Cover Picture: Tungiasis is a parasitic skin disease caused by the sand flea Tunga penetrans. It has been classified by the WHO as a neglected tropical disease, and is highly endemic in many resource-poor population in sub-Saharan Africa, Latin America and the Caribbean. In Africa, tungiasis is widespread, and in Nigeria it has been considered a public health problem. This study presents the results of an evidence-based One Health intervention in a rural Nigerian community, based on identified risk factors. Cement was provided for free to community members, and community participation was encouraged for upgrading houses by sealing sandy floors which serve as breeding sites for the off-host stages of the flea. Free-roaming pigs which serve as animal reservoirs were banned, and pig farming was discouraged, and pigs were confined to pigpens. The community members were encouraged to use footwear regularly, and to clean the compounds and streets from waste. The prevalence was reduced from 45% to 21%, after one year, and severe symptoms and pathology (such as difficulty walking, deformation of toenails, loss of toenails, and bacterial superinfection) were reduced from high to negligible levels. After 14 years, no active tungiasis was found at all in the community. This study shows that sustainable intervention is feasibly at low cost, based on the One Health approach. Policy makers and health professionals will have to create synergies between communities and regions and develop local, national, and regional control programs to reduce the severe burden caused by tungiasis, with the aim to eliminate tungiasis as a public health problem from the African continent.
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