{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:11:15Z","timestamp":1788171075217,"version":"build-2803163510"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\nIntroduction<\/jats:title>\nTungiasis is an overlooked tropical disease resulting from the penetration of the skin by sand fleas. It leads to significant suffering and can be fatal, particularly affecting school age children and elders, primarily above 60 years old, in rural and urban slums across Sub-Saharan Africa. Despite its great public health consequences, the condition remains largely under reported by the scientific communities mainly in Sub Saharan African countries.<\/jats:p>\n<\/jats:sec>\n\nObjective<\/jats:title>\nTo assess the prevalence of Tungiasis and associated factors among school-age children in Sub-Saharan Africa.<\/jats:p>\n<\/jats:sec>\n\nMethods and materials<\/jats:title>\nThis systematic review and meta-analysis was done based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020). Literatures were searched from a variety of databases, including PubMed, Science-Direct, Google Scholar, Hinari, and Google. The eligible studies data were extracted using Microsoft Excel and exported to statistical software, STATA version 14 for further analysis. A random-effect model was considered to estimate the prevalence of Tungiasis. The Egger test and funnel plot were used to evaluate publication bias, whereas I2<\/jats:sup> statistic was used to measure heterogeneity. The finding of this SRMA was done using 23 selected studies with 9781 study participants.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThis review revealed that the pooled prevalence of Tungiasis was 37.86%% (95% CI: 30.95\u201344.77; I2\u2009=\u200998.3%, P\u2009<\u20090.000). In terms of risk factors of Tungiasis, school children who lived with domestic animals (cat or dog) in their home were 2.73 times more likely to affected by Tungiasis compared to those without these pets in their home (OR: 2.73, 95% CI: 1.53\u20133.94). Additionally, school age children who did not wear shoes at all and wear occasionally were 11.26 (AOR: 11.26, 95% CI: 4.04, 18.49) and 7.61 (OR: 7.61, 95% CI: 3.39, 11.83) more likely to affected by Tungiasis compared to those who were regularly. Finally, school-age children who lived in mud-plastered walls were 4.97 times more likely to be affected by Tungiasis compared to those who lived in cemented wall homes (OR: 4.97, 95% CI: 2.61, 4.61).<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nGenerally, this systematic review and meta-analysis disclosed that a third of school age children were affected by Tungiasis. Additionally, housing conditions, shoe-wearing practices, and the condition of living with domestic animals were factors significantly associated with Tungiasis. Hence, concerned governmental and non-governmental organizations should work to enhance behavioral modification towards prevention and control of Tungiasis. One-third of the school-aged children were affected by Tungiasis. Contributing factors included inadequate housing conditions, footwear habits, and the presence of domestic animals. Therefore, relevant governmental and non-governmental organizations should promote behavioral changes to prevent and control Tungiasis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0321513","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T17:36:18Z","timestamp":1746725778000},"page":"e0321513","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prevalence and factors associated with Tungiasis among school age children in Sub Saharan Africa: A systematic review and 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Adriko","year":"2022"},{"issue":"10","key":"pone.0321513.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003133","article-title":"Tungiasis--a neglected disease with many challenges for global public health","volume":"8","author":"H Feldmeier","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0321513.ref014","unstructured":"Tukahebwa M, Nuwa A, Kimera I, Walimbwa GB, Odong S, Senabulya GW, et al. 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Ngunjiri","year":"2015","journal-title":"International Research Journal of Public and Environmental Health"},{"key":"pone.0321513.ref020","unstructured":"Gitau AK, Oyieke FO, Richard W. Assessment of tungiasis management knowledge in Kandara sub-county, Kenya. 2021."},{"issue":"3","key":"pone.0321513.ref021","first-page":"1180","article-title":"Prevalence of jigger flea (Tunga Penetrans) infestation amongst age groups, male and female persons in Jinja District, Eastern Uganda.","volume":"7","author":"G Amatre","year":"2018","journal-title":"International Journal of Science and Research"},{"key":"pone.0321513.ref022","unstructured":"Gitau AK, Oyieke FA. Assessment of the Role Played by Housing Conditions in Exacerbating Tungiasis in Kandara Sub-County, Kenya. 2022."},{"issue":"4","key":"pone.0321513.ref023","first-page":"80","article-title":"Factors Associated with Tungiasis Infestation among School age Children in Ugenya Sub-County, Siaya County, Kenya","volume":"33","author":"J Mwai","year":"2020","journal-title":"African Journal of Health Sciences"},{"issue":"10","key":"pone.0321513.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259411","article-title":"Prevalence and associated factors of Tunga penetrans infestation among 5-14-year-olds in rural Ethiopia","volume":"16","author":"A Tamene","year":"2021","journal-title":"PLoS One"},{"key":"pone.0321513.ref025","doi-asserted-by":"crossref","first-page":"106076","DOI":"10.1016\/j.actatropica.2021.106076","article-title":"Evaluating the potentials of randomised integrated control trial on tungiasis in a South-western Nigerian community","volume":"223","author":"VN Enwemiwe","year":"2021","journal-title":"Acta Trop"},{"issue":"2","key":"pone.0321513.ref026","doi-asserted-by":"crossref","DOI":"10.4081\/jphia.2011.e21","article-title":"Severe tungiasis in Western Tanzania: case series","volume":"2","author":"HD Mazigo","year":"2011","journal-title":"Journal of Public Health in Africa"},{"key":"pone.0321513.ref027","unstructured":"Namuhani N, Kiwanuka SN. Jigger persistence and associated factors among households in Mayuge District, Uganda. 2016."},{"issue":"1","key":"pone.0321513.ref028","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s41182-021-00338-8","article-title":"Presence of dogs and proximity to a wildlife reserve increase household level risk of tungiasis in Kwale, Kenya","volume":"49","author":"PS Larson","year":"2021","journal-title":"Trop Med Health"},{"issue":"5","key":"pone.0321513.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011800","article-title":"Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life","volume":"18","author":"L Elson","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pone.0321513.ref030","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0262168","article-title":"Prevalence of Tungiasis and its risk factors of among children of Mettu woreda, southwest Ethiopia, 2020","volume":"17","author":"SD Jorga","year":"2022","journal-title":"PLoS One"},{"key":"pone.0321513.ref031","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"key":"pone.0321513.ref032","unstructured":"Peters MD, et al. The Joanna Briggs Institute reviewers\u2019 manual 2015: methodology for JBI scoping reviews. 2015."},{"issue":"11","key":"pone.0321513.ref033","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"JPT Higgins","year":"2002","journal-title":"Stat Med"},{"issue":"7109","key":"pone.0321513.ref034","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"M Egger","year":"1997","journal-title":"BMJ"},{"issue":"4","key":"pone.0321513.ref035","article-title":"The Prevalence, Risk Factors and Treatment Methods for Tungiasis among Residents of Musokoto Sub-Location, in Kenya","volume":"4","author":"N Albert","year":"2016","journal-title":"Prevalence"},{"key":"pone.0321513.ref036","unstructured":"Joseph C. Tunga penetrans, Pediculus capitis and Sarcopte scabei infestations among Children < 15yrs in Kamagut Location, Uasin Gishu District, Kenya. 2009."},{"issue":"1","key":"pone.0321513.ref037","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/inthealth\/ihac013","article-title":"Factors associated with tungiasis among school-age children in Kwale County, rural Kenya","volume":"15","author":"J Mwai","year":"2023","journal-title":"Int Health"},{"issue":"3","key":"pone.0321513.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003517","article-title":"Characterization of Tunga penetrans antigens in selected epidemic areas in Murang\u2019a county in Kenya","volume":"9","author":"JN Mwangi","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0321513.ref039","article-title":"Epidemiology of Tunga penetrans Infestation and Antigens Characterization in Selected Locations in Kiharu Constituency, Murang\u2019a County, Kenya","author":"MJ Ndung\u2019u","year":"2015"},{"key":"pone.0321513.ref040","unstructured":"OkothAA. Tungiasis in Western Kenya: Knowledge, Perceptions, and Practices of Household Heads\u2013A Crossectional Study. n.d."},{"issue":"10","key":"pone.0321513.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005925","article-title":"Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. 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Hygiene and skin infections among children below 15 years in Rukindo Primary School, Bushenyi-Ishaka Municipality, Bushenyi District-Western Uganda. 2017."},{"issue":"1","key":"pone.0321513.ref050","first-page":"2","article-title":"Tungiasis: a neglected health problem in rural Cameroon","volume":"1","author":"G Collins","year":"2009","journal-title":"International Journal of Collaborative Research on Internal Medicine and Public Health"},{"key":"pone.0321513.ref051","volume-title":"Impact of Tungiasis on school age children in Muranga county, Kenya","author":"JW Ngunjiri","year":"2015"},{"issue":"5","key":"pone.0321513.ref052","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/j.1365-4632.2007.03245.x","article-title":"Tungiasis: high prevalence, parasite load, and morbidity in a rural community in Lagos State, Nigeria","volume":"46","author":"US Ugbomoiko","year":"2007","journal-title":"Int J Dermatol"},{"key":"pone.0321513.ref053","volume-title":"Morbidity, Risk Factors, and flea species responsible for Tungiasis in selected villages in Kisumu County, Kenya","author":"AA Okoth","year":"2015"},{"key":"pone.0321513.ref054","first-page":"177","volume-title":"Geospatial Analysis of Tungiasis Disease Transmission Risk in East Africa, in Health Geography in Sub-Saharan Africa: Development-Health Nexus","author":"MA Deka","year":"2023"},{"issue":"1","key":"pone.0321513.ref055","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005939","article-title":"Tungiasis-related life quality impairment in children living in rural Kenya","volume":"12","author":"S Wiese","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0321513.ref056","article-title":"Knowledge, attitude and practices on jigger infestation among household members aged 18 to 60 years: case study of a rural location in Kenya","volume":"13","author":"B Kimani","year":"2012","journal-title":"The Pan African Medical Journal"},{"issue":"4","key":"pone.0321513.ref057","first-page":"440","article-title":"Tungiasis in Bangou (West Cameroon)","volume":"22","author":"P Bour\u00e9e","year":"2012","journal-title":"Med Sante Trop"},{"key":"pone.0321513.ref058","article-title":"Prevalence of Tungiasis and its associated risk factors among residents of Kipkelion West Sub-county, Kericho County, Kenya","author":"S Waruguru Chiuri","year":"2016"},{"key":"pone.0321513.ref059","first-page":"56","article-title":"Tungiasis in rural communities of Badagry Local Government Area, Lagos State, Nigeria","volume":"4","author":"O. 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