A simple method for rapid community assessment of tungiasis.

OBJECTIVE To evaluate a rapid assessment method to estimate the overall prevalence of tungiasis and severity of disease in endemic communities. METHODS We analysed data from 10 population-based surveys on tungiasis, performed in five endemic communities in Brazil and Nigeria between 2001 and 2008. To assess the association between occurrence of tungiasis on six defined topographic areas of the feet and the true prevalence/prevalence of severe disease, linear regression analyses were performed. Estimated prevalences were calculated for each of the 10 surveys and compared to true prevalences. We then selected the most useful topographic localization to define a rapid assessment method, based on the strength of association and operational aspects. RESULTS In total, 7121 individuals of the five communities were examined. Prevalence of tungiasis varied between 21.1% and 54.4%. The presence of periungual lesions on the toes was identified as the most useful rapid assessment to estimate the prevalence of tungiasis (absolute errors: -4% to +3.6%; R(2 )=96%; P < 0.0001). Prevalence of severe tungiasis (>20 lesions) was also estimated by the method (absolute errors: -3.1% to +2.5%; R(2 )=76%; P = 0.001). CONCLUSION Prevalence of tungiasis and prevalence of severe disease can be reliably estimated in communities with distinct cultural and geographical characteristics, by applying a simple and rapid epidemiological method. This approach will help to detect high-risk communities and to monitor control measures aimed at the reduction of tungiasis.