Some countries have plain health challenges, others have enormous health challenges. Uganda most probably lies in the latter. Most infections that haunt Ugandans lie in the largely preventable category.
Of late however, the phenomenal rise of jigger infections in the Eastern Ugandan region of Busoga has raised a lot of questions on Uganda’s strategic health communication and strategic sensitization of the public.
Recently, it took the death of a 3month old boy in Bugiri district before a mass sensitization and relief plan was launched by politicians from the region. If only the drive had been launched earlier, the boy would more less be saved.
Such is the reactionary attitude of Ugandans that experts have concluded that the major cause of these epidemics lies in the attitude of Ugandans towards health issues. “Until one is infected, many a Ugandan doesn’t care to take a check-up,” notes Dr Peter Kibuuka, a medical practitioner at Kampala-based Rubaga Hospital.
Dr Kibuuka adds that the case of Busoga can largely be blamed on negligence on the side of victims as well as regional health officers who ought to sensitize the public on the dangers posed by jiggers. He describes a Jigger as having a head that is angular, has no comb of spines, and the thoracic segments are narrow at the top.
The female Jigger feeds by burrowing into the skin of its host. The abdomen becomes enormously enlarged between the second and third segments so that the flea forms a round sac with the shape and size of a pea.
He says that the first evidence of infestation by this sand flea (Jigger) is a tiny black dot on the skin at the point of penetration.
Because the flea is a poor jumper, most lesions occur on the feet, often on the soles, the toe webs, and around or under the toenails. A small, inflammatory papule with a central black dot forms early.
Within the next few weeks, the papule slowly enlarges into a white, pea-sized nodule with well-defined borders between 4-10mm in diameter. This lesion can range from asymptomatic to pruritic to extremely painful.
Multiple/severe infestations may result in a cluster of nodules with a honeycomb appearance.
While both male and female sand fleas intermittently feed on their warm-blooded hosts, it is the pregnant female flea that burrows into the skin of the host and causes the cutaneous lesion.
Jiggers are normally found in the sandy terrain of warm, dry climates. It prefers deserts, beaches, stables, stock farms, and the soil and dust close to farms. Not much stock farms exist in Busoga but the area is both dusty and the climate is warm.
Heavy infestations may lead to severe inflammation, ulceration, and fibrosis. Lymphangitis, gangrene, sepsis, the loss of toenails, auto-amputation of the digits, and death may also occur. In most cases, however, this lesion heals without further complications.“Nonetheless, the risk of secondary infection is high,” says Dr Kibuuka before noting that Tetanus is a common secondary infection that has reported associations with death.
The eggs of a female Jigger hatch on the ground in 3-4 days. In the next 3-4 weeks, they go through their larval and pupal stages and become adults. The complete life cycle lasts about a month.
At any one time, a Jigger can release over 100 eggs into your skin before dying and slowly being sloughed by the host’s skin.
An infestation begins to irritate and itch when is almost fully developed. Sometimes it causes severe inflammation and ulceration. If the female flea dies in the skin, it may cause a secondary infection. A clear effect of an attack by Jiggers is the inability to walk easily due to pain in the affected areas of the legs coupled with inability to carry out normal day to day activities.
The treatment consists of the extraction of the entire intact insect. The breaking of the jigger may cause inflammation and possible infection. The best recommended treatment for this kind of attack would be to soak the feet in a solution of alcohol for instance hydrogen peroxide or the other commercial disinfectants.
According to experts, a victim should soak their feet for about 15 minutes every day for about two weeks and this will completely kill the bugs. For a complete eradication of the bug, their homes should be thoroughly fumigated and any animals that also have the fleas treated.
To ensure that the home is bug free, the victim and the rest of the family have to be educated on the need to observe hygiene and ensure that the bugs do not find a home in their homes again.
The prime preventive measure of the jigger is observing cleanliness. Wearing of shoes should also be encouraged to ensure that the flea does not find entry into ones feet.
In infested areas, people should check their feet daily for freshly burrowing jiggers, which are visible as minute black spots and cause an itchy sensation. Indeed, Dr Kibuuka contends that the leading cause of Jigger infections is poor hygiene conditions hence insists on cleanliness as the best way to prevent infections. “Hygiene, hygiene, hygiene,” he exclaims before declaring that it all begins with you.
