In the early 60s, in Igbere Bende Local Govern Area of Abia State, almost three quarters of children and teenagers had jigger infestation. Igbere people call jigger Ikpurikpu.
Then as children we had no idea, how our toes got infested with jigger. It was a disturbing puzzle to me. I did not know I was aggravating jigger infestation when we used our foot to create a hole under the sand domes to create our childhood metaphorical home. We wore only a pair of slippers and played our footballs or contraption of football, on our sandy play ground – bare footed.
My parents , then lived in the north Benue – Plateau State, and my siblings and I were sent to Igbere clan to – live with our grandmother.
The removal of jiggers from our toes was a professional job done by our grandmother or other younger wives of my uncles. One of the things we prayed for then was “a clean foot free from jigger, so as to pursue our itinerant hubby, playing football on the sand.
Surprisingly whenever we traveled to the north, Lafia, in current Nasarawa State to be precise, our contact with sand became less because our house in Lafia was cemented. So we had less jigger infestation. Our childhood minds did not unravel the mystery that jigger infestation rests on playing on the sand
Again after the holidays, and our return to our village Igbere, the vicious cycle of jigger infestation resurfaces.
During the Nigerian/Biafran war, when we ran into the bush. Jigger infestation reduced somehow, because we were then itinerant.
Immediately after the war, in the early 70s, most of us were now in our early teens, we had outgrown building houses in the sand with our feet. We now played football in a standard football field and indirectly our jigger infestation reduced.
In the late 70s, when I entered University, I became an expert in jigger infestation, our Indian lecturer Prof. Kumar Uni in University of Jos was so enamoured by my stories on jigger infestation that he gave the whole class assignment on jigger. It was then I first found out from the Library that Jigger is a type of flea with order Siphonaptera . That jigger is a minute arachnoid.
For the younger ones who are below 60 and have no knowledge of jigger I shall attempt to explain the epidemic that terrorised us as children.
It was then I discovered that jigger infestation is called tungiasis.
In a research by Uade Samuel et al. they presented a case report of a severe form of jigger infestation in an orphan with mental disease, living in a rural village in Lagos. They said that more than 1,100 embedded jigger flea were counted from one person, I wish I could bring the picture of what became of his feet.
This was published in Tropical Medicine and Health Magazene Volune 36 No 2 in 2008; and was sponsored by Japanese Society of Tropical Medicine. So we needed a Japanese Sponsorship to tell our story.
According to the publication. The Jigger infestations were causing severe pathology on the feet and difficulty in walking. Lesions of the jigger also occurred on the hands elbow, and buttocks.
The case showed that jigger infestation may cause severe disease in a small proportion of high risk individuals in endemic communities. Action was needed to reduce the severe morbidity cause by this parasitic skin disease in this and other under privileged communities.
Let us start from the beginning. Jigger infestation also known as Tungiasis is a parasitic skin disease caused by penetration of the female sand flea Tunga penetrans, this is a scourge for many people in under privileged communities in Sub-Saharan Africa – eg Nigeria, then Latin America and the Caribbean’s Islands.
Jigger infestation may cause severe disease resulting in deformation of digits, chronic Lymphedema, ulceration and secondary infection. Staphylococcus aureus and streptococcus have been isolated most frequently from lesions, and other aerobic and anaerobic bacteria such as clostridia have also been found.
Historical and recent reports have described Jigger infestation (tungiasis) as a cause of tetanus.
In addition to people living in endemic area like Igbere, in Bende Local Government area of Abia State, Jigger infestation occurs among travellers visiting these areas.
However Jigger infestation, has rarely been considered a public health problem by World Health Organisation (WHO) or policy makers or even by the scientific community.
It was reported that a work in Angorin Beach, a small community of less than 100 families in the rural area of the city of Badagry in Lagos State, a team of researchers detected a person of unknown age (approximately 18 years old).
An orphan brought to the community by a church leader one year previously.
This young man was living alone in a small hut without sanitation and only a sandy floor. Being stigmatised, he spent most of the day in this hut, where according to community members infestation occurred to a large extent.
The patient did not have any access to education or health care, and hygienic conditions were precarious. In addition, he was suffering from mental disease, possibly schizothymia, and was unable to remove the sand fleas with a needle nor did he allow others to do so.
Upon clinical examination, he presented with approximately, 1,140 embedded jigger infestations (sand flea – tunga penetrans. Erythema inflammation, fissures and desquamation of the skin were present on the feet. The entire feet were ulcerated and oedematous. Toe deformation was present, all toenails were deformed and the lesions were bacterially super infected.
The patient had difficulty in both walking and gripping.
The individual was treated topically with a repellant known to be efficacious in severe jigger infestation; for a period of two weeks and referred to the General Hospital. For tetanus vaccination. The community was informed about the importance of regular inspection of feet for embedded jigger flea. And their immediate extraction under sterile condition.
Jigger infestation is a typical example of a neglected tropical disease among underprivileged populations. It occurs almost exclusively in poor communities. It is endemic in rural areas.
It is associated with stigma. There are no products in the market targeting treatment of the disease.
Jigger infestation is common in Nigeria and other West African Countries, but no case of more than a thousand lesions in one individual has been reported so far from Nigeria.
The World Health Organisation (WHO)
Has listed Jigger infestation (tungiasis) as a neglected disease of marginalised populations and has encouraged more significant research of the disease.
Traveler’s to affected countries as well as people native to those areas must be advised to wear shoes, not sandals, when walking along sandy areas in affected regions and to refrain from sitting or lying in the sand.
Always be medically guided.
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