Tungiasis pilot studies
Tungiasis, a parasitic skin disease, inflicts pain and suffering on millions of people in Sub-Saharan Africa, and yet gets little attention from donors, scientists, governments and health workers. It is an ectoparasitosis affecting the poorest of the poor living in tropical and subtropical conditions. In resource-poor communities without optimal medical care and limited ability to pay for expensive medications, prevention is the most valuable control measure. There is currently no effective, widely available, safe and simple treatment for tungiasis. Instead communities in their desperation remove the embedded fleas using unsterilized pins and plant thorns which carry huge risk of secondary infection with bacteria and viruses.
We currently implement two projects:
(1) Risk factor analyses to identify key determinant of the disease including the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours. To date, all factors identified to double and triple disease risk were directly associated with lowest socio-economic status; namely poor housing, specifically the absence of a cemented floor, lack of hygiene in terms of regularly washing with water and soap, poor clothing including the absence of shoes. Entomological sampling showed that infection hotspots are people’s homes, specifically the bedrooms of children. School surveys also indicated an increased risk when schools were overcrowded, and classroom floors were not cemented. Findings indicate that simple measures could be implemented to prevent the disease. Based on these findings we are currently developing proposal ideas.
(2) Phase IIA, randomised controlled trial of a locally-made, herbal remedy (neem & coconut oil) for treatment of sand fleas (Tunga penetrans; jiggers)
The government of Kenya currently recommends the use of potassium permanganate for treatment of jiggers which is ineffective and painful. In Kilifi County, a mix of natural products based mostly on neem oil and coconut oil is used by local community self-help groups and observational studies suggest high effectiveness and acceptability. Coconut oil is widely used in the food and cosmetics industry and neem oil is known to have antiseptic and insecticidal properties. Their combined effect on pathology, bacteria, fungi or insects has never been tested scientifically. We developed a clinical trial protocol which was approved by the Expert Committee for Clinical Trials by the Kenyan Pharmacy and Poisons Board to generate phase II evidence for the efficacy and safety of neem oil for treatment of tungiasis. We have consequently established a working relationship with the MOH and community stakeholders in Kilifi Country and are currently (February to March 2018) implementing the trial which is monitored by an independent trial monitor.
Role: Dr. U. Fillinger - PI.
Donor: German Doctors e.V.
Collaborations: Charité Medical School, Berlin (Prof Feldmeier); Berlin University, Institute of Parasitology and Tropical Veterinary Medicine (Dr Juergen Kruecken); WAJIMIDA Jigger Campaign Watamu, Kenya (Dr Lynne Elson). 2016-2018.