Jiggers: A neglected public health concern
WHEN the Tororo resident district commissioner, Samuel Mpimbaza Hashaka, attributed the district’s low performance in the 2007 Primary Leaving Examinations (PLE) to jiggers, many treated his remarks as a joke.<br>Jiggers are synonymous with ridicule and stigmatisation.
By Irene Nabusoba
WHEN the Tororo resident district commissioner, Samuel Mpimbaza Hashaka, attributed the district’s low performance in the 2007 Primary Leaving Examinations (PLE) to jiggers, many treated his remarks as a joke.
Jiggers are synonymous with ridicule and stigmatisation.
When mentioned, the problem is brushed off as a thing of the past, or as a minor problem that can be relegated for more pressing issues.
But public health experts warn that heavy infestations of jiggers go beyond mere discomfort. Infestation leads to loss of toe/finger nails, amputation of the digits and could cause death from the high risk of tetanus — a common secondary infection.
But the most worrying concern is that jiggers have been found to be a channel for transmission of HIV/AIDS.
“HIV/AIDS can be passed from one person to another in the process of sharing sharp instruments like pins, which are used to remove the jiggers,†says Dr. Dawson Mbulamberi, the assistant commissioner of health services in charge of control of vector-borne diseases at the Ministry of Health.
Mbulamberi says since jiggers are synonymous with poverty and illiteracy, the victims cannot afford razorblades and safety pins that are used to remove the pests.
“They repeatedly use old, rusted instruments which they share, risking infection of tetanus and HIV/AIDS. We have not conducted any studies to ascertain the extent of this problem because of financial constraints, but jiggers have for long been a neglected tropical health problem,†Mbulamberi says.
Jiggers, scientifically known as Tunga Penetrans or ordinarily as sand fleas, feed on blood by burrowing into the skin of their host. The abdomen becomes enormously enlarged so that the flea forms a round sac, like a pea.
A Kenyan-based anti-jigger website, www.jigger-ahadi.org, says the bug embeds itself in the skin under the toe and finger nails. The resultant sores become infected and may fill with pus.
It notes that the risk of transmission of HIV/AIDS is likely through infected blood on unsterilised equipment from a person with jiggers.
“It was noted that many people share a single pin to extract jiggers. This is a situation that exposes individuals to HIV infection from those who already have the virus,†the site warns.
Ahadi is one of the worst jigger infested areas in Kenya.
“The first evidence of infestation by this sand flea is a tiny black dot on the skin at the point of penetration. Because the flea is a poor jumper, most lesions occur on the feet, often on the soles, the toe webs, and around or under the toenails,†the site says.
Mbulamberi says children and the aged are particularly vulnerable. “If they have negligent caretakers or live on their own, in cases of old grandparents, infestation may become severe, resulting in a cluster of nodules with a honey comb appearance,†he says.
The infestation begins to irritate and itch when almost fully developed, sometimes causing severe inflammation and ulceration.
If the female flea dies in the skin, it may cause a secondary infection which, if ignored, could lead to tetanus, gangrene and even loss of a toe.
Prevalence and magnitude of the problem
Mbulamberi says jiggers are commonest in Busoga region, particularly Kamuli district in a village called Mawandala.
“The area MP, who is the minister of state for regional affairs, Isaac Musumba, wrote to the Ministry of Health to intervene. The jigger problem is causing misery to its victims in many rural areas. It is just that we have not done any mapping of the affected areas,†he says.
“We plan to go there and embark on a massive public health campaign. We have sent teams ahead, but since jiggers do not cause many deaths, they do not attract donor or government funding,†he says.
Other areas affected are Kagadi in Kibaale district, Kayonza sub-county in Kayunga, Tororo district, Kisoro, among many other rural areas.
Mbulamberi says since jiggers feed on blood, one could get anaemia (blood deficiency).
“If infestation lasts about one to two months, it could lead to death. This is because people are not productive and this could lead to other factors like starvation,†he warns.
Observation of the victims shows that jiggers cause pain and difficulty in walking. Victims move in a zig-zag form, with their feet facing opposite directions. The toes often point in different directions, with ugly appearances because of the various extractions.
The skin does not fall back into its original position with ease.
“Such people will not be productive economically. School-going children are not able to concentrate in class. For others, infestation leads to absenteeism,†says Ibrahim Kanakulya, the district education officer, Kamuli district.
“Besides, there is some degree of stigmatisation of the victims, leading to low self-esteem,†Kanakulya adds.
Management
On www.jigger-ahadi.org, it is noted that treatment consists of the extraction of the entire insect intact. Breaking the jigger may cause inflammation and possible infection.
It adds that the best recommended treatment is to soak the feet in a solution of alcohol, hydrogen peroxide or the other disinfectants like Dettol or Savlon.
“The victim should soak their feet for about 15 minutes everyday for about two weeks. This will completely kill the bugs,†it says.
For complete eradication of the bug, people’s homes should be thoroughly fumigated and any animals that have fleas treated. The victim and the rest of the family should be educated on the need to observe strict hygiene. Wearing shoes should also be encouraged.
“In infested areas, people should check their feet daily.
The fleas can also be deterred by a repellent applied to the skin,†Mbulamberi says. He adds that if it is possible to locate the area where the jiggers originate, it should be burnt off or sprayed with a suitable insecticide.
He urges people to smear their floors with cow dung to avoid dust and to stop sharing accommodation with animals and birds. “People should also not store produce in the house. They should build granaries.
Food in the house attracts rats which carry fleas,†he says.
A school inspector in Busoga, who preferred anonymity, regrets that schools are not observing hygiene as effectively as they used to be because of the big numbers of pupils.
“In the past,†he says, “pupils would be inspected for jiggers, lice and bedbugs at parades and during Physical Education. Hence, the problem of jiggers is compounded because of lack of responsible caretaker, especially for orphans and children living with old grandparents, or drunks.â€
The most effective approach, however, is massive campaigns on hygiene. But who will save these rural ‘stone-age’ souls when everyone seems to have resigned to the emerging problems of the ‘dot.com era’?
Tips for community leaders on
how to manage jiggers
Make regular visits to schools to inspect the children.
Find out why these pests are prevalent. Most of the cases are due to unhygienic conditions like dusty floors and improper personal hygiene in children.
Visit homes and find out the living conditions of the children and old people.
Take up the issue with your higher local government in order to find a solution, like massive spraying or indoor fumigation. An ideal solution would be to spray classrooms with pesticides.
Encourage people to apply cow dung onto dusty floors.
Children should be encouraged to bathe with soap and keep their nails short.
Jiggers in children can also be removed by use of methylated spirit, applied on the affected areas.
Residents should be cautioned against sharing accommodation with animals and birds.
Advise people to make special stores for their produce.
WHEN the Tororo resident district commissioner, Samuel Mpimbaza Hashaka, attributed the district’s low performance in the 2007 Primary Leaving Examinations (PLE) to jiggers, many treated his remarks as a joke.
Jiggers are synonymous with ridicule and stigmatisation.
When mentioned, the problem is brushed off as a thing of the past, or as a minor problem that can be relegated for more pressing issues.
But public health experts warn that heavy infestations of jiggers go beyond mere discomfort. Infestation leads to loss of toe/finger nails, amputation of the digits and could cause death from the high risk of tetanus — a common secondary infection.
But the most worrying concern is that jiggers have been found to be a channel for transmission of HIV/AIDS.
“HIV/AIDS can be passed from one person to another in the process of sharing sharp instruments like pins, which are used to remove the jiggers,†says Dr. Dawson Mbulamberi, the assistant commissioner of health services in charge of control of vector-borne diseases at the Ministry of Health.
Mbulamberi says since jiggers are synonymous with poverty and illiteracy, the victims cannot afford razorblades and safety pins that are used to remove the pests.
“They repeatedly use old, rusted instruments which they share, risking infection of tetanus and HIV/AIDS. We have not conducted any studies to ascertain the extent of this problem because of financial constraints, but jiggers have for long been a neglected tropical health problem,†Mbulamberi says.
Jiggers, scientifically known as Tunga Penetrans or ordinarily as sand fleas, feed on blood by burrowing into the skin of their host. The abdomen becomes enormously enlarged so that the flea forms a round sac, like a pea.
A Kenyan-based anti-jigger website, www.jigger-ahadi.org, says the bug embeds itself in the skin under the toe and finger nails. The resultant sores become infected and may fill with pus.
It notes that the risk of transmission of HIV/AIDS is likely through infected blood on unsterilised equipment from a person with jiggers.
“It was noted that many people share a single pin to extract jiggers. This is a situation that exposes individuals to HIV infection from those who already have the virus,†the site warns.
Ahadi is one of the worst jigger infested areas in Kenya.
“The first evidence of infestation by this sand flea is a tiny black dot on the skin at the point of penetration. Because the flea is a poor jumper, most lesions occur on the feet, often on the soles, the toe webs, and around or under the toenails,†the site says.
Mbulamberi says children and the aged are particularly vulnerable. “If they have negligent caretakers or live on their own, in cases of old grandparents, infestation may become severe, resulting in a cluster of nodules with a honey comb appearance,†he says.
The infestation begins to irritate and itch when almost fully developed, sometimes causing severe inflammation and ulceration.
If the female flea dies in the skin, it may cause a secondary infection which, if ignored, could lead to tetanus, gangrene and even loss of a toe.
Prevalence and magnitude of the problem
Mbulamberi says jiggers are commonest in Busoga region, particularly Kamuli district in a village called Mawandala.
“The area MP, who is the minister of state for regional affairs, Isaac Musumba, wrote to the Ministry of Health to intervene. The jigger problem is causing misery to its victims in many rural areas. It is just that we have not done any mapping of the affected areas,†he says.
“We plan to go there and embark on a massive public health campaign. We have sent teams ahead, but since jiggers do not cause many deaths, they do not attract donor or government funding,†he says.
Other areas affected are Kagadi in Kibaale district, Kayonza sub-county in Kayunga, Tororo district, Kisoro, among many other rural areas.
Mbulamberi says since jiggers feed on blood, one could get anaemia (blood deficiency).
“If infestation lasts about one to two months, it could lead to death. This is because people are not productive and this could lead to other factors like starvation,†he warns.
Observation of the victims shows that jiggers cause pain and difficulty in walking. Victims move in a zig-zag form, with their feet facing opposite directions. The toes often point in different directions, with ugly appearances because of the various extractions.
The skin does not fall back into its original position with ease.
“Such people will not be productive economically. School-going children are not able to concentrate in class. For others, infestation leads to absenteeism,†says Ibrahim Kanakulya, the district education officer, Kamuli district.
“Besides, there is some degree of stigmatisation of the victims, leading to low self-esteem,†Kanakulya adds.
Management
On www.jigger-ahadi.org, it is noted that treatment consists of the extraction of the entire insect intact. Breaking the jigger may cause inflammation and possible infection.
It adds that the best recommended treatment is to soak the feet in a solution of alcohol, hydrogen peroxide or the other disinfectants like Dettol or Savlon.
“The victim should soak their feet for about 15 minutes everyday for about two weeks. This will completely kill the bugs,†it says.
For complete eradication of the bug, people’s homes should be thoroughly fumigated and any animals that have fleas treated. The victim and the rest of the family should be educated on the need to observe strict hygiene. Wearing shoes should also be encouraged.
“In infested areas, people should check their feet daily.
The fleas can also be deterred by a repellent applied to the skin,†Mbulamberi says. He adds that if it is possible to locate the area where the jiggers originate, it should be burnt off or sprayed with a suitable insecticide.
He urges people to smear their floors with cow dung to avoid dust and to stop sharing accommodation with animals and birds. “People should also not store produce in the house. They should build granaries.
Food in the house attracts rats which carry fleas,†he says.
A school inspector in Busoga, who preferred anonymity, regrets that schools are not observing hygiene as effectively as they used to be because of the big numbers of pupils.
“In the past,†he says, “pupils would be inspected for jiggers, lice and bedbugs at parades and during Physical Education. Hence, the problem of jiggers is compounded because of lack of responsible caretaker, especially for orphans and children living with old grandparents, or drunks.â€
The most effective approach, however, is massive campaigns on hygiene. But who will save these rural ‘stone-age’ souls when everyone seems to have resigned to the emerging problems of the ‘dot.com era’?
Tips for community leaders on
how to manage jiggers
Make regular visits to schools to inspect the children.
Find out why these pests are prevalent. Most of the cases are due to unhygienic conditions like dusty floors and improper personal hygiene in children.
Visit homes and find out the living conditions of the children and old people.
Take up the issue with your higher local government in order to find a solution, like massive spraying or indoor fumigation. An ideal solution would be to spray classrooms with pesticides.
Encourage people to apply cow dung onto dusty floors.
Children should be encouraged to bathe with soap and keep their nails short.
Jiggers in children can also be removed by use of methylated spirit, applied on the affected areas.
Residents should be cautioned against sharing accommodation with animals and birds.
Advise people to make special stores for their produce.