Updated: Feb 3, 2018
Tunga penetrans (Jiggers) infestation is a disease that affects a high number individuals in Kenya, but has for a long time been neglected. Its impact on communities is generally underestimated, often leading to subtle debilitating sickness that is accompanied with extreme stigma, and may have highly negative impact on the economy and wellbeing of communities.
The prevalence of jiggers often follows a characteristic pattern with a maximum prevalence in children and elderly people. COHESU has a keen interest in school health, and particularly in neglected parasitic infections that are often overlooked in mainstream health programs.
We have identified Tunga as one of the diseases that need immediate attention among school-going children in certain areas of Western Kenya and the Lake Victoria region, and granular mapping of the disease as a first step towards the ability to use resources effectively by knowing exactly where to target efforts.
We launched the exercise in 10 schools, and found the prevalence to stand at 6.8%, ranging from 1.6% to 12.2%. The results of this exercise show a gender bias, with boys habouring more infections than girls. The highest prevalence in the ten schools was in children aged 8-13 years old.
Jiggers are small pin head sized fleas found in warm dry climates. They are native to Central and South America, and were unintentionally introduced by humans to Africa where they are currently wreaking havoc in communities. Jiggers live in dust and sand, and are found on the floors, walls of dwellings and items like furniture. They feed on their hosts including man, cats, dogs, rats, pigs, cattle, sheep and poultry.
Jiggers in small numbers can be managed, but the secondary infections they cause can be fatal. Jiggers mostly attack the feet (especially the toes), but may also attack any part of the body including the head, hands, feet, knees. Symptoms include pain, itching, difficulty walking and sleeping, lack of concentrating in school or work, danger of fatal tetanus infection, inability to carry out normal day to day activities like working or playing, indirectly to poverty, and death. Apart from the physical impacts, there is also the social stigma and low self-esteem associated with shame which worsen the situation by causing the victims to hide the problem.
In Kenya, few surveys have reported infection in most areas except Northern arid-lands. Factors believed to contribute to jigger infection include poverty, lack of access to water and soap, poor personal hygiene, lack of closed shoes, compounds with litter and animal waste, soil types and climate.
COHESU is conducting surveys and mapping tungaensis in Counties around Lake Victoria, Vihiga County, and Kakamega County. The surveys are conducted in primary schools in clusters of 10 schools for reasons of logistics. In each school, students are enrolled using Simprints biometric scanner integrated into COHESU's in-house android application - COHESION.
The current map, shows the infected schools in Red, the unknowns in Yellow, and the non-infected in Green. COHESU would wish to see the entire map turn green! The area of Kisumu Town West Constituency where the facility will be constructed falls in an area that has currently been identified to be RED.Implementation of jigger eradication for COHESU has been boosted by the partnership with TOMS One for One® Company, who have given shoes and sandals to individuals being treated for jiggers.
COHESU undertakes both community and school based treatment of jiggers. School results show that the very young children are most affected, and treatment in the community shows the elderly as being extremely debilitated due to jiggers. For the school-based treatment, it is assumed that the children will be treated in school until cured. For treatment, our technical team starts by cleaning the feet and hands of affected individuals using a disinfectant soap, followed by soaking the feet or hands in 6% Lysol solution for approximately 15 minutes. The feet are then allowed to dry, and a herbal oil called Jigfix is applied to the affected areas. While we have the honor of receiving TOMS shoes, treated individuals are then given TOMS sandals, after the first treatment, and a pair of TOMS canvas shoes when the feet heal.
Community Based Treatment
We understand that for best results, the affected children should be followed up to their homes and their homes sprayed to prevent re-infection. A number of Community Health Workers have been trained and given the Capacity to follow up the children back to their homes for treatment. This provides very successful results, but is very labour intensive. One of the approaches that COHESU has used to help with lack of capacity to follow-up to each child’s home,is operating drop in centers such as the two at Sabatia and Maseno, where community members who are infected can drop in and get treatment. This has worked out very well, and the two communities where these clinics are held have come a long way in overcoming stigma. The Maseno clinic is held on Saturdays under a tree, but the Sabatia clinic is held on most days. The Maseno clinic is limited by lack of a physical facility, treatment supplies and volunteer personnel to run them on a more regular basis. Because of the popularity of these community clinics, COHESU is looking for partnerships to put up a physical facility in Maseno, as well as deploy some community health workers and treatment supplies to meet the demand.
Construction of shed for drop-in treatment
The Maseno drop –in center for jiggers treatment is currently held under a tree at a volunteers house. Those being treated sit under trees on the grass. We would like to see this facility improved so that those being treated can have a place to sit. An improved shed will also be more hygienic and prevent the dangers of individuals reinfecting each other.
The floor of the proposed shed would be cemented so as to be easily cleaned. The roof would protect individuals from the weather, and a tank to harvest water, would provide plenty of water for washing the feet of those under treatment.
Health education and treatment with JIGFIX
(Herbal Jigger remedy made from Neem and Coconut Oil)
There are many myths associated with jiggers, and we hold community trainings to dispel these, and to compel people to seek treatment. We hope to partner with local administration to participate in Chief’s barazas. Ideally the affected houses in the community should also be sprayed, and household members given the necessary health education.
One of the issues encouraged is the need to smear houses regularly with cow dung to avoid cracks on the floors and walls which act as very good breeding grounds for jiggers.
We have successfully used Jigfix schools in the western Region of Kenya i.e. Kisumu county, Busia and Vihiga County. This treatment (Jigfix) has been trialled by KEMRI in Kwale and found to be safe and effective. We conducted a small trial and found it highly effective, simple, quick & painless. It is also effective against bacterial & fungal infections in the skin including ringworm (mashillingi).
Each bottle of jigfix is estimated to treat 3 individuals, and the time it takes for each individual to cure depends on the severity of infection and frequency of treatment.Victims will be encouraged to wear shoes so that the flea cannot find its way into ones feet. Stigma about jiggers is still common among the communities affected.
Domestic animals are still kept too close to and within the houses, which does not help the jigger’s situation at all. To eliminate jiggers, the victims’ homes should be thoroughly fumigated. Victims and their families should be educated on the need to observe hygiene. Animals that may be carrying the fleas should also be treated. Healing victims should check their feet daily for fresh burrowing jiggers which are visible as small black sports and cause itchy sensation, this should be done in the infested areas. We hope that with time, the County governments can prioritize the jigger menace and incorporate spraying of insecticides in the location where the jiggers are rampant.