Introduction

Tungiasis is defined as a dermatological disease caused by two types of sand fleas known as Tunga penetrans and Tunga trimammillata. These sand flea species are both female and are two of the thirteen total female species of sand fleas.¹ This parasitic disease is typically contracted through these fleas biting the feet. Regarding the geographical distribution of this condition, most cases are in resource-poor communities within tropical and subtropical regions such as South America and Africa, alongside the Caribbean islands.² Studies in many different regions, such as in certain parts of Brazil, have revealed that there is a wide array of socio-economic factors which influence the prevalence of Tungiasis. Generally, this condition affects poor communities such as those living in slums of shanty towns.³ This article is going to explore the relationship between Tungiasis and poverty.

Different case studies will be evaluated, as well as how tungiasis affects people both socially and economically, alongside the obvious health concerns. This article will also delve into preventative measures and future strategies to lower the future prevalence of this condition.

Understanding tungiasis

As aforementioned, the most common flea that leads to tungiasis is Tunga penetrans. Studies have revealed that the larvae of these fleas take approximately 1-6 days to hatch from their eggs and that pupa formation occurs a couple of days later. This is the stage between a larva and an adult flea. Within another 8 days, an adult flea is formed, and after five minutes, it tries to find a host and enter the skin. A day later, most of the flea enters the skin, and prior to two days, the flea fully enters the human host, where they lay eggs 6 days later.⁴ Transmission typically occurs around an area where there is contaminated soil, as this is where animal hosts are situated; these fleas can travel many hundreds of kilometres on a daily basis, hence people in these areas are very susceptible to this condition.⁵ 

The main symptoms are inflammation, pain and lesions which are characteristic of tungiasis manifestation. These fleas are vectors for other pathogens; hence, secondary infections are also common in instances of this disease.⁶ The physical symptoms, such as itching, swelling and general pain, are obvious and easy to diagnose; however, tungiasis also has physiological implications, as those infected may feel isolated, since this condition is largely stigmatised due to the association with poor sanitation and living conditions.⁷

Poverty as a risk factor for tungiasis

Poverty is a clear risk factor for this condition, and there are a variety of factors due to poverty which lead to an increased prevalence of this condition. Poor infrastructure and housing are issues, as the floors are very dirty. In some areas within lower-income countries, livestock may be kept within the housing, and feral matter such as cow dung may be on the floors, making this very unsanitary and a breeding ground for fleas.⁸ Lower water availability in poor housing leads to less than adequate sanitation, which also increases the risk of being bitten by a flea, particularly if people do not wash their feet, as this is a common mode of penetration.⁹

Resources are also important regarding tungiasis prevalence, as those with lower access to protective clothing and footwear are much more likely to be susceptible to flea bites.¹⁰ Healthcare providers in communities that are commonly affected by Tungiasis do not have the resources to treat this condition and can neglect this disease; hence, there is low access to treatment and management of the condition, which is linked to poverty.¹¹ The environment is a

very important risk factor; for example, in some poverty-stricken areas, the indoor areas used for sleeping are within close proximity of unclean outdoor areas; thus, they are targeted by fleas. Fortunately, it is easy to identify infection hotspots as a result, and this can be mitigated by targeting living locations and areas affected by flea infestations.¹²

The vicious cycle of tungiasis and poverty

Tungiasis has a wide array of socio-economic impacts. This condition has a large economic impact on the affected communities due to the disease greatly limiting productivity. This is due to those with this disease having limited ability to work and having mobility difficulties. Due to this disease being stigmatised and being indicative of poverty, as aforementioned, this leads to fewer people who are willing to be seen in public.¹³ Also, there is a lack of low-cost treatments and management strategies, which further contributes to economic implications in the affected communities.¹⁴ The social impact cannot be underestimated, as those with the disease may feel ashamed to work or be unable to work due to the stigma of this condition.¹³ 

Tungiasis mainly affects those who are younger in age, and this disease leads to lower school attendance, thus negatively affecting academic achievement for those with the condition.¹⁵ Tungiasis can lead to many long-term complications, such as tetanus; thus, this disease has a major negative impact on the health of individuals.¹⁶ As this disease is largely neglected by healthcare providers, tungiasis leads to higher overall healthcare costs and lower accessibility for those who are impoverished, which in turn contributes to increased poverty.¹⁴

Preventive and control measures

There are many available strategies to lower the prevalence of tungiasis. Firstly, educating communities about the risk factors for tungiasis and encouraging people to wear shoes will prevent flea bites and ensure that hygiene measures are put in place to prevent fleas from infecting humans.¹⁷ Increasing access to treatments and encouraging knowledge about this condition through outreach initiatives are also key in reducing the number of people with tungiasis. Making healthcare affordable for those with the disease is integral in decreasing the prevalence of tungiasis.¹⁸

As previously mentioned, this disease is typically neglected by organisations. Government initiatives and the work of non-governmental organisations (NGOs) in the near future will therefore be key in lowering the effects of poverty in poorer communities.¹⁹ Increasing the awareness and overall knowledge of this disease in public health is crucial so that initiatives can be put in place to tackle this condition and the vicious poverty cycle.²⁰

Case studies and examples

There have been a few instances in which measures have been successful in managing tungiasis. In rural Nigeria, for example, pigs, which commonly attract fleas, were prevented from roaming freely and housed in pigpens. This ensured that there were appropriately isolated, and the communities were less susceptible to infection. House developments were also implemented, such as by sealing the floors that were previously made out of sand, therefore ensuring that the floors were cleaner. As well as this, tetanus infections were introduced to prevent secondary interventions, and the use of footwear was increased to lower the chance of flea bites.²¹ 

Similar strategies and awareness campaigns have been introduced in other countries, such as Kenya, and have proved relatively successful thus far.²² Unfortunately, in some instances, such as in a Brazilian fishing community, interventions have not been effective. There needs to be higher accessibility to treatment in these communities, and the environments must be monitored closely.²³

Summary

Poverty and tungiasis are greatly linked. Tungiasis is typically spread as a result of factors linked to poverty, such as limited access to healthcare and resources, such as footwear, alongside limited healthcare accessibility. In order to prevent this from being an issue, there needs to be a much higher awareness of this disease and more efforts in place to reduce risk factors, such as better sanitary practices. This condition is largely neglected; hence, public health interventions are required to try and gradually lower the prevalence of tungiasis in poverty-stricken communities. Poverty and this condition follow a cycle, as this disease leads to further poverty; hence, dealing with poverty is essential in ensuring that this disease becomes less of an issue in the future.