Continued persistence of Tungiasis in rural Tanzania’s southern highlands

Background: Tungiasis, a neglected tropical dermatosis caused by the flea Tunga penetrans, imposes a significant burden on health and livelihoods in resource-poor communities. While recognised as a public health issue in Tanzania, high-resolution data on prevalence and drivers of transmission in the Southern Highlands region are scarce. This study aimed to determine the prevalence, demographic patterns, and household-level risk factors associated with tungiasis in this endemic area. Methods: A community-based cross-sectional study was conducted in two villages of Makambako, Njombe region, from April to June 2024. Data were collected through household questionnaires, clinical observation of household members, and environmental assessments. Diagnosis was based on the Fortaleza clinical classification. Logistic regression analysis was used to identify factors independently associated with tungiasis, with results expressed as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: Among 156 surveyed households, the overall prevalence of tungiasis was 53.3% (n=88). Prevalence was high across all age groups: 44% in under-fives and schoolchildren, 44% in adults aged 15-50, and 12% in adults over 50. In multivariable analysis, significant risk factors included: living in a house with earthen or cracked floors (AOR = 4.2, 95% CI: 2.1–8.5), the practice of walking barefoot outdoors (AOR = 3.8, 95% CI: 1.9–7.6), and free roaming of domestic dogs (AOR = 2.9, 95% CI: 1.4–5.8). Ownership of free-roaming poultry and the presence of rodents were also commonly reported in affected households. Conclusion: This study reveals an alarmingly high prevalence of tungiasis in the Southern Highlands, driven by a synergy of environmental, behavioural, and zoonotic factors. The findings underscore the urgent need for an integrated, One Health intervention strategy. This should combine targeted health education on footwear use and safe treatment, house improvement programs focusing on floor sealing, and veterinary public health measures to control flea reservoirs in domestic animals, particularly dogs.