditions are precarious, such as in villages located on remote beaches, communities in the rural hinterland, and shanty towns of big cities. In these settings, the poorest of the poor carry the highest burden of the disease.
Clementine is a woman of 40 years old. She has a kid suffering from Tungiasis. She says how she cannot sleep with her kid during the night because of Tungiasis.
“My child has been suffering from Tungiasis for two years. When it is time to bed, it is hard for me to sleep because the children are in pain, which keeps us all awake. The authorities promised to give us a cure, but it did not reach us.”
She added that she does not know what to do because the cause is poverty and she cannot improve anything herself. Some people who have Tungiasis are from the Nyange, Muko, and Nkotsi sectors. We try to remove them, but we cannot eradicate Tungiasis.
Mukanyandwi is a woman of 45 years old. She said that poverty is a barrier to their social health.
“We sleep on the ground without bedcover. No cement in our house ground and the fleas penetrate our feet and multiply eggs on our feet or fingers then we start to feel bad. For me, I can’t think widely because of Tungiasis.”
In September 2024, a family of seven people migrated or relocated from the Nkotsi sector to the Muko sector because of Tungiasis. Their neighbors said that the cause was that they were poisoned with Tungiasis.
Théobald Kayiranga is a Vice Mayor of the Musanze district and is in charge of Social Affairs. In an interview with Forefront Magazine, he said that poverty is not related to Tungiasis.
The Tungiasis is not related to Tungiasis or poison. The cause is poor sanitation in their home and workplaces. The best weapon we choose to eliminate Tungiasis is education through the mobilization of sanitation to their bodies, at home, and at their workplace. Said Kayiranga.
Tungiasis in Africa
The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens.
The pooled prevalence of Tungiasis in SSA was 33.4% (95% CI: 27.6–39.8), while Tungiasis prevalence was 46.5%, 44.9%, 42.0%, 37.2%, 28.1%, 22.7% and 20.1% for Ethiopia, Cameroon, Tanzania, Kenya, Nigeria, Rwanda, and Uganda, respectively.
Nshimiyimana Ladislas Neglected Tropical Disease (NTD) Research Senior Officer at Rwanda Biomedical Centre. An interview with Forefront Magazine said that Tungiasis appears in different rural areas of the country.
Tungiasis is not transmittable because they do not go from one person to another person. Causes by domestic animals include fleas like, gots dogs, cats, and rats, poor hygiene, and being with domestic animals in one house. It increases because the fleas penetrate the body.
“To prevent Tungiasis is possible. The first thing is to separate domestic animals from people. Keeping animals in their house and people in their houses, spraying pesticides, avoiding indoor dust, and spraying water daily before cleaning if your house does not have cement, because the smaller the dust covering the fleas. The people must know that cleanliness of the body is important because it is the basis of sanitation.”
He added that eliminating Tungiasis is possible because they conduct campaigns to help people change their behavior toward Tungiasis and know the truth that is not poison as some of them say.
“We train different categories of people like local leaders’ health community workers, and church leaders because they support us in the campaigns and those leaders live with people a day per day,” Nshimiyimana said.
About the status of Tungiasis in Rwanda, Nshimiyimana said that Rwanda does not have a high number of people affected by Tungiasis.
“The number is not common because people treat it themselves at home, not going to the health centers. We could count 1500 people per year.”
The most common NTDs in Rwanda are; intestinal worms (affecting 41 percent of Rwandans, with a 48 percent prevalence in adults), bilharzia/ schistosomiasis (1,000 cases), podoconiosis (about 6,000 cases annually), scabies (100,000 cases), taeniasis (3,000 cases), cysticercosis, rabies from dog bites (1,000 cases), and snakebites envenomation (1,500 cases).
Rwanda’s achievements in the fight against NTDs have been significant, including the validation by WHO of the elimination of Rhodesiense Human Africa Trypanosomiasis (Sleeping Sickness) as a public health problem, solidified by the Kigali Declaration signed by world leaders in 2022, committing to ending NTDs by 2030.
