Assessment of the school environment for risk factors for tungiasis in nine counties of Kenya: a cross-sectional survey

BackgroundTungiasis is a neglected tropical skin disease mostly affecting children under 15 years, the elderly and disabled people in the most resource poor populations in Latin America and Sub-Saharan Africa. While most transmission seems to occur at home inside houses, we aimed to identify factors in the school environment that may put children at increased risk of infection. MethodsAs part of a cross-sectional school-based prevalence survey of 21,466 pupils in nine counties of Kenya, observations of school infrastructure were made and the headteacher interviewed in each of 196 schools. In a subset of 97 schools, detailed observations of 322 classrooms were made and 117 teachers interviewed. Mixed effect logistic regression models were used to identify factors associated with tungiasis infection in pupils. ResultsWe found a higher odds of tungiasis infection for pupils in schools where more than 400 pupils were enrolled (aOR 2.24, 95% CI 1.12-4.50, p=0.023), where clean water was not always available (aOR 2.28, 95% CI 1.13-4.60, p=0.021); and if the school buildings were in a bad structural condition (aOR 2.15, 95% CI 1.00-4.62, p=0.050). Of the 5,102 pupils in 97 schools, 99% studied in a classroom with a concrete floor and those with a lot of loose soil or sand on top of the concrete floor had a six times higher odds of infection than those on a clean concrete floor (aOR 6.52, 95% CI 1.61-26.35, p=0.008). Only 45% of (head)teachers in affected schools knew they had infected pupils in their school or grade. Those who did, were aware of the impact it was having on the pupils and yet only three of 76 affected schools had conducted a tungiasis intervention activity within the last year. ConclusionMost schools do not pose a risk of tungiasis for pupils, instead the home environment is the main risk. However, where school buildings are not well maintained and water not always available a multisectoral approach to control tungiasis is needed involving the Department of Health as well as the school management and the Department of Education.