Tungiasis-related knowledge and treatment practices in two endemic communities in northeast Brazil

Background: Tungiasis, caused by the sand flea Tunga penetrans, is highly prevalent in many resource-poor communities in sub-Saharan Africa, Latin America and the Caribbean. Studies on knowledge and treatment practices related to tungiasis in affected populations are virtually nonexistent. To fill this gap, we performed a study in two resource-poor communities in northeast Brazil where this parasitic skin disease is highly prevalent. Methodology: Structured interviews were realized in a representative sample of household leaders in an urban slum in Fortaleza, capital of Ceara State (northeast Brazil), and in a traditional fishing village 60 km southeast of the city. Results: Two hundred ninety household leaders were interviewed in the urban slum and 136 in the fishing village. Knowledge about the etiological agent of tungiasis and its transmission was high in both communities: 90% knew the flea as the etiological agent of tungiasis. Transmission of tungiasis was thought to be related to sandy soil (72% and 84% in the urban slum and in the fishing village, respectively), presence of animals (52% and 59%), walking barefoot (5% and 23%), and with the presence of garbage littering the area (23% and 21%). Surgical extraction of embedded sand fleas using unsterile sewing needles was the most commonly treatment applied (97% and 96%). In addition, a variety of topical products and medical ointments was used. Mothers were almost exclusively responsible for treatment and knowledge transfer to the next generation. The health sector neither provided health education nor treatment. Conclusions: In communities of low socio-economic status in northeast Brazil, knowledge on tungiasis was high, but individuals did not follow appropriate treatment. A reduction of intensity of infestation, bacterial superinfection and associated morbidity is feasible with minimum support from the health sector, such as supplying hypodermic needles and disinfectants to mothers, and targeted health education.