Assessing the impact of tungiasis on childrens quality of life in Kenya.

Tungiasis is a neglected tropical skin disease caused by the sand flea, Tunga penetrans which penetrates the skin causing considerable pain and itching. In this cross-sectional study we aimed to assess its impact on the quality of life of school children in Kenya. School pupils (198) aged 8-14 years with tungiasis were randomly selected and interviewed using a tungiasis-specific quality of life instrument (TLQI). The caregivers of each infected pupil and 199 randomly selected caregivers of uninfected pupils were interviewed using the proxy KIDscreen52(R) to assess their childs general health-related quality of life (HR-QoL). Generalized linear models were used to assess associations between quality-of-life variables, childrens tungiasis status and other covariables. Among infected children, 62.4% had TLQI scores reflecting a moderate to very high impact, with no significant difference between mild and severe cases. Severe cases had a lower proxy-HR-QoL than uninfected pupils ({beta} -21.15, 95% CI -39.63 - -2.68, p=0.025), but this was not significant in multivariable models. For the first time, this study demonstrated for children whose caregivers were depressed, tungiasis had a higher impact on their quality of life (TLQI adjusted {beta} 0.28, 95% CI 0.08-0.49, p=0.006) and had a lower general HR-QoL (adjusted {beta} -40.34, 95%CI -55.91- -24.76, p<0.001). Conversely, if their caregiver showed them affection, tungiasis had a lower impact on their quality of life (TLQI, adjusted {beta} -0.45, 95% CI -0.70- -0.20, p<0.001). Further studies are needed to investigate the interaction of tungiasis with parenting styles, the mental health of children and their caregivers and their effect on childrens well-being. Plain English SummaryTungiasis is an extremely neglected tropical skin disease which causes immense suffering among children in resource poor communities in many tropical countries. A good quality of life is considered a Right of all people and is consequently used as the most important outcome of treatment programs. The impact on quality of life by tungiasis has only been investigated in very few studies, but evidence of impact is needed to monitor interventions. Here we assessed the impact of the disease on the quality of life of school pupils using a disease-specific instrument with children and a general health-related instrument with their caregivers. The study demonstrated the considerable impact tungiasis has on the quality of life of school-age children. Tungiasis affected childrens ability to sleep and caused feelings of sadness and shame. Tungiasis had a greater impact on children whose caregivers were depressed, and they had a lower general health-related quality of life. Conversely, tungiasis had a lower impact on quality of life for children whose caregivers showed them affection. Further research is needed to investigate the interaction of tungiasis with parenting styles and the mental health of children and their caregivers and their effect on childrens well-being.