Classification of tungiasis lesions [1].

Tungiasis is a widespread and debilitating zoonotic Neglected Tropical Disease (NTD). Manual extraction of the sand fleas with non-sterile sharp instruments is the most common but unsafe treatment method in affected communities. Topical application of a dimeticone oil formula (NYDA) has previously been shown to be a safe and effective method of killing embedded sand fleas. The objective of this study was to evaluate a two-year long humanitarian One Health tungiasis control project in 17 villages in Napak district, Karamoja region, Northeastern Uganda. The community-based intervention included quarterly systematic tungiasis detection and treatment with the dimeticone oil formula in residents and domestic animals in combination with community health promotion. In each of the eight quarterly tungiasis diagnosis and treatment rounds, between 3,674 and 5,155 residents were examined (coverage 73.6-89.9%). Overall, 12,540 tungiasis cases among residents were diagnosed and treated and 16 community dialogue meetings were held. Tungiasis prevalence among residents decreased from 62.8% to 5.7% in the two-year study period. While at baseline tungiasis was most prevalent in children and the elderly, at the end elderly women were the single most affected group. The prevalence of tungiasis-related walking difficulties in the community decreased from 11.5% to 0.5%, and pain and itching were greatly reduced. The number of animals present in the villages was low (between 79 and 414 per treatment round) and the prevalence of tungiasis in animals dropped from 14.2% to 0% throughout the two-year project. This implementation study shows that regular community-based treatment of tungiasis cases among humans and animals with dimeticone oil formula, combined with community engagement and health promotion, can reduce tungiasis prevalence and morbidity to very low levels within two years, even in a hyperendemic area where people live in extreme poverty.